Burden Of Non-communicable Diseases Research Articles

The case of Wellness Valley: promoting physical activity and exercise medicine for a sustainable health care system

ABSTRACT Today’s health care systems primarily focus on treating noncommunicable diseases (NCDs) rather than preventing them. Currently, this approach is not sustainable and requires innovative transformations to face the challenges posed by the aging population, the increasing NCD prevalence, widespread physical inactivity, and growing obesity rates. Regular physical activity and exercise improve quality of life and are effective for the prevention and treatment of numerous NCDs and to reduce health care costs. Physical activity promotion and exercise medicine thus represent cost-effective solutions for a sustainable model of health. The Wellness Valley initiative in Emilia-Romagna, Italy, exemplifies this model by fostering active, healthy lifestyles. In Wellness Valley, physical activity is promoted through multi-stakeholder initiatives of education and engagement, and exercise medicine is supported in the medical community through continuous education and dedicated infrastructure, such as certified health-promoting gyms. With these initiatives in place, the population of Wellness Valley is more physically active compared to the Italian national average. Overall, shifting health models toward preventative strategies centered on healthy active lifestyles and exercise can increase physical activity levels and contribute to alleviating the growing burden of NCDs on health care systems.

Research opportunity for Prevention and Control of No communicable Diseases

Introduction: Palestine is facing an epidemiological transformation that affects its health to the major health diseases of Non communicable diseases (NCDs) and the majority of mortality rates. The aim to know the contextualize the research requirements and prevention for Non communicable diseases (NCDs)Methods: Using both systematic and other literature search, we identified and reviewed NCD and reported since 2000. Information was extracted from published papers. The extracted information was refined through further review and then underwent a textual narrative synthesis.Result: Cardiovascular disorders, asthma, cancer and chronic obstructive pulmonary diseases (COPD) are the main NCDs The key risk factors common for many chronic diseases are smoking, diet, physical inactivity, high blood pressure, and obesity.Important epidemiological descriptions have told us of the causes and distribution of NCDs and the insufficiencies in tackling NCDs have been demonstrated by their risk factors, including non-health determinants (poverty, schooling, jobs, and health system assessments. In the shaping of the research agenda, many global initiatives and publications have given guidance.Conclusion: Major progress has been made in research related to Non communicable diseases in the nation. As we take its stock, it is evident that to optimize research outputs to address the increasing burden of chronic Non communicable diseases, a strategic path and thrust is needed. It needs simultaneous galvanization of monitoring, surveillance and cooperation activities, thus reinforcing efforts to provide universal health care for all people.

Evolution and effectiveness of bilateral and multilateral development assistance for health: a mixed-methods review of trends and strategic shifts (1990–2022)

BackgroundDevelopment assistance for health (DAH) plays a vital role in supporting health programmes in low- and middle-income countries. While DAH has historically focused on infectious diseases and maternal and child...

Opportunities and barriers for reimbursement of digital therapeutics in Austria: Findings From expert interviews.

Digital therapeutics (DTx) are software-based interventions that aim to prevent or treat especially non-communicable diseases. Currently, no framework for reimbursement of DTx exists in Austria. The aim of this study was to gather a comprehensive perspective on regulatory considerations of Austrian stakeholders with regard to reimbursement of DTx and to outline strategies for establishing a national reimbursement framework. Based on a stakeholder analysis, seven semi-structured interviews with Austrian experts from the digital health-related fields medicine, public health, health technology assessment, health industry and social security providers were conducted. Interviews were analyzed according to seven predefined themes. Overall, participants agreed that reimbursement of DTx by the public insurance in Austria is desirable. Prerequisites are (i) a high user and prescriber acceptance of DTx, which must be integrated into a transparent and interoperable Austrian e-Health infrastructure, (ii) a sufficient, risk-based level of evidence for clinical effectiveness, (iii) national authorities that transparently provide evidence-base, indications, contra-indications and potential risks, (iv) adopting European regulations about data security, secondary use of data and use of artificial intelligence and (v) a health-economical evaluation of DTx. A comprehensive national strategy for reimbursing DTx will need to consider technical, scientific and socio-economical requirements, patient safety and liability, secure health data handling and use of artificial intelligence in order to establish a sound framework with equitable access also for socioeconomically disadvantaged persons in order to address the growing burden of non-communicable diseases.

