Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States

General and sport-specific nutrition knowledge and behaviors of adolescent athletes

INTRODUCTION

Most youth do not meet national nutrition recommendations and overconsume high-calorie, low nutrient-dense foods. Adequate nutritional intake is crucial for growth and development. Nutrition practices play a key role in sports performance and recovery. Nutritional knowledge can affect eating patterns. However, there is limited research on general and sport-specific nutrition knowledge and behaviors of adolescent athletes.

PURPOSE

To examine general and sport-specific nutrition knowledge and behaviors of adolescent athletes.

METHODS

Adolescent athletes were assessed on nutrition knowledge and general and sport-specific nutrition behaviors, including food group consumption, hydration practices, and sport supplement use. Gender differences in general and sport-specific nutrition behaviors were compared using a Mann-Whitney U test. Odds ratios and logistic regression, controlling for age, ethnicity, and years in sport participation were used to determine differences in correct responses between genders. Significance was set at the p < 0.05 level.

RESULTS

One hundred and ninety-four athletes (n = 63 male, n = 132 female, mean age = 14.9 ± 1.63 years) were assessed. Differences in nutrition behaviors were found in fruit, dairy, and sugary beverage consumption between genders. Male athletes were more likely to monitor hydration and use sports supplements. Both males and females scored less than 50% on both general and sport-specific knowledge questions.

CONCLUSION

Adolescent athletes report lower than recommended food group consumption and lack knowledge of general and sport-specific nutrition information. Improvements in these areas can play a significant role in the health and performance of adolescent athletes.

Effectiveness of Peer-Led Interventions in Improving the Dietary Behavior of Adolescents in Low- and Middle-Income Countries: A Systematic Review

CONTEXT

Adequate nutrition is crucial during adolescence due to significant physical, mental, and emotional changes, yet in many adolescents poor dietary behaviors lead to inadequate nutrient intake and increased health risks. Peer-led interventions have shown promise in improving these behaviors. Thus, synthesizing evidence from primary studies is crucial to enhance their effectiveness and policy implications.

OBJECTIVE

In this review we synthesized evidence on the effectiveness of peer-led interventions in improving the dietary behavior of adolescents in low and middle-income countries (LMICs).

DATA SOURCES

We searched thePubMed, CINAHL, PsycINFO, ERIC, Cochrane Library, and SCOPUS databases for studies on peer-led interventions among adolescents aged 10-19 years. No specific publication timeframe was set for the search. Studies lacking quantitative outcome measures were excluded.

DATA EXTRACTION

Of the 3177 records initially identified, 8 studies were included. Study quality was assessed by use of Joanna Briggs Institute quality appraisal tools. Data extraction involved capturing study characteristics, intervention components, outcomes, and key findings.

DATA ANALYSIS

The studies were conducted in the regions of Sub-Saharan Africa, the Middle East, Southeast Asia, and South Asia, with intervention durations ranging from 3 weeks to 3 years. Interventions included peer leaders facilitating group discussions, making posters, and providing practical demonstrations. Most studies reported improvements in dietary intake such as increases in fruit and vegetable consumption and reductions in unhealthy snack intake following the intervention. Knowledge and attitudes toward healthy dietary behavior also improved. None of the studies included explicit detail involving adolescents in the initial design of interventions. Multicomponent interventions and longer durations were more successful.

CONCLUSION

Peer-led interventions effectively improved the dietary behaviors of adolescents in LMICs. The findings of this review underscore the importance of multicomponent strategies and longer intervention durations. Involving adolescents in program design is recommended to enhance the relevance and impact of interventions. Researchers should identify the most effective intervention components and delivery methods.

Non-nutritive sweeteners in food-drug interactions: An overview of current evidence

Food-drug interactions occur when the presence of foods interferes with the absorption, distribution, metabolism, or excretion of pharmaceuticals. Specific compounds within foods, like certain phytochemicals from grapefruit, have been known to precipitate food-drug interactions for decades, leading to guidance from physicians and pharmacists about patients' dietary restrictions while taking certain drugs. Although approved by the Food and Drug Administration, high-intensity non-nutritive sweeteners (NNS) share qualities with drugs that suggest the potential for similar interactions. In this minireview, we have reviewed 5 of the most popular NNS, including saccharin, aspartame, acesulfame potassium, sucralose, and stevia, and detail their drug-like qualities, regulatory status, pharmacokinetics, and primary research articles containing evidence of NNS interacting with drug absorption, distribution, metabolism, and excretion. Although studies varied widely in concentration ranges for NNS, model systems, and methods, all NNS included in this review were found to have known interactions with mediators of absorption, distribution, metabolism, and excretion from studies conducted after their Food and Drug Administration approval or generally recognized as safe designation. We have highlighted essential gaps in the literature and recommend the scientific community actively research NNS as food additives that may interact with drugs. SIGNIFICANCE STATEMENT: Food-drug interactions are a growing concern in Western societies where polypharmacy and ultraprocessed foods and beverages are increasingly common. High-intensity non-nutritive sweeteners bear structural similarities to pharmaceuticals, and evidence suggests they interact with mediators of drug pharmacokinetics. This minireview highlights the interactions uncovered thus far and serves as a call to action for the scientific community to establish rigorous, consistent testing that will enable updated safety guidelines for consumers.

