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Kunzová M, Maranhao Neto GA, González-Rivas JP. Sugar-sweetened beverages and childhood abnormal adiposity in the Czech Republic - narrative literature review. Cent Eur J Public Health 2023; 31:30-37. [PMID: 37086418 DOI: 10.21101/cejph.a7479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES In Czech children, the burden related to the high body-mass index is rising. In the last three decades, Western eating patterns have influenced Czech children's diet, including the high consumption of sugar-sweetened beverages. This narrative review aims to evaluate evidence of the trend of sugar-sweetened beverages consumption in Czech children and its impact on the prevalence of childhood abnormal adiposity. METHODS A comprehensive literature review in MEDLINE (PubMed) and a hand search using references in identified articles were performed. The inclusion criteria were population-based studies of randomly selected samples of children from 0 to 18 years old, data involving the Czech population, published from 1990 to 2021. The results were organized into three sections - childhood abnormal adiposity, SSBs consumption, and the association between SSBs consumption and abnormal adiposity. RESULTS The studies showed a significant increase in abnormal adiposity in both genders and all age categories. The highest prevalence of abnormal adiposity was observed in boys and younger children. On the contrary, sugar-sweetened beverages showed a significant decline in daily consumption among Czech children of both genders and all age categories. No results were found for consequences of abnormal adiposity concerning sugar-sweetened beverages consumption. CONCLUSION Findings from this review could serve public health experts to detect the areas of a gap in research and establish potential interventions in vulnerable groups. Observation of potential obesogenic contributors - including sugar-sweetened beverages - should be an integral part of effective action against the obesity pandemic.
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Affiliation(s)
- Monika Kunzová
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Geraldo A Maranhao Neto
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Juan P González-Rivas
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela, Caracas, Venezuela
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Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15:nu15010055. [PMID: 36615712 PMCID: PMC9823488 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
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Santos D, Pintado M, Lopes da Silva JA. Potential nutritional and functional improvement of extruded breakfast cereals based on incorporation of fruit and vegetable by-products - A review. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Identification of Lifestyle Risk Factors in Adolescence Influencing Cardiovascular Health in Young Adults: The BELINDA Study. Nutrients 2022; 14:nu14102089. [PMID: 35631230 PMCID: PMC9146351 DOI: 10.3390/nu14102089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/03/2022] Open
Abstract
Cardiovascular diseases are the leading cause of mortality worldwide. These diseases originate in childhood, and a better understanding of their early determinants and risk factors would allow better prevention. The BELINDA (BEtter LIfe by Nutrition During Adulthood) study is a 10−14-year follow-up of the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (the HELENA study, a European cross-sectional study in adolescents). The study aims to evaluate cardiovascular risk using the PDAY (Pathobiological Determinants of Atherosclerosis in Youth) risk score during young adulthood (21−32 years), and to examine the impact of risk factors identified during adolescence (12.5−17.5 years). Our secondary objective is to compare the characteristics of the BELINDA study population with the HELENA population not participating in the follow-up study. The HELENA study recruited 3528 adolescents during 2006−2007 and reassessed 232 of them 10−14 years later as young adults. We assessed clinical status, anthropometry, nutrition, physical activity (including sedentary behavior), physical fitness, and mental health parameters, and collected biological samples (blood, stool, and hair). Dietary intake, and physical activity and fitness data were also collected. A multivariable linear regression model will be used for the analysis of the primary outcome. A Chi-square and T-test were conducted for the comparison of the descriptive data (gender, age, weight, height, body mass index (BMI), and maternal school level) between participating and non-participating BELINDA adolescents. When comparing the 1327 eligible subjects with the 232 included in the BELINDA study, no significant differences regarding gender (p = 0.72), age (p = 0.60), height (p = 0.11), and weight (p = 0.083) at adolescence were found. However, the participating population had a lower BMI (20.4 ± 3.1 kg/m2 versus 21.2 ± 3.6 kg/m2; p < 0.001) and a higher maternal educational level (46.8% high school or university level versus 38.6%; p = 0.027) than the HELENA population who did not participate in the BELINDA study. The complete phenotyping obtained at adolescence through the HELENA study is a unique opportunity to identify adolescent risk factors for cardiovascular diseases. This paper will serve as a methodological basis for future analysis of this study.