Globalization and Burden of Non-communicable Diseases in Sub-Saharan African Countries

Globalization and Burden of Non-communicable Diseases in Sub-Saharan African Countries

Unraveling the Causal Relationship Between Non-Communicable Diseases, Obesity, and Health Expenditure: Insights from the Toda-Yamamoto Approach.

Understanding the relationship between non-communicable diseases (NCDs), obesity, and health expenditure is crucial for developing effective public health policies, particularly in light of the rising global burden of NCDs and obesity. Therefore, this study aimed to investigate the causal relationships between NCDs, obesity, and health expenditure in Turkiye. Data were collected from the World Health Organization and Our World in Data. Time series econometric analysis was performed using the Toda-Yamamoto causality approach. A model was designed to regularly capture causal relationships to ensure robust and consistent findings. The analysis revealed four significant results. First, a causal relationship was observed between obesity and the prevalence of NCDs, indicating that higher obesity rates lead to an increase in NCDs within the population. Second, obesity had a direct impact on health expenditures, as rising obesity levels drove up healthcare costs. Third, the burden of NCDs contributed to increased health expenditure. Finally, the combined effect of obesity and NCDs on health expenditure was statistically significant at the 0.05 level. These results highlight the need for policymakers to develop more effective strategies to address both obesity and NCDs. Recommended policies include the implementation of public health programs aimed at preventing obesity, strengthening early diagnosis and treatment methods, and increasing awareness campaigns focused on NCDs. These measures would be crucial steps in improving public health and controlling healthcare expenditures.

Prevalence of antihypertensive medication adherence and associated factors in India: A systematic review and meta-analysis.

Non-adherence to antihypertensive medication is a key factor contributing to uncontrolled blood pressure and the subsequent complications of hypertension. Despite its importance, there is a lack of data regarding the prevalence of and factors associated with non-adherence to medication among individuals with hypertension in India. This review aimed to assess medication adherence rates among hypertensive patients in India and identify the factors influencing non-adherence. A comprehensive search was conducted across PubMed, Scopus, Embase, and Google Scholar. Studies reporting medication adherence/non-adherence to antihypertensive medications in India, using the Morisky Medication Adherence Scale (MMAS), with publication dates up to July 2023, were included. Twelve studies were included, involving a total of 3164 participants. The pooled rate of medication adherence to antihypertensive medications in India was determined to be 15.8% (95% CI: 4.4; 43.4). The important factors associated with non-adherence included higher age, medication regimen complexity, low socioeconomic status, low education levels, uncontrolled blood pressure, and comorbidities. The adherence rate to antihypertensive medication was observed to be quite low. Therefore, it is imperative to enhance the rate of medication adherence among individuals with hypertension in order to attain effective blood pressure control and reduce the burden of non-communicable diseases.

Using artificial intelligence to predict post-operative outcomes in congenital heart surgeries: a systematic review

IntroductionCongenital heart disease (CHD) represents the most common group of congenital anomalies, constitutes a significant contributor to the burden of non-communicable diseases, highlighting the critical need for improved risk assessment tools. Artificial intelligence (AI) holds promise in enhancing outcome predictions for congenital cardiac surgery. This study aims to systematically review the utilization of AI in predicting post-operative outcomes in this population.MethodsFollowing PRISMA guidelines, a comprehensive search of Pubmed, Scopus, and Web of Science databases was conducted. Two independent reviewers screened articles based on predefined criteria. Included studies focused on AI models predicting various post-operative outcomes in congenital heart surgery.ResultsThe review included 35 articles, primarily published within the last four years, indicating growing interest in AI applications. Models predominantly targeted mortality and survival (n = 16), prolonged length of hospital or ICU stay (n = 7), postoperative complications (n = 6), prolonged mechanical ventilatory support time (n = 4), with additional focus on specific outcomes such as peri-ventricular leucomalacia (n = 2) and malnutrition (n = 1). Performance metrics, such as area under the curve (AUC), ranged from 0.52 to 0.997. Notably, these AI models consistently outperformed traditional risk stratification categories. For instance, in assessing the risk of morbidity and mortality, the AI models demonstrated superior performance compared to conventional methods.ConclusionAI-driven prediction models show significant promise in improving outcome predictions for congenital heart surgery. They surpass traditional risk prediction tools not only in immediate postoperative risks but also in long-term outcomes such as 1-year survival and malnutrition. Further studies with robust external validation are necessary to assess the practical applicability of these models in clinical settings.The protocol of this review was prospectively registered on PROSPERO (CRD42024550942).