Family matters: Exploring the intergenerational transmission of the unhealthy = tasty intuition

Children often consume not enough vegetables, and the overall quality of their diet is concerning. This research investigates the intergenerational transmission of the Unhealthy = Tasty Intuition (UTI) from parents to children and its role in shaping children's vegetable consumption. In two studies involving both children and their parents, we test whether parental UTI beliefs predict their children's UTI beliefs. Our findings demonstrate a positive relationship between parental and child UTI beliefs, which, in turn, are negatively associated with children's vegetable consumption. In the second study, we explore which parental feeding practices can help explain the socialization of the UTI. Our research contributes to the understanding of how children's food beliefs and consumption are socialized. Recognizing the impact of the UTI on children's dietary consumption provides valuable insights for developing interventions and policies aimed at promoting healthier eating habits among children. By addressing the intergenerational transmission of the UTI, we can take significant steps toward mitigating childhood obesity and its associated health risks.

The impact of food and nonalcoholic beverage sponsorship and marketing in the school environment on the food choices of school-going children and adolescents: A scoping review, 2011-2023

Globally, childhood obesity presents as a major public health challenge that is steadily on the increase. This is a result of, among other factors, children consuming excessive amounts of empty calories, specifically from foods high in saturated fats, refined sugar, and sodium, which may be exacerbated by targeted marketing and sponsorships. This scoping review aimed to investigate the prevalence of food and nonalcoholic beverage marketing in schools and to determine the impact marketing and sponsorship in the school environment has on the food choices of school-going children and adolescents. The objectives of the scoping review were to conduct a systematic search of available and relevant literature, identify recurring themes and knowledge gaps, and make recommendations for future research. For this scoping review, PubMed, Scopus, Web of Science, and EBSCO were searched for relevant studies published between 2011 and 2023. Gray literature was searched for on ProQuest and Google Scholar. The results were exported from the database into CADIMA for screening and data analysis; 1608 references were screened. Twelve primary studies (n = 12) were included in the final review. The evidence mapped out through this scoping review found that a link has been established between food and nonalcoholic beverage marketing and enhanced interest in these products from adolescents. It showed that food and nonalcoholic beverage marketing is prevalent in the school environment and influences the dietary behavior of school-going children. The school food environment is an opportunity to positively influence children and adolescents' food choices and consumption habits through nutrition education and health promotion.

Beverage Consumption Patterns Among Navajo Children Aged 2-5 Years

Background

Child beverage habits contribute to long-term health outcomes, including health conditions shaped by diet and adequate hydration. However, little is known about beverage consumption patterns of young American Indian children.

Objectives

We sought to characterize beverage intake among Navajo children aged 2-5 y and identify factors associated with healthier beverage habits.

Methods

This observational, cross-sectional study took place from 2022 to 2023. We enrolled 80 Navajo children aged 2-5 y attending early child education programs located on Navajo Nation. Children's primary caregivers and site staff were also enrolled. Cross-sectional surveys included the Beverage Intake Questionnaire for Preschool-aged Children. We used age-based national guidelines to determine the proportion of children meeting recommendations for sugar-sweetened beverage (SSB) intake and adequate beverage hydration.

Results

In this cohort of 80 children, 10.0% met recommendations for SSB intake and 26.3% maintained adequate beverage hydration. Of all beverage types, water was consumed the most, averaging 16.7 fluid ounces per day (standard deviation 11.7). Children also consumed a daily average of 12.9 fluid ounces of SSBs (standard deviation 17.8). Younger and more physically active children were more likely to meet adequate beverage hydration guidelines. The majority of participating early child education sites adhered to national beverage-related recommendations.

Conclusions

In this cohort of young Navajo children, water was consumed more than any beverage and early child education sites provided healthy beverage environments. Adequate beverage hydration, observed in 26.3% of children, was associated with younger age and greater physical activity. Establishing healthy beverage habits at an early age, ensuring access to safe drinking water, and promoting culture and tradition could sustain healthy beverage choices among American Indian children.

"Salt and Eat It or No Salt and Trash It?" Shifts in Support for School Meal Program Flexibilities in Public Comments

Background: The Healthy, Hunger-Free Kids Act was passed in 2010 to update nutrition standards in the National School Lunch and Breakfast Programs to be in accordance with evidence-based guidelines. In 2017 and 2020, the United States Department of Agriculture proposed flexibilities to the nutrition standards for milk, whole grains, and sodium. Objective: This study examines the positions used by stakeholders in support for or opposition to the proposed rules. Methods: We conducted a longitudinal qualitative content analysis of public comments posted to the U.S. Federal Register in response to the USDA's proposed rules in 2017 and 2020. All public comments submitted by individuals and organizations were analyzed (n = 7323, 2017 and n = 2513, 2020). Results: Results indicated three categories of arguments: (1) comments favoring the original law, (2) comments favoring flexibilities, and (3) other. In both comment periods, constituents opposed the implementation of flexibilities, while schools and manufacturers/industry predominately supported them. Academic and advocacy organizations opposed the original proposed change (2017) but relaxed their position in 2020. Conclusions: Any flexibility to the required nutritional standards of school meals has the potential to affect the health trajectory of youth. It is imperative to understand how stakeholders view this issue and inform policy change.