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Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O'Neill LM, Mohamad MN, Kassis A, Ayesh W, Kharroubi S, Hwalla N. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health 2022; 22:319. [PMID: 35168591 PMCID: PMC8848814 DOI: 10.1186/s12889-022-12616-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months. METHODS This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators. RESULTS Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains. CONCLUSIONS This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.
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Affiliation(s)
- Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX1 2JD, UK
| | - Ayesha S Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Sarah Ibrahim
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Habiba I Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Lynda M O'Neill
- Nestlé Institute of Health Sciences, Nestlé Research Center, Société des Produits Nestlé S.A., Vers-chez-les-Blanc, 1000, 26, Lausanne, Switzerland
| | - Maysm N Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Amira Kassis
- Whiteboard Nutrition Science, Beaconsfield, Quebec, Canada
| | - Wafaa Ayesh
- Public Health Protection Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon.
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Béghin L, Huybrechts I, Drumez E, Kersting M, Walker RW, Kafatos A, Molnar D, Manios Y, Moreno LA, De Henauw S, Gottrand F. High Fructose Intake Contributes to Elevated Diastolic Blood Pressure in Adolescent Girls: Results from The HELENA Study. Nutrients 2021; 13:3608. [PMID: 34684609 PMCID: PMC8538236 DOI: 10.3390/nu13103608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between fructose consumption and elevated blood pressure in an European adolescent population. METHODS A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA-DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score-BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake. RESULTS Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17-4.40); p = 0.015) after adjustment for cofounding factors. CONCLUSIONS Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.
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Affiliation(s)
- Laurent Béghin
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE and CIC-1403, F-59000 Lille, France;
| | - Inge Huybrechts
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium; (I.H.); (S.D.H.)
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, F-69000 Lyon, France
| | - Elodie Drumez
- Univ. Lille, CHU Lille, ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France;
- CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - Mathilde Kersting
- Research Department of Child Nutrition, Pediatric University Clinic, Ruhr-University Bochum, D-44791 Bochum, Germany;
| | - Ryan W Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Anthony Kafatos
- Preventive Medicine and Nutrition Clinic, University of Crete School of Medicine, G-14122 Crete, Greece;
| | - Denes Molnar
- Department of Pediatrics, University of Pecs, H-7600 Pecs, Hungary;
| | - Yannis Manios
- Department of Nutrition and Dietetics, University of Harakopio, G-10431 Athens, Greece;
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group Escuela Universitaria de Ciencas de la Salud, Universidad de Zaragoza, S-50009 Zaragoza, Spain;
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium; (I.H.); (S.D.H.)
| | - Frédéric Gottrand
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE and CIC-1403, F-59000 Lille, France;
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Jomaa L, Hamamji S, Kharroubi S, Diab-El-Harakeh M, Al Zahraa Chokor F, Nasreddine L. Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys. Eur J Nutr 2021; 60:2655-2669. [PMID: 33389083 DOI: 10.1007/s00394-020-02444-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/12/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. METHODS This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5-18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. RESULTS Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5-18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. CONCLUSION The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.
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Affiliation(s)
- Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Samer Hamamji
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Marwa Diab-El-Harakeh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107-2020, Lebanon.
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Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094474. [PMID: 33922427 PMCID: PMC8122824 DOI: 10.3390/ijerph18094474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.