The utility of physical activity questionnaires among African origin populations; lost in translation?

Background: Physical activity (PA) is an important preventive factor of non-communicable diseases (NCDs), particularly cardiovascular disease, yet progress towards reducing physical inactivity in populations is slow. Population-levels of PA are most often estimated using self-report questionnaires in population surveys, such as the Global PA Questionnaire (GPAQ), which may not accurately reflect objectively measured PA, such as accelerometers. The aim of the current study was to compare self-report vs objectively measured PA across 5 African-origin populations. Methods: Approximately 2,000 African-origin men and women (35-55 yrs) were enrolled in a prospective cohort study to explore the relationship between lifestyle and cardiometabolic health. Participants were from Ghana, South Africa (SA), Jamaica, Seychelles, and the United States (US). Data collection included objective PA (accelerometer) and self-reported PA (GPAQ). WHO defines "sufficiently active" as performing >150 minutes of moderate intensity PA per week, or >600 MET*min/week (metabolic equivalent of task in minutes/week). Logistic regression was used to determine the proportion of participants that were physically active by accelerometry, among those who were found as sufficiently active based on GPAQ. Results: 1,161 participants had complete self-reported PA and accelerometery data. Overall, 23.5% were classified as sufficiently active by both PA measures, while 38.2% of those classified as sufficiently active based on self-reported PA did not meet the criteria using objective monitoring (sensitivity of GPAQ: 74%, specificity: 44%). Among participants who were classified as sufficiently active according to the questionnaire (n=717), participants from Ghana (OR=3.2, p<0.01), SA (OR=5.3, p<0.01), Jamaica (OR=2.3, p=0.01), and Seychelles (OR=1.9, p=0.03) were more likely to be similarly classified as sufficiently active based on accelerometry, compared to those from the US, and men (OR=2.9, p<0.01) more likely than women. Finally, obese participants had 0.4 times lower adjusted odds to be similarly classified as sufficiently active using objective measures compared to non-obese participants (p<0.01). Conclusion: Our findings further underscore difficulties in interpreting self-reported PA, which may furthermore vary across different settings and socio-economic settings. Given the importance of PA interventions for reducing the NCD burden, future research should explore tailored approaches to better understand self-report PA accuracy and to better assess the dose-response between PA and cardiometabolic risk.

Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States

Health-adjusted life expectancy, a measure of healthy longevity, lags longevity gains, resulting in a healthspan-lifespan gap. To quantify the healthspan-lifespan gap across the globe, investigate for sex disparities, and analyze morbidity and mortality associations. This retrospective cross-sectional study used the World Health Organization (WHO) Global Health Observatory as the global data source and acquired national-level data covering all continents. The 183 WHO member states were investigated. Statistical analysis was conducted from January to May 2024. Data represent 2 decades of longitudinal follow-up. Changes in life expectancy and health-adjusted life expectancy, as well as the healthspan-lifespan gap were quantified for all participating member states. Gap assessment was stratified by sex. Correlations of the gap with morbidity and mortality were examined. The healthspan-lifespan gap has widened globally over the last 2 decades among 183 WHO member states, extending to 9.6 years. A sex difference was observed with women presenting a mean (SD) healthspan-lifespan gap of 2.4 (0.5) years wider than men (P < .001). Healthspan-lifespan gaps were positively associated with the burden of noncommunicable diseases and total morbidity, and negatively with mortality. The US presented the largest healthspan-lifespan gap, amounting to 12.4 years, underpinned by a rise in noncommunicable diseases. This study identifies growing healthspan-lifespan gaps around the globe, threatening healthy longevity across worldwide populations. Women globally exhibited a larger healthspan-lifespan gap than men.