Food consumption and adherence to dietary guidelines among Jordanian children and adolescents

Background

Early-life food consumption patterns may affect children's health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood.

Aims

To evaluate Jordanian children and adolescents' energy and macronutrient intake and how closely they adhere to dietary recommendations.

Methods

This cross-sectional study used data from Jordan's Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines.

Results

The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake.

Conclusion

The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Quantitative relationship between free sugars intake and early childhood caries among preschoolers in Sri Lanka

INTRODUCTION

Before implementing the WHO sugar recommendations, more studies are needed concerning its application to given contexts.

OBJECTIVE

To identify free sugars intake levels associated with a minimum caries risk in primary dentition METHODS: Using probability proportionate to size technique and cluster sampling, 813 children aged 4-5-years were selected from preschools in the Colombo district, Sri Lanka. A 67-item quantitative food frequency questionnaire was developed and validated to evaluate free sugars intake. Dental caries was assessed clinically using dmft index. For the selection of cut-off values for free sugars intake levels, ROC curves were used.

RESULTS

The median (IQR) amount of free sugars intake was 57.9 (33.2 -95.8) g/day or 21.1 % (12.5 %-35.9 %) of total energy requirement, with a frequency of 4.0 (2.7-6.1) times/day. Dental caries prevalence was 42.9 % (n = 349). Among all possible risk factors, free sugars intake as a percentage of total energy requirement (p < 0.001) and frequency of free sugars intake (p < 0.001) were significantly associated with the presence of dental caries. The percentage of free sugars that discriminates against a possible highest number of children with dental caries (99 %) was determined as 4 %, of the total energy requirement of a child, which is approximately 12 g/day (3 level teaspoons/day). Sugar intake once a day has a 97 % sensitivity in identifying children with dental caries. These cut-off values do not differ among the group who brush twice a day with fluoridated toothpaste.

CONCLUSION

For optimal caries prevention, children's free sugar intake should limit to <5 % of their total energy intake or consume less frequently than once daily.

CLINICAL SIGNIFICANCE

This study provides facts that policy makers and dental clinicians can use for dietary recommendations in Sri Lanka, which they will include in the next revision of the booklet, "Uniform Oral Health Messages for Sri Lankans". Additionally, health professionals and health information materials will disseminate these recommendations to the public.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

Metabolomics signatures of sweetened beverages and added sugar are related to anthropometric measures of adiposity in young individuals: results from a cohort study

BACKGROUND

The associations of sweetened beverages (SBs) and added sugar (AS) intake with adiposity are still debated. Metabolomics could provide insights into the mechanisms linking their intake to adiposity.

OBJECTIVES

We aimed to identify metabolomics biomarkers of intake of low- and no-calorie sweetened beverages (LNCSBs), sugar-sweetened beverages (SSBs), and ASs and to investigate their associations with body mass index, body fat percentage, and waist circumference.

METHODS

We analyzed 3 data sets from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) cohort study, of children who provided 2 urine samples (n = 297), adolescents who provided a single urine sample (n = 339), and young adults who provided a single plasma sample (n = 195). Urine and plasma were analyzed using untargeted metabolomics. Dietary intakes were assessed using 3-d weighed dietary records. The random forest, partial least squares, and least absolute shrinkage and selection operator were jointly used for metabolite selection. We examined associations of intakes with metabolites and anthropometric measures using linear and mixed-effects regression.

RESULTS

In adolescents, LNCSB were positively associated with acesulfame (β: 0.0012; 95% confidence interval [CI]: 0.0006, 0.0019) and saccharin (β: 0.0009; 95% CI: 0.0002, 0.0015). In children, the association was observed with saccharin (β: 0.0016; 95% CI: 0.0005, 0.0027). In urine and plasma, SSBs were positively associated with 1-methylxanthine (β: 0.0005; 95% CI: 0.0003, 0.0008; and β: 0.0010, 95% CI 0.0004, 0.0015, respectively) and 5-acetylamino-6-amino-3-methyluracil (β: 0.0005; 95% CI: 0.0002, 0.0008; and β: 0.0009; 95% CI: 0.0003, 0.0014, respectively). AS was associated with urinary sucrose (β: 0.0095; 95% CI: 0.0069, 0.0121) in adolescents. Some of the food-related metabolomics profiles were also associated with adiposity measures.

CONCLUSIONS

We identified SBs- and AS-related metabolites, which may be important for understanding the interplay between these intakes and adiposity in young individuals.

Goals, Barriers, and Facilitators of Caregivers Who Participated in an In-Home Intervention to Improve Food Parenting Practices and Child Diet Quality

OBJECTIVE

To explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments.

DESIGN

Secondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention.

PARTICIPANTS

Thirty-three Hispanic/Latinx caregivers, predominantly of low income.

PHENOMENON OF INTEREST

Patterns in goal content and anticipated barriers and facilitators.

ANALYSIS

Thematic analysis of goal sheets with a mixed inductive-deductive approach.

RESULTS

Almost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers' perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members' eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation).

CONCLUSIONS AND IMPLICATIONS

Understanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools

BACKGROUND

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.

METHODS

The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.

CONCLUSIONS

Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Dietary Patterns Among US Children: A Cluster Analysis

BACKGROUND

Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions.

OBJECTIVE

This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics.

DESIGN

Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns.