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Scapin T, Fernandes AC, Curioni CC, Pettigrew S, Neal B, Coyle DH, Rodrigues VM, Bernardo GL, Uggioni PL, Proença RPC. Influence of sugar label formats on consumer understanding and amount of sugar in food choices: a systematic review and meta-analyses. Nutr Rev 2020; 79:788-801. [PMID: 33313917 DOI: 10.1093/nutrit/nuaa108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption. OBJECTIVE The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers' understanding of sugar information, and the amount of sugar in consumers' food choices. DATA SOURCES Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020. STUDY SELECTION Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers' understanding of sugar information or on the amount of sugar in consumers' food choices. DATA EXTRACTION Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models. RESULTS Twenty-three studies, which examined 39 comparisons, were included. Label formats using "high in sugar" interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9-45.4] and warning signs [OR 1.33; 95%CI 1.0-1.78]) were most effective in increasing consumers' understanding of the sugar content in packaged foods. Health warning messages (SMD -0.32; 95%CI -0.43 to -0.22), graphical depictions of sugar content in teaspoons (SMD -0.32; 95%CI -0.48 to -0.17), and warning signs (SMD -0.24; 95%CI -0.35 to -0.13) were most effective for influencing consumers to choose products with lower sugar content. CONCLUSIONS Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42018081222.
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Affiliation(s)
- Tailane Scapin
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ana C Fernandes
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Cintia C Curioni
- Department of Social and Applied Nutrition, Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Simone Pettigrew
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vanessa M Rodrigues
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Greyce L Bernardo
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Paula L Uggioni
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Rossana P C Proença
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Flieh SM, Moreno LA, Miguel-Berges ML, Stehle P, Marcos A, Molnár D, Widhalm K, Béghin L, De Henauw S, Kafatos A, Leclercq C, Gonzalez-Gross M, Dallongeville J, Molina-Hidalgo C, González-Gil EM. Free Sugar Consumption and Obesity in European Adolescents: The HELENA Study. Nutrients 2020; 12:nu12123747. [PMID: 33291491 PMCID: PMC7762126 DOI: 10.3390/nu12123747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022] Open
Abstract
Few studies have evaluated the association between dietary free sugars intake (FSI) and obesity in adolescents. We examined the relation between FSI and their contributors from the main food groups and obesity in European adolescents. We included 843 adolescents (51.6% male) from the cross-sectional HELENA study with two completed 24 h recalls and anthropometric data. Linear mixed models were applied to investigate the relation between FSI and different anthropometric indices. Odds ratios for having a high body mass index (BMI) were also estimated by multilevel ordinal regression. Total FSI was higher in males than females (102.60 g and 87.58 g, respectively, p < 0.001). No effect was observed between free sugar from the main food groups and BMI. Consumers of FSI from "cakes, pies and biscuits" in males (odd ratio (OR) = 0.455; 95% Confidence interval (CI) 0.251, 0.824) and from "breakfast cereals" in females had a lower probability of having obesity (OR = 0.423; 95%CI 0.204, 0.878), whereas females consuming FSI from 'fruit and vegetables juices' had a higher probability of obesity (OR= 2.733; 95% CI 1.286, 5.810). This study provides no evidence that increased FSI is associated with obesity in adolescents. Further studies are needed to assess the longitudinal exposure to FSI and their effect on obesity development.
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Affiliation(s)
- Sondos M. Flieh
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Correspondence:
| | - María L. Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, D-53115 Bonn, Germany;
| | - Ascensión Marcos
- Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), 28040 Madrid, Spain;
| | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Kurt Widhalm
- Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Laurent Béghin
- Inserm, U1286—INFINITE—Clinical Investigation Center—Institute for Translational Research in Inflammation and CIC 1403, University Lille, CHU Lille, F-59000 Lille, France;
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Anthony Kafatos
- Faculty of Medicine, University of Crete, GR-71003 Crete, Greece;
| | - Catherine Leclercq
- Food and Nutrition Research Centre—Council for Agricultural Research and Economics, 00198 Rome, Italy;
| | - Marcela Gonzalez-Gross
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Jean Dallongeville
- Department of Epidemiology and Public Health, Institut Pasteur de Lille, 59000 Lille, France;
| | - Cristina Molina-Hidalgo
- EFFECTS 262, Department of Physiology, Faculty of Medicine, University of Granada, 18016 Granada, Spain;
| | - Esther M. González-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Center of Biomedical Research (CIBM), Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, University of Granada, 18071 Granada, Spain
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Lommi S, Figueiredo RADO, Tuorila H, Viljakainen H. Frequent use of selected sugary products associates with thinness, but not overweight during preadolescence: a cross-sectional study. Br J Nutr 2020; 124:631-640. [PMID: 32312332 PMCID: PMC7525105 DOI: 10.1017/s0007114520001361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 12/20/2022]
Abstract
Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n 8461; mean age 11·1 (sd 0·9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off < 4·0), medium (Q2 + Q3, range 4·0-10·5) and high STI (Q4, cut-off > 10·5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1·20, 95 % CI 1·02, 1·41) and lower risk of being overweight (OR 0·79, 95 % CI 0·67, 0·92), while subjects with a low STI were at higher risk of being overweight (OR 1·32, 95 % CI 1·14, 1·53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.