Crosstalk between periodontitis and cardiovascular risk.

Recent demographic developments resulted in an aged society with a rising disease burden of systemic and non-communicable diseases (NCDs). In cardiovascular disease (CVD), a NCD with high morbidity and mortality, recent preventive strategies include the investigation of comorbidities to reduce its significant economic burden. Periodontal disease, an oral bacterial-induced inflammatory disease of tooth-supporting tissue, is regulated in its prevalence and severity by the individual host response to a dysbiotic oral microbiota. Clinically, both NCDs are highly associated; however, shared risk factors such as smoking, obesity, type II diabetes mellitus and chronic stress represent only an insufficient explanation for the multifaceted interactions of both disease entities. Specifically, the crosstalk between both diseases is not yet fully understood. This review summarizes current knowledge on the clinical association of periodontitis and CVD, and elaborates on how periodontitis-induced pathophysiological mechanisms in patients may contribute to increased cardiovascular risk with focus on atherosclerosis. Clinical implications as well as current and future therapy considerations are discussed. Overall, this review supports novel scientific endeavors aiming at improving the quality of life with a comprehensive and integrated approach to improve well-being of the aging populations worldwide.

Bayesian analysis of non-communicable diseases risk factors: a focus on the lower-educated population in Bangladesh.

This study investigates non-communicable disease (NCD) risk factors, specifically hypertension and diabetes, among Bangladeshi adults with lower educational attainment. With an increasing global burden of NCDs, understanding the dynamics in lower-educated populations becomes crucial for targeted interventions and achieving Sustainable Development Goal 3.4-curtailing premature mortality from non-communicable diseases by one-third by 2030 through prevention and treatment. Utilizing data from the Bangladesh Demographic and Health Survey (2017-2018), a two-stage stratified sampling design identified 7287 lower-educated individuals. Bayesian logistic regression was applied for risk factor analysis. The prevalence of hypertension and diabetes among lower-educated people was 31% and 9.3%, respectively. NCD prevalence (37.3%) underscored a significant health burden. Factors such as gender, age, wealth status, working status, residence and region showed significant associations with NCDs. Bayesian analysis revealed that females were 1.30 times more likely to develop NCDs, while older age groups demonstrated 4.30 times greater likelihood. Employed individuals exhibited a 43% lower risk. Wealthier households showed higher NCD likelihood and residence in the central region was associated with an 11% lower risk. This study highlights the high risk of developing NCDs among lower-educated females, particularly those ≥35y of age in Bangladesh. Therefore, targeted interventions for this group are critical to reducing NCD risks, supporting national health objectives and advancing progress toward the Sustainable Development Goals.

The impact of tobacco smoking and smoking cessation on lung cancer and stroke incidence among people with HIV on antiretroviral therapy in South Africa: a simulation modeling study

IntroductionWith declining HIV-related mortality, over 20% of people with HIV (PWH) in South Africa are now over age 50 years, and tobacco-related non-communicable disease burden is increasing. We quantified the...

Assessment of morbidity profile among workers of metallurgy factories processing aluminium in Howrah district of West Bengal.

Workers who work in metallurgy factories processing aluminium are at risk of exposure to various kinds of metals and chemicals. To describe sociodemographic characteristics and to find out morbidity profile of study participants . A cross-sectional O bservational descriptive study was conducted in two aluminium processing metallurgy factories in Howrah district of Indian state of West Bengal. The sample size for the proposed research study was 424 workers. Data were collected through a predesigned and pretested questionnaire and were subsequently analyzed by using suitable statistical package. The mean age of the workers was 45.46 years with standard deviation of 10.25 years. Maximum (28.54%) respondents had completed primary standard, and majority of respondents were from upper middle class (34.67%). 16.75% of workers reported that they suffered from communicable disease s, and 76.42% of participants reported noncommunicable diseases. 63.44% of study participants were overweight. This study showed musculoskeletal discomfort in different joints and body parts in 23.35% of participants; 2.82% of participants had ventilatory defects of lung. 3.07% of participants were suffering from hearing loss, and 5.90% of participants had refractive error of eyes. Noncommunicable disease burden was higher than communicable diseases among study participants. Almost one out of four participants reported musculoskeletal discomfort in different joints and body parts.