PARTICIPANTS AND SETTING

Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall.

MAIN OUTCOME MEASURES

The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores.

STATISTICAL ANALYSES PERFORMED

A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership.

RESULTS

Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster.

CONCLUSIONS

Children in this study displayed different dietary patterns, with key sociodemographic variation.

Caffeine affects the neurobehavioral impact of sodium benzoate in adolescent rats

The continuous high intake of caffeinated products may harm CNS. Sodium benzoate (SB), broadly used for food preservation, may also have an impact. The current research studied the influence of caffeine and two doses of SB during adolescence period on behavior and brain alterations. Adolescent rats (90-120 gm) were exposed to vehicle, SB 100 and 400 mg/kg, p.o, caffeine (30 mg/kg, i.p), SB 100 or 400 + caffeine for 28 days. Locomotor performances were assessed by the open field, learning and memory were considered with novel object and y-maze, while anxiety was evaluated by light and dark as well as successive allays tests. The results showed that the motor activity of adolescent rats increased with each single treatment. Recognition memory was improved by SB100 and its combination with caffeine while working memory was reduced by SB (100 or 400) combination with caffeine compared with caffeine group. The anxiolytic effect of caffeine was reduced by SB co-treatment in either dose. Concerning biochemical study in the frontal cortex and hippocampus, oxidative biomarkers as well as Cholinesterase content were elevated due to SB400 + caffeine. Dopamine content was almost elevated by all treatments in both regions while GABA content was increased in the frontal cortex only. The obtained results pointed to histopathological changes as a result of brain oxidative stress and undesirable working memory consequences due to caffeine administration with SB, mostly the large dose. The outcomes propose new recommendations to evade the consolidation between processed nourishment and caffeinated beverages during adolescence.

Temporal trends of carbonated soft-drink consumption among adolescents aged 12-15 years from eighteen countries in Africa, Asia and the Americas

Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.

A food-exchange model for achieving the recommended dietary intakes for saturated fat in Irish children: analysis from the cross-sectional National Children's Food Survey II

OBJECTIVE

To identify the main foods determining SFA intakes and model the impact of food exchanges to improve compliance with dietary fat recommendations in Irish children.

DESIGN

Estimated food and nutrient intakes were obtained from a cross-sectional study, the National Children's Food Survey II. Participants were categorised into low, medium and high SFA consumers, and the contribution of food categories to SFA intakes was compared. A food-exchange model was developed, whereby a selected range of high SFA foods was exchanged with lower SFA or unsaturated fat alternatives.

SETTING

Participants were randomly selected from primary schools throughout the Republic of Ireland.

PARTICIPANTS

A representative sample of 600 Irish children (5-12 years).

RESULTS

The main determinants of low and high SFA consumers were milk, cheese and butter. These foods, including snack foods and meat and meat products, were considered exchangeable foods within the model. Compared with baseline data, modelled intakes for total fat, SFA, MUFA and trans-fat presented decreases of 3·2, 2·7, 1·6 and < 0·1 % of total energy (% TE), respectively. PUFA, n-6, n-3 and alpha-linolenic acid showed increases of 1·0, 0·8, 0·2 and 0·1 % TE, respectively. Compliance with total fat, MUFA and trans-fat recommendations remained adequate (100 %). Adherence to SFA and PUFA recommendations improved from 18 to 63 % and 80 to 100 %, respectively.

CONCLUSION

The food-exchange model decreased SFA intakes and increased PUFA intakes, suggesting modest dietary changes to children's diets can effectively improve their overall dietary fat profile.

Microfluidic paper analytic device (μPAD) technology for food safety applications

Foodborne pathogens, food adulterants, allergens, and toxic chemicals in food can cause major health hazards to humans and animals. Stringent quality control measures at all stages of food processing are required to ensure food safety. There is, therefore, a global need for affordable, reliable, and rapid tests that can be conducted at different process steps and processing sites, spanning the range from the sourcing of food to the end-product acquired by the consumer. Current laboratory-based food quality control tests are well established, but many are not suitable for rapid on-site investigations and are costly. Microfluidic paper analytical devices (μPADs) are a fast-growing field in medical diagnostics that can fill these gaps. In this review, we describe the latest developments in the applications of microfluidic paper analytic device (μPAD) technology in the food safety sector. State-of-the-art μPAD designs and fabrication methods, microfluidic assay principles, and various types of μPAD devices with food-specific applications are discussed. We have identified the prominent research and development trends and future directions for maximizing the value of microfluidic technology in the food sector and have highlighted key areas for improvement. We conclude that the μPAD technology is promising in food safety applications by using novel materials and improved methods to enhance the sensitivity and specificity of the assays, with low cost.

Sources of free sugar in the diet of Saudi children

Introduction

Data concerning sources of free sugar (FS) in the diet of Saudi children are limited. Identification of the top sources of FS would permit to develop tailored interventions that aid in meeting the recommendations of the World Health Organization for FS (≤ 25 g/day). This study aimed to investigate sources of FS in children's diet.

Methods

A cross-sectional data of healthy children ages between 6 and 12 years who reside in Saudi Arabia were gathered from their mothers using online platforms (WhatsApp, Facebook, and X) (n = 424; 210 boys and 214 girls). An interview was conducted through the phone with the mother and her child to collect data pertaining FS intake using a validated food frequency questionnaire.