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Affiliation(s)
- Sohvi Lommi
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Folkhälsan Research Center, 00250Helsinki, Finland
| | | | - Hely Tuorila
- Department of Food and Nutrition, University of Helsinki, 00014Helsinki, Finland
| | - Heli Viljakainen
- Folkhälsan Research Center, 00250Helsinki, Finland
- Department of Food and Nutrition, University of Helsinki, 00014Helsinki, Finland
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Kadel P, Schneider S, Mata J. Soft drink consumption and mental health problems: Longitudinal relations in children and adolescents. Soc Sci Med 2020; 258:113123. [PMID: 32593956 DOI: 10.1016/j.socscimed.2020.113123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased soft drink consumption has been proposed as both predictor and result of mental health problems. Although possible mechanisms for both directions have been suggested, understanding of the association is limited. Most previous research has been cross-sectional and could not assess directionality. METHOD This study investigated the directionality of the association between soft drink consumption and mental health using longitudinal panel data of 5882 children and adolescents from the nationally representative German KiGGS baseline study (2003-2006) and KiGGS Wave 1 (2009-2012). Soft drink consumption and mental health problems were assessed by standardized questionnaire (baseline) and telephone interview (Wave 1). Four cross-lagged panel models were specified and compared regarding their fit indices. Specific paths were tested for significance. RESULTS Positive cross-sectional associations between soft drink consumption and mental health problems were found at both measurement points (ps < .01), even after controlling for third variables (including age, gender, and socioeconomic status). Only the lagged effect of mental health problems on soft drink consumption reached statistical significance (β = 0.031, p = .020), but not the effect in the opposite direction. The corresponding model also showed the best model fit overall. CONCLUSIONS Mental health problems predicted soft drink consumption over an average of six years, but not vice versa. These findings suggest that consuming soft drinks might be a dysfunctional strategy of coping with mental health problems for children and adolescents and highlight the importance of considering mental health problems in the prevention of soft drink overconsumption and obesity.
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Affiliation(s)
- Philipp Kadel
- Health Psychology, School of Social Sciences, University of Mannheim, Germany.
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Germany
| | - Jutta Mata
- Health Psychology, School of Social Sciences, University of Mannheim, Germany
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Knowledge, Attitude, and Practice of Adolescent Parents on Free Sugar and Influencing Factors about Recognition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114003. [PMID: 32512927 PMCID: PMC7311966 DOI: 10.3390/ijerph17114003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022]
Abstract
Physiological problems caused by excessive intake of free sugar have been concerning important public health issues, especially the impact on adolescents. The World Health Organization (WHO) strongly recommends controlling daily sugar intake in order to reduce the stress caused by high sugar uptake. Finding out the factors that affect adolescents’ sugar intake will help further interventions to control the intake of sugar. Therefore, we conducted a cross-sectional study among 10 middle schools in Changsha, the capital of Hunan province. Two classes of the first and second grades were randomly selected from each school, and their parents in these classes participated in the survey. Questionnaires were used to access the status of adolescent parents’ knowledge, attitude and practice (KAP) towards free sugar. Out of 1136 valid participants, 70.4% of respondents were female with the mean (Standard Deviation) age of 41.76 (±5.27) years. They had a good attitude but relatively poor knowledge and behavior towards free sugar. Binary logistic regression analysis found that parents whose gender is female, with a high education level and a girl as their child, hold a high level of free sugar recognition. These findings could help free sugar control interventions for adolescents in the future.