Cardiovascular wellness in low-resource settings: A mobile app-based risk prediction study among fuel filling station employees in Puducherry district.

India is witnessing a significant increase in the prevalence of non-communicable diseases (NCDs), and addressing this requires a comprehensive and multi-faceted approach. The burden of NCDs puts a strain on the healthcare system, requiring an increased focus on preventive measures, early detection, and management of chronic conditions. Adopting a risk-based approach to cardiovascular diseases (CVDs) in resource-poor settings offers several economic and social advantages. The aim of the study was to assess the prevalence of CVD risk factors among fuel filling station employees in the Puducherry district and the 10-year CVD risk prediction score among the study participants with the World Health Organisation package of essential non-communicable (WHO PEN) app and package for resource-poor settings. A community-based cross-sectional study was conducted among the fuel filling station employees in Puducherry. A universal sampling method was employed. The data were collected using a pilot-tested, predesigned, structured questionnaire and the WHO PEN app was used to estimate the CVD risk score. The data were collected from February 2021 to January 2022 and analysed using Statistical Package for Social Sciences (SPSS) version 20. Frequency distribution along with the Chi-square test was employed to test statistical significance. Out of 212 subjects, 170 (80.2%) were males, out of which 116 (54.7%) were between 40 and 50 years old. Nearly half the participants (48%) had CVD risk scores ranging from 5 to 20%, with an increased prevalence of CVD risk factors, namely, obesity/overweight (65.5%), physical inactivity (58.5%), hypertension (52%), alcohol consumption (51%) and tobacco consumption in any form (25.5%). This study sheds light on the sedentary nature of the occupation and the increased prevalence of CVD risk factors among the study participants. It is also evident that the participants had higher CVD risk scores for developing CVDs in the future. Recommendations: The use of mobile-based apps can be used as a feasible strategy to save scarce resources in delivering primary health care. We also propose that the nature of occupation be taken into account as one of the parameters for risk prediction. Risk prediction assessment should be made mandatory during the annual examination of employees.

Strengthening AYUSH Integration with Preventive Medicine

Integrating Ayurveda, Yoga, Unani, Siddha, and Homoeopathy (AYUSH) into preventive medicine enhances holistic health care by addressing lifestyle, mental well-being, and disease prevention. This integration is vital for addressing India’s quadruple burden of non-communicable diseases (NCDs), communicable diseases, poor maternal and child health (MCH) outcomes, and an aging population. The National Health Policy 2017 promotes this integration through “Pluralism,” aligning with the World Health Organization (WHO)’s Sustainable Development Goal (SDG) 3 and global traditional medicine priorities. Essential actions include adopting integrative care models, standardizing treatment protocols, training healthcare professionals, and advancing research. Despite its promise, challenges persist, such as limited awareness among modern physicians, minimal interaction between practitioners, lack of standardized protocols, and insufficient research on AYUSH’s synergistic effects. The Indian Association of Preventive and Social Medicine (IAPSM) can play a pivotal role in overcoming these barriers. By advocating for policy development, adopting integrative care frameworks, and fostering educational and research collaborations with AYUSH institutes, IAPSM can advance the integration of AYUSH into preventive medicine. Promoting research and increasing public awareness of AYUSH’s role in disease prevention and health promotion is essential for achieving a comprehensive healthcare system.