Results

The primary sources of FS were Sweetened Beverages, followed by Sugars, Sweet Bakery Products, Other Desserts, and Candies, of which the added sugar consisted mostly of its total sugar. The consumption of FS coming from solid food sources for the highest quartile of children almost doubled the amount of FS coming from liquid food sources. Compared to boys, girls in the top quartile of FS intake consumed significantly higher amounts of solid sugars (p = 0.030). Only the intake of FS coming from Sweetened Beverages was associated negatively with age of children (p = 0.032).

Discussion

Public health interventions should emphasize the necessity of reducing the consumption of the top sources of FS to practically achieve the recommendations of FS intake.

Algorithm as Recommending Source and Persuasive Health Communication: Effects of Source Cues, Language Intensity, and Perceived Issue Involvement

Algorithms are now playing significant roles in online health information selection and recommendation. A question arises as to when and why people would be persuaded by the content they recommend. We conducted a 4 (recommending source: algorithm, other users, a friend, the CDC) x 2 (language intensity: high vs. low) experiment to find out. Participants (N = 299) were exposed to a health-related public service announcement embedded in a social media post. The results showed that overall, an algorithm induced a similar level of compliance intention compared with other recommending sources. We also found a significant three-way interaction when comparing the effects of the algorithm and the CDC: for individuals with low issue involvement, the algorithm was less persuasive when paired with a message with high language intensity. In contrast, for high-involvement individuals, the algorithm elicited more fear than the CDC when recommending an assertive message, partially leading to more compliance intention.

Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth

Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.

Substitution of sugar-sweetened beverages with non-caloric alternatives and weight change: A systematic review of randomized trials and meta-analysis

BACKGROUND

Intake of sugar-sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar-sweetened beverages with non-caloric beverages results in long-term reduction in body weight.

OBJECTIVE

The objective of this study is to explore if a long-term reduction in body weight can be achieved by replacing an existing intake of sugar-sweetened beverages with non-caloric beverages.

METHODS

Systematic review and meta-analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a "substitution" design were included, that is, studies where subjects substituted an existing intake of sugar-sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow-up of weight change were included.

RESULTS

Six trials with a total of 1729 participants were included in the meta-analysis. Replacing an existing intake of sugar-sweetened beverages with a non-caloric beverage resulted in a long-term BMI reduction of 0.31 kg/m2 compared with the sugar-sweetened beverage-group (95% CI; 0.17-0.44). One study with 1 year's intervention and 2 years follow-up showed a regression towards baseline BMI after the intervention had ended.

CONCLUSION

Replacing an existing use of sugar-sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long-term 0.31 kg/m2 reduction in BMI equivalent to 0.5-1 kg in children and adults, respectively, as long as the interventions lasted.

Breastfeeding and less healthy beverage intake during the first year of life

BACKGROUND AND OBJECTIVES

Breastfeeding during infancy is associated with healthier beverage consumption later in childhood, but little is known about this relation during infancy. This was a longitudinal study of breastfeeding and less healthy beverage consumption during the first year of life, in a birth cohort study conducted 2013-2018 in the Southeastern United States (n = 666).

METHODS

We estimated monthly rates of 100% juice and sugar-sweetened beverage (SSB) consumption comparing infants who were exclusively or partially breastfed, versus those who were not, in multivariable adjusted models.

RESULTS

Mothers had a median age of 26.5 years, 71% identified as Black/African-American, and 61% reported household incomes <$20 000/year. The prevalence of any breastfeeding during the first month was 78.2% and 18.7% at month 12. By age 12 months, infants consumed juice a mean (SD) 9.1 (10.1) times per week and SSBs 3.6 (9.5) times per week. Breastfed infants had a 38% lower incidence rate of weekly juice consumption (95% CI 52%, 15%, p = 0.003) and a 57% lower incidence rate of weekly SSB consumption (95% CI 76%, 22%, p = 0.006), compared with infants who were not breastfed.

CONCLUSIONS

Research on early-life correlates of dietary health should focus on the earliest beverages, given evidence that consumption of obesogenic beverages may begin prior to age 1 year.

Feeding the gut microbiome: impact on multiple sclerosis

Multiple sclerosis (MS) is a multifactorial neurological disease characterized by chronic inflammation and immune-driven demyelination of the central nervous system (CNS). The rising number of MS cases in the last decade could be partially attributed to environmental changes, among which the alteration of the gut microbiome driven by novel dietary habits is now of particular interest. The intent of this review is to describe how diet can impact the development and course of MS by feeding the gut microbiome. We discuss the role of nutrition and the gut microbiota in MS disease, describing preclinical studies on experimental autoimmune encephalomyelitis (EAE) and clinical studies on dietary interventions in MS, with particular attention to gut metabolites-immune system interactions. Possible tools that target the gut microbiome in MS, such as the use of probiotics, prebiotics and postbiotics, are analyzed as well. Finally, we discuss the open questions and the prospects of these microbiome-targeted therapies for people with MS and for future research.