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Honicky M, Cardoso SM, de Lima LRA, Ozcariz SGI, Vieira FGK, de Carlos Back I, Moreno YMF. Added sugar and trans fatty acid intake and sedentary behavior were associated with excess total-body and central adiposity in children and adolescents with congenital heart disease. Pediatr Obes 2020; 15:e12623. [PMID: 32050058 DOI: 10.1111/ijpo.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past three decades, the prevalence rate of overweight and obesity has increased in survivors with congenital heart disease, and little is known about the body composition and its association with clinical characteristics and lifestyle factors. OBJECTIVES To evaluate excess total-body adiposity and central adiposity and, to describe associated factors. METHODS Cross-sectional study with children and adolescents who underwent procedure to treat congenital heart disease, from January to July 2017. Sociodemographic and clinical characteristics, and lifestyle factors (dietary intake, physical activity, and sedentary behavior) were assessed. Adiposity was assessed using air-displacement plethysmography and waist circumference. Factors associated with excess total-body adiposity and central adiposity were analyzed using logistic regression models. RESULTS Of 232 patients, 22.4% were identified with excess total-body adiposity and 24.6% with central adiposity. Significant factors positively associated with excess total-body adiposity were intake of added sugar and trans fatty acids, adjusted for confounding factors. Similarly, lifestyle factors were positively associated with central adiposity: intake of added sugar and trans fatty acids, sedentary behavior, and family history of obesity. CONCLUSIONS Lifestyle factors were associated with excess total-body adiposity and central adiposity. Assessment of body composition and healthy-lifestyle counseling into outpatient care may be the key point to prevent obesity in children and adolescents with congenital heart disease.
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Affiliation(s)
- M Honicky
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - S M Cardoso
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - L R A de Lima
- Department of Physical Education, University of State Santa Catarina, Laguna, South Carolina, Brazil
| | - S G I Ozcariz
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - F G K Vieira
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - I de Carlos Back
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - Y M F Moreno
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
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Association between Heat-Induced Chemical Markers and Ultra-Processed Foods: A Case Study on Breakfast Cereals. Nutrients 2020; 12:nu12051418. [PMID: 32423099 PMCID: PMC7285198 DOI: 10.3390/nu12051418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/01/2023] Open
Abstract
Nutritional composition and neo-formed contaminant content in ultra-processed foods, amongst other factors, may contribute to increasing overall risk of non-communicable diseases and cancer. Commercial breakfast cereals (n = 53) were classified according to the NOVA approach as un-/minimally processed (NOVA-1, 11%), processed (NOVA-3, 30%), and ultra-processed (NOVA-4, 59%) foods. Acrylamide and hydroxymethylfurfural (HMF) content as heat-induced chemical markers was taken from our research team database. The NutriScore was used as the nutritional profiling system. Samples were distributed between groups A (19%), B (13%), C (38%), and D (30%). No statistically significant differences in acrylamide and HMF were found across the NutriScore groups. Sugar content was the only nutritional descriptor found to be significantly different between processed (11.6 g/100 g) and ultra-processed (23.1 g/100 g) breakfast cereal groups. Sugar content correlated with acrylamide (p < 0.001) and HMF (p < 0.0001). Acrylamide and HMF contents were not significantly higher in the NOVA-4 group when compared with the NOVA-3 group. However, trends towards higher acrylamide and HMF content are observed, amounting to a change of 75 µg/kg and 13.3 mg/kg in processed breakfast cereals, and 142 µg/kg and 32.1 mg/kg in ultra-processed breakfast cereals, respectively. Thus, the NOVA classification may not reflect the extent of the thermal treatment applied to the breakfast cereal but the type and amount of ingredients incorporated. Ultra-processed breakfast cereal does not predict significantly higher toxicological concern based on acrylamide content than processed breakfast cereals; a clear trend is seen whose contributing factors should be further studied.