Need for a Strong FOPL in India-position Statement

Due to lifestyle changes, urbanization, and the rise of ultra-processed foods (UPF), India is undergoing a rapid nutritional transformation. These dietary shifts have significantly contributed to the rise in non-communicable diseases (NCDs), which now account for a substantial portion of mortality and disease burden in the country. A strong Front-of-Pack Labeling (FOPL) system is recommended in this position statement as a powerful public health tool to address this issue. Through the provision of easily comprehensible nutritional data, FOPL encourages food producers to create healthier goods while empowering customers to make educated dietary decisions. Current labeling practices in India, such as the Indian Nutritional Rating (INR), fall short due to complexity and voluntary implementation. This paper evaluates international best practices, including warning labels and color-coded systems, highlighting their effectiveness in reducing the consumption of high-risk foods. We argue for straightforward, uniform, and globally evidence-based approach to mandatory FOPL implementation. Policymakers, industry stakeholders, and public health advocates must collaborate to develop an FOPL system that addresses India’s unique dietary landscape. Such an initiative is crucial to reducing the NCD burden and fostering healthier eating habits nationwide.

SWOT Analysis of Indonesian Public Health Policy Using PCA Method

This study aims to analyze the strengths, weaknesses, opportunities, and threats (SWOT) of Indonesian public health policies using the Principal Component Analysis (PCA). Public health in Indonesia has faced numerous challenges, including inadequate infrastructure, uneven access to health services, and emerging infectious diseases. Effective policy formulation is crucial to address these issues, but there is a need for a more structured approach to assess the dynamic factors influencing public health in the country. The purpose of this research is to employ SWOT analysis combined with PCA to provide a more comprehensive and data-driven evaluation of Indonesia public health policies. The research utilizes secondary data obtained from government reports, health surveys, and international health indexes. The data were processed through PCA to reduce dimensionality and identify the key components that most significantly affect the country health system. This statistical approach allows for a more objective identification of critical variables, which are then categorized into the four SWOT. A qualitative assessment is also used to interpret the results and suggest strategic recommendations for policy improvements. The results of the PCA revealed several key factors impacting Indonesian public health, including healthcare accessibility, funding, and the effectiveness of disease prevention programs. The analysis showed that while there are significant strengths in terms of government commitment and international partnerships, there are also notable weaknesses in infrastructure and healthcare distribution. Opportunities for improvement lie in the potential for digital health integration and public-private partnerships, while threats include the increasing burden of non-communicable diseases and natural disasters.

Identifying relevant diabetes and hypertension control management guidelines in primary healthcare and community settings in Indonesia: A Delphi survey.

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia.

Trends and Characteristics of the Whole-Grain Diet.

Whole-grain foods are good choices for a nutritious diet and play an important role in lowering the risk of chronic diseases. China is a large cereal-consuming country that is experiencing rapid economic growth and an increased burden of noncommunicable diseases. Studies have shown that insufficient intake of whole grains has increased the burden on public health to some extent. Therefore, we aimed to analyze the characteristics and trends of whole-grain consumption in China to contribute to the development of a healthy Chinese population. We searched for important policies, standards, and dietary recommendations related to whole grains through the official websites of the China State Council and its affiliated ministries. Official and public databases, such as the National Bureau of Statistics and the China Health and Nutrition Survey (CHNS), were utilized to obtain data on whole grains and different foods. This approach was employed to gain insight into changes in whole-grain intake levels and dietary structure. Since 2010, the development of whole grains in China has received significant attention. Supportive policies have been continuously introduced on both the supply and demand sides. Numerous whole-grain standards have been developed, and terms and definitions related to whole grains have been preliminarily defined. The consumption of whole grains has fluctuated among Chinese residents since 2000, with a downward trend from 2000 to 2009, followed by an upward trend from 2009 to 2018. However, despite this increasing trend, the whole-grain intake of 80% of the adult residents was still lower than the minimum recommended dietary intake (50[Formula: see text]g/day). Furthermore, the dietary structure of Chinese residents has undergone a significant transformation, characterized by high consumption of high-fat foods, excessive consumption of meat, low intake of dietary fiber, and insufficient consumption of whole grains. These findings highlight the need for further monitoring of whole-grain intake in China. In addition, a sound whole-grain standardization system should be established, and the availability and consumer awareness of whole grains should be improved, with the goal of increasing the intake of whole grains.