Early-life influences of low-calorie sweetener consumption on sugar taste

Children and adolescents are the highest consumers of added sugars, particularly from sugar-sweetened beverages (SSB). Regular consumption of SSB early in life induces a variety of negative consequences on health that can last into adulthood. Low-calorie sweeteners (LCS) are increasingly used as an alternative to added sugars because they provide a sweet sensation without adding calories to the diet. However, the long-term effects of early-life consumption of LCS are not well understood. Considering LCS engage at least one of the same taste receptors as sugars and potentially modulate cellular mechanisms of glucose transport and metabolism, it is especially important to understand how early-life LCS consumption impacts intake of and regulatory responses to caloric sugars. In our recent study, we found that habitual intake of LCS during the juvenile-adolescence period significantly changed how rats responded to sugar later in life. Here, we review evidence that LCS and sugars are sensed via common and distinct gustatory pathways, and then discuss the implications this has for shaping sugar-associated appetitive, consummatory, and physiological responses. Ultimately, the review highlights the diverse gaps in knowledge that will be necessary to fill to understand the consequences of regular LCS consumption during important phases of development.

Role of liquid fructose/sucrose in regulating the hepatic transcriptome in a high-fat Western diet model of NAFLD

Nonalcoholic fatty liver disease (NAFLD), which ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), is the most common chronic liver disease. Yet, the molecular mechanisms for the progression of steatosis to NASH remain largely undiscovered. Thus, there is a need for identifying specific gene and pathway changes that drive the progression of NAFLD. This study uses high-fat Western diet (HFWD) together with liquid sugar [fructose and sucrose (F/S)] feeding for 12 weeks in mice to induce obesity and examine hepatic transcriptomic changes that occur in NAFLD progression. The combination of a HFWD+F/S in the drinking water exacerbated HFWD-induced obesity, hyperinsulinemia, hyperglycemia, hepatic steatosis, inflammation, and human and murine fibrosis gene set enrichment that is consistent with progression to NASH. RNAseq analysis revealed differentially expressed genes (DEGs) associated with HFWD and HFWD+F/S dietary treatments compared to Chow-fed mice. However, liquid sugar consumption resulted in a unique set of hepatic DEGs in HFWD+F/S-fed mice, which were enriched in the complement and coagulation cascades using network and biological analysis. Cluster analysis identified Orosomucoid (ORM) as a HFWD+F/S upregulated complement and coagulation cascades gene that was also upregulated in hepatocytes treated with TNFα or free fatty acids in combination with hypoxia. ORM expression was found to correlate with NAFLD parameters in obese mice. Taken together, this study examined key genes, biological processes, and pathway changes in the liver of HFWD+F/S mice in an effort to provide insight into the molecular basis for which the addition of liquid sugar promotes the progression of NAFLD.

Children's food choices are highly dependent on patterns of parenting practices and food availability at home in families at high risk for type 2 diabetes in Europe: Cross-sectional results from the Feel4Diabetes study

BACKGROUND

Food parenting practices, behaviours and food availability at home are associated with children's food choices; however, these associations have been mainly studied for each parenting practice separately and focused mostly on healthy populations. The aim of the study was to identify patterns of parenting practices (including data regarding food availability at home, food and physical activity-related behaviours and rewards) and to investigate their cross-sectional associations with children's food choices in families at high risk for type 2 diabetes (T2D).

METHODS

Data of parents and children (n = 2278), from the Feel4Diabetes study conducted in six European countries, were collected using validated questionnaires. The data analysed included children's food choices, food availability at home and food and physical activity-related parenting practices. Four patterns of parenting practices were identified using principal component analysis, and associations between those components and children's food choices were assessed using adjusted, individual linear regressions.

RESULTS

Parenting patterns focusing on unhealthy habits, such as allowing unhealthy snacks and unlimited screen time, providing higher availability of unhealthy foods at home, rewarding with snacks and screen time, were positively associated with children's unhealthy food choices (consumption of savoury/sweet snacks, fizzy drinks, etc.). The parenting patterns providing fruit/vegetables at home, consuming fruit, and being physically active with the child were positively associated with children's healthier food choices (consumption of fruit, vegetables, whole grain cereals, etc.).

CONCLUSIONS

Public health initiatives should focus on high-risk families for T2D, assisting them to adopt appropriate parenting practices and behaviours to promote healthier food choices for children.

Implementation of Flexibilities to the National School Lunch and Breakfast Programs and Their Impact on Schools in Missouri

BACKGROUND

In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served.

METHODS

We developed a survey using the Consolidated Framework of Implementation to determine schools' implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served.

RESULTS

Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students' preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals.

CONCLUSIONS

Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined.

Protective effect of melatonin on learning and memory impairment and hippocampal dysfunction in rats induced by high-fructose corn syrup

Objectives

We investigated the harmful effects of high fructose corn syrup (HFCS) on learning and memory in the hippocampus and the ameliorative effects of melatonin (Mel).

Materials and Methods

Thirty-six adult male Sprague Dawley rats were divided into three groups: Group I, control; Group II, HFCS; and Group III, HFCS+Mel. HFCS form F55 was prepared as a 20% fructose syrup solution. Rats in HFCS and HFCS+Mel groups were given drinking water for 10 weeks. Rats in the HFCS+Mel group have been given 10 mg/kg/day melatonin orally for the 6 weeks, in addition to HFCS 55. The Morris water maze (MWM) test was applied to all animals for 5 days to determine their learning and memory levels. After decapitation, one-half of the hippocampus samples were collected for western blot analysis, and another half of the tissues were collected for histopathological and immunohistochemical analyses.