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Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System. Nutrients 2020; 12:nu12040884. [PMID: 32218115 PMCID: PMC7230794 DOI: 10.3390/nu12040884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.
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17
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Marttila-Tornio K, Ruotsalainen H, Miettunen J, Männikkö N, Kääriäinen M. Clusters of health behaviours and their relation to body mass index among adolescents in Northern Finland. Scand J Caring Sci 2019; 34:666-674. [PMID: 31667874 DOI: 10.1111/scs.12769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/06/2019] [Indexed: 12/28/2022]
Abstract
AIMS To identify clusters of health behaviours among Finnish adolescents and examine whether these clusters are associated with body mass index (BMI). METHODS The data, drawn from the prospective population-based Northern Finland Birth Cohort 1986, comprised a total of 7182 adolescents who replied to a follow-up postal questionnaire at the age 15 to 16. The adolescents were asked about multiple health behaviours, such as physical activity, screen time, cigarette smoking, alcohol use and diet. Adolescents who answered the questions concerning all of these variables were included in the study, yielding a final sample of 4305 subjects. K-means cluster analysis was performed to identify group of adolescents with similar health behaviours. Chi-squared tests were performed to analyse the association between the clusters and BMI. RESULTS Two clusters - Healthy Lifestyle and Unhealthy Lifestyle - were identified for both genders. The values of all the studied variables differed significantly between the clusters identified for both boys and girls. No significant relationship between the identified clusters and BMI was found for either boys or girls. CONCLUSIONS It is important to consider multiple lifestyle-related behaviours and trying to identify groups that present probability for developing lifestyle diseases.
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Affiliation(s)
- Kaisa Marttila-Tornio
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Heidi Ruotsalainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Department of Social Services and Rehabilitation, Oulu University of Applied Sciences, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Niko Männikkö
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Department of Social Services and Rehabilitation, Oulu University of Applied Sciences, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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Samaniego Vaesken MDL, Partearroyo T, Varela-Moreiras G. Presence and consumption of sugars and low and no-calorie sweeteners in the Spanish diet: an updated overview. NUTR HOSP 2019; 36:8-12. [PMID: 31368329 DOI: 10.20960/nh.02799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Introduction: the term "sugars" describes a specific group of carbohydrates and one of the most controversial components of our diet, as public health authorities worldwide acknowledge that there is an excessive intake. Reformulation practices with low and no-calorie sweeteners (LNCS) are being carried out worldwide. However, a lack of information about the present market status and evolution is highly recognized. Materials and methods: review of the most recent studies. Results: there is a lack of comprehensive Food Composition Tables (FCT) and Databases (DB) including sugar contents and many countries have developed their own for the estimation of sugar intakes or with the aim of monitoring changes in processed food composition. Moreover, surveys assessing carbohydrate and sugar consumption and their dietary sources are scarce and sometimes not comparable due to the different methodologies, FCT and DB used, and non-harmonised use of terms and nomenclature, especially for the estimation of added sugars. Results from studies show that total and added sugar intakes around the world are quite comparable in terms of percentage of total energy from diet and major dietary sources. WHO's recommendations are being exceeded, especially amongst the younger population groups. Conclusions: future research on sweeteners, both caloric and low or non-caloric, should comprise the development of comprehensible, harmonized and updated databases of added sugar and LNCS, the evaluation of the frequent consumption of LNCS from foods and beverages and its potential association with an improved food model/pattern and lifestyles. Finally, intervention studies with LNCS are urgently needed.
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Abstract
PURPOSE OF REVIEW To describe current findings on sugar intake in children worldwide, including sugar sources and their impact on child health focusing on cardiometabolic alterations usually associated to obesity. RECENT FINDINGS In children less than 4 years, intakes of added sugars across countries ranged from 9.8 to 11.2% of total energy; in children 4-10 years, it ranged from less than 3-18%; and in adolescents, it ranged from 13.6 to 16.6%. For most countries, intakes of added sugars were greater than the recommended upper limit of 10% of total energy for children and adolescents and less or around 10% in infants. In most studies, soft drinks and fruit-based drinks accounted for the greatest proportion of the added sugars intake, followed by milk products and sweet bakery products. High added sugar intake has been associated with increased obesity risk and fat deposition in the liver, contributing to dyslipidemia, high blood pressure, insulin resistance and cardio-metabolic risk. SUMMARY As a high added sugar intake is associated with cardio-metabolic conditions in children and adolescents, the current scenario supports the need for stronger targeted long-term policies that prevent the excessive sugar intake in young populations.