Results

In the HFCS group, there was a significant difference between the time to find the platform in the MWM test and time spent in the quadrant between days 1 and 5 (P=0.037 and P=0.001, respectively). In addition, a decreased level of MT1A receptor, TNF-α, iNOS, osteopontin (OPN), and interleukin-6 (IL-6) expressions were significantly increased in the HFCS group. Melatonin treatment reversed MT1A receptor levels and TNF-α, iNOS, OPN, and IL-6 expressions. During the histopathological examination, increased neuronal degenerations were observed in the HFCS group. Melatonin ameliorated these changes.

Conclusion

Consumption of HFCS caused deterioration of learning and memory in adult rats. We suggest that melatonin is effective against learning and memory disorders.

How Does Consistency of Food and Nutrition Support Effect Daily Food Consumption among Children Living in Poverty? Recession-Era Implications

Underutilization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance (SNAP) food safety net programs may compromise child nutritional benefits for families with limited incomes. Using a sample of children surveyed before (2003−2006) and after the Great Recession (2007−2009), we examine whether consistent access to WIC and SNAP during times of increased economic stress moderated the association between poverty level (i.e., income-needs ratio [INR]) and fruits and vegetables (FV) or foods high in saturated fats and added sugars (SFAS). Fragile Families and Child Wellbeing Study income-eligible mothers/children (≤185% of poverty) with available FV and SFAS data at the 5- (2003−2006) and 9-year (2007−2010) waves (n = 733) were included. Main effects of INR and interaction effects of consistency of WIC, SNAP, and dual WIC and SNAP support from birth through age 5 were examined. INR was associated with decreased FV consumption frequency from age 5 to 9, conditional upon consistency of dual WIC/SNAP enrollment. FV declined when there was low consistency (<1 year) of dual support. FV consumption was stable across INR when combined WIC/SNAP support lasted at least 2 years. Results can inform strategies for optimizing the nutritional impact of WIC and SNAP by focusing on those most at risk for underutilization of multiple benefits.

Top sources and trends in consumption of total energy and energy from solid fats and added sugars among youth aged 2-18 years: United States 2009-2018

BACKGROUND

High energy intake from non-nutrient-dense sources correlates with poorer diet quality.

OBJECTIVES

The aims were to 1) estimate total energy intake and energy from solid fats and added sugars combined (SoFAS) and identify their top food category sources for ages 2-18 y in 2015-2018 and 2) describe trends over time in 2009-2018.

METHODS

Data were from the NHANES. Pairwise differences were examined using univariate t statistics (2015-2018, n = 5038), and trends by age and over time (2009-2018, n = 14,038) were examined using orthogonal polynomials.

RESULTS

In 2015-2018, SoFAS contributed a mean (SE) of 30.0% (0.3%) of total energy. Solid fats [16.1% (0.2%)] and added sugars [13.8% (0.2%)] each contributed >10%. The contribution of added sugars increased with age from 11.1% (2-3 y) to 14.4% (14-18 y), and was higher for all other race/Hispanic origins than non-Hispanic Asians. The top 5 sources of energy were sweet bakery products, savory snacks, pizza, other mixed dishes, and unflavored milk, and for SoFAS also included soft drinks, other desserts, candy, and snack bars. Total energy did not change between 2009 and 2018, but energy from SoFAS, and servings of solid fats, and added sugars declined. The contribution of unflavored milk to total energy declined for all ages and most race/Hispanic origins. Fruit drinks (all ages) and soft drinks (9-18 y) remained among top added sugars sources despite declines. The contribution of sweet bakery products to energy from SoFAS increased for most ages and candy and snack bars to energy from added sugars.

CONCLUSIONS

In 2015-2018, SoFAS contributed >30% of total energy for ages 2-18 y, which doubled the Dietary Guidelines for Americans' recommended limit of 15%. The top 5 sources of total energy were similar to those of solid fats, and those of SoFAS similar to those of added sugars. These results may inform public health efforts for improving diet quality.

Withdrawal: A key consideration in evaluating whether highly processed foods are addictive

Researchers are currently debating whether theories of addiction explain compulsive overeating of highly processed (HP) foods (i.e., industrially created foods high in refined carbohydrates and/or fat), which contributes to obesity and diet-related disease. A subset of individuals consumes HP foods with behavioral phenotypes that mirror substance use disorders. Withdrawal, the emergence of aversive physical and psychological symptoms upon reduction or cessation of substance use, is a core component of addiction that was central to historical debates about other substances' addictive potential (e.g., nicotine and cocaine). However, no one has systematically considered evidence for whether HP foods cause withdrawal, which represents a key knowledge gap regarding the utility of addiction models for understanding compulsive overeating. Thus, we reviewed evidence for whether animals and humans exhibit withdrawal when reducing or eliminating HP food intake. Controlled experimental evidence indicates animals experience HP food withdrawal marked by neural reward changes and behaviors consistent with withdrawal from other addictive substances. In humans, preliminary evidence supports subjective withdrawal-like experiences. However, most current human research is limited to retrospective recall. Further experimental research is needed to evaluate this construct. We outline future research directions to investigate HP food withdrawal in humans and consider potential clinical implications.