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Affiliation(s)
- Azahara Iris Rupérez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza
| | - María Isabel Mesana
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza
| | - Luis Alberto Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza
- CIBER Obesity and Nutrition Physiopathology (CIBEROBN). Madrid, Spain
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Pielak M, Czarniecka-Skubina E, Trafiałek J, Głuchowski A. Contemporary Trends and Habits in the Consumption of Sugar and Sweeteners-A Questionnaire Survey among Poles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071164. [PMID: 30939732 PMCID: PMC6479998 DOI: 10.3390/ijerph16071164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/17/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022]
Abstract
The purpose of the paper was a cross sectional study to evaluate the use of sugars and selected sweeteners by Polish consumers in their diet. The survey was conducted using the direct interview method on the group of 2000 adults declaring the consumption of sugar or sweeteners. The ANOVA test and multi-dimensional cluster analysis was used to the data interpretation (p < 0.05). It was stated that the consumption of sugar among consumers remained at a high level. Respondents declared taking up the activities towards reducing sugar intake in their diet mostly due to health-related reasons. It was emphasized in particular by women taking part in the survey. The most frequent way to limit the amount of sugar in the diet consisted in choosing sweeteners, mainly stevia and xylitol. However, the knowledge concerning steviol glycosides among the consumers was not extensive. Results are the source of up-to-date information concerning the consumption of sugar and sweeteners. Consumers to whom nutrition campaigns on the necessity to limit the content of sugar in the diet are worth addressing were identified. A hypothesis, that consumers are currently more aware of the negative influence of increased sugar consumption on their health and they aim at limiting the content of added sugar in their diet, was confirmed.
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Affiliation(s)
- Marlena Pielak
- Department of Food Gastronomy and Food Hygiene, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland.
| | - Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland.
| | - Joanna Trafiałek
- Department of Food Gastronomy and Food Hygiene, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland.
| | - Artur Głuchowski
- Department of Food Gastronomy and Food Hygiene, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland.
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Braz M, Assumpção DD, Barros MBDA, Barros Filho ADA. Added sugar intake by adolescents: A population-based study. CIENCIA & SAUDE COLETIVA 2018; 24:3237-3246. [PMID: 31508744 DOI: 10.1590/1413-81232018249.24692017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 02/13/2018] [Indexed: 01/09/2023] Open
Abstract
The aim of the present study was to estimate the prevalence of added sugar intake within the maximum limit of 5% of the total energy of the diet and test associations with demographic/socioeconomic characteristics, health-related behaviors and nutritional status in adolescents. A population-based, cross-sectional study was conducted with two-stage cluster sampling. The amount of free sugar in the diet was estimated using a 24-hour dietary recall. Among the 924 adolescents evaluated, only 20.1% (95% CI: 16.8-23.9) met the recommendation of not exceeding 5% of total calories with added sugar. Higher prevalence rates of adherence to the recommendation were found among males (22.0%), adolescents aged 15 to 19 years (24.3%), those born outside the state of São Paulo (30.4%), those with less screen time (27.5%), those with a lower number of household appliances (0-7: 29.5%; 8-15: 20.3%) and those with higher diet quality scores (2nd tertile: 17.7%; 3rd tertile: 37.2%). The findings demonstrate factors associated with added sugar intake from an epidemiological perspective, revealing the simultaneity of inappropriate behaviors, that is, the adolescents who consume more sugar also have longer screen time and worse overall diet quality.