Dietary diversity and determinants of young adults in central China: A cross-sectional study from 2015 to 2020

Background

Early adulthood is a vulnerable period for improved nutrition at all phases of the life cycle. However, there is limited research on diversity information in young adults from middle-income countries undergoing an apparent nutritional transition. The purpose of this study was to explore dietary diversity and determinants among young adults aged 18–35 years in central China.

Methods

From January 2015 to December 2020, a cross-sectional survey of 49,021 young adults in a health management center of central China was conducted through report and phone-assisted self-report for information. The outcome variable was the Dietary Diversity Score. Independent variables included age, sex, race, material status, education, BMI, taste preference, regular meals, midnight snacks, sugared beverage/coffee consumption, and smoking/drinking status. Multivariate logistic regression was performed.

Results

Of 49,021 young adults, 38,374 (78.3%) reported insufficient dietary diversity, and 422 (0.9%) reported sufficient dietary diversity. Light taste preference [adjusted odds ratio (aOR) = 2.325; 95% CI: 1.779, 3.039] and those who had meals regularly (aOR = 1.241; 95% CI: 1.018, 1.513) and consumed coffee (aOR = 2.765; 95% CI: 2.257, 3.387) were more likely to be associated with sufficient dietary diversity. Midnight snacks (aOR = 0.728; 95% CI: 0.588, 0.901) and sugary beverages (aOR = 0.666; 95% CI: 0.535, 0.829) were less likely to be associated with sufficient dietary diversity. Higher BMI (aOR = 1.092; 95% CI: 1.061, 1.125) was associated with higher odds of sufficient dietary diversity. Additionally, participants who were 18–30 years old, with master or above degree and away from cigarette/alcohol were more likely to report better dietary diversity.

Conclusion

Our results painted a less than ideal nutritional condition affecting young adults. High-fat/sugar/salt dietary practices can lead to low dietary diversity, while high dietary diversity might have adverse BMI outcomes in youth. This study highlighted the importance of increasing the diversity of healthy and selective food items before wide recommendation for dietary diversity.

Dietary Intake among Children Attending Childcare Centers: Impact of the New CACFP Meal Guidelines

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings.

Intervention effects of a school-based health promotion programme on children’s nutrition behaviour

Aim

The programme “Join the Healthy Boat” promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme’s effectiveness, this study longitudinally investigated children’s nutrition behaviour.

Subject and methods

A total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site.

Results

After one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019).

Conclusion

This shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions.

Development and Validation of Huffaz ProHealth 1.0©: A Module to Improve the Well-Being of Tahfiz Students in Selangor, Malaysia

The increase in the number of Tahfiz schools in Malaysia indicates a high demand from the community for Tahfiz education. Tahfiz schools provide a Quran memorization syllabus as the main part of the curriculum at the primary and secondary levels. There is no holistic module that combines learning and health for Tahfiz students in Malaysia. Huffaz ProHealth 1.0^© Module is a health intervention module developed explicitly for Tahfiz students by a group of researchers from Universiti Kebangsaan Malaysia Kuala Lumpur (UKMKL). The module encompasses educational and motivational components for the Tahfiz students, and acts as a guide for their teachers and staff to improve the students’ health and quality of life. The module consists of three components: physical health, nutritional and psychological well-being. Each component is divided into several units with specific activities. The Sidek Module Development Model (SDMM) was used as a reference model. The study involved two phases: the development (Phase I) and evaluation (Phase II). In Phase I, a needs assessment was conducted among students and teachers from Tahfiz schools to evaluate their knowledge, attitude, and practice on the related topics. Meanwhile, the module’s validity and feasibility were assessed by healthcare experts and Tahfiz teachers in Phase II. The item–content validity index (I–CVI), content validity value, Tool to Evaluate Materials used in Patient Education (TEMPtEd) score, and expert feedback were evaluated. In conclusion, the Huffaz ProHealth 1.0^© module was successfully developed and evaluated. Strong validity values were observed in all components, indicating high suitability to be employed at Tahfiz schools.

Investigating oral and systemic pathways between unhealthy and healthy dietary patterns to periodontitis in adolescents: A population-based study

AIM

To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age).

MATERIALS AND METHODS

This population-based study (n = 2515) modelled direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing [BoP], probing depth [PD] ≥ 4 mm, clinical attachment loss [CAL] ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP-AAP) periodontitis definitions, adjusting for sex, socio-economic status, smoking, and alcohol, through structural equation modelling (α = 5%).

RESULTS

Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient [SC] = -0.160; p < .001), moderate periodontitis (SC = -0.202; p < .001), and EFP-AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05).

CONCLUSIONS

Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.

Food additives in childhood: a review on consumption and health consequences

OBJECTIVE

To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group.

METHODS

A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search.

RESULTS

Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented.

CONCLUSIONS

This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.

MICA: Motivational Interviewing Conversational Agent for Parents as Proxies for their Children in Healthy Eating (Preprint)

Background

Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children.

Objective

We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children.

Methods

We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA.

Results

Findings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals.

Conclusions

We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.

Home Delivery of Water for Caries Prevention in Latinx Children (“Sediento por una Sonrisa,” Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study

Background

Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children.

Objective

This protocol describes the rationale, design, and methods of the “Thirsty for a Smile” feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage.

Methods