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Affiliation(s)
- Marici Braz
- Departamento de Pediatria, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Daniela de Assumpção
- Departamento de Pediatria, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | | | - Antonio de Azevedo Barros Filho
- Departamento de Pediatria, Universidade Estadual de Campinas (Unicamp). R. Tessália Vieira de Camargo 126, Zeferino Vaz. 13083-887 Campinas SP Brasil.
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Self-reported use of nutrition labels to make food choices is associated with healthier dietary behaviours in adolescents. Public Health Nutr 2017; 20:2329-2339. [DOI: 10.1017/s1368980017001252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe study aimed to examine nutrition label use and dietary behaviours among ethnically diverse middle- and high-school students, in Texas, USA.DesignThe School Physical Activity and Nutrition (SPAN) survey is a cross-sectional statewide study using a self-administered questionnaire to assess nutrition and physical activity behaviours. Height and weight measurements were used to determine BMI. Multivariable logistic regression was used to determine associations between nutrition label use and dietary behaviours, with gender, grade, ethnicity, BMI, parent education, socio-economic status and nutrition knowledge as covariates.SettingParticipants from 283 schools, weighted to represent Texas youth.SubjectsSPAN 2009–2011 included 6716 8th and 11th graders (3465 girls and 3251 boys). The study population consisted of 39·83 % White/Other, 14·61 % African-American and 45·56 % Hispanic adolescents; with a mean age of 14·9 years, and 61·95 % at a healthy weight, 15·71 % having overweight and 22·34 % having obesity.ResultsAdolescents who did not use nutrition labels had 1·69 times greater odds of consuming ≥1 sugary beverages/d (P<0·05). Adolescents who used nutrition labels had 2·13 times greater odds of consuming ≥1 fruits and vegetables/d (P<0·05). Adolescents who used nutrition labels had significantly higher healthy eating scores than those who did not (P<0·001). For every 1-point increase in nutrition knowledge, adolescents had 1·22 greater odds of using nutrition labels.ConclusionsNutrition label use is associated with healthier dietary behaviours in adolescents. Intervention strategies for youth should include efforts to teach adolescents to use labels to make healthy food choices.
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Azaïs-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA. A review of total & added sugar intakes and dietary sources in Europe. Nutr J 2017; 16:6. [PMID: 28109280 PMCID: PMC5251321 DOI: 10.1186/s12937-016-0225-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/25/2016] [Indexed: 02/07/2023] Open
Abstract
Public health policies, including in Europe, are considering measures and recommendations to limit the intake of added or free sugars. For such policies to be efficient and monitored, a precise knowledge of the current situation regarding sugar intake in Europe is needed. This review summarizes published or re-analyzed data from 11 representative surveys in Belgium, France, Denmark, Hungary, Ireland, Italy, Norway, The Netherlands, Spain and the UK. Relative intakes were higher in children than in adults: total sugars ranged between 15 and 21% of energy intake in adults and between 16 and 26% in children. Added sugars (or non-milk extrinsic sugars (NMES), in the UK) contributed 7 to 11% of total energy intake in adults and represented a higher proportion of children's energy intake (11 to 17%). Educational level did not significantly affect intakes of total or added sugars in France and the Netherlands. Sweet products (e.g. confectionery, chocolates, cakes and biscuits, sugar, and jam) were major contributors to total sugars intake in all countries, genders and age groups, followed by fruits, beverages and dairy products. Fruits contributed more and beverages contributed less to adults' total sugars intakes than to children's. Added sugars were provided mostly by sweet products (36 to 61% in adults and 40 to 50% in children), followed by beverages (12 to 31% in adults and 20 to 34% in children, fruit juices excluded), then by dairy products (4 to 15% in adults and 6 to 18% in children). Caution is needed, however, as survey methodologies differ on important items such as dietary data collection, food composition tables or estimation of added sugars. Cross-country comparisons are thus not meaningful and overall information might thus not be robust enough to provide a solid basis for implementation of policy measures. Data nevertheless confirm that intakes of total and added sugars are high in the European countries considered, especially in children, and point to sweet products and beverages as the major contributors to added sugar intakes.
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Affiliation(s)
| | - Diewertje Sluik
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Frans Kok
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
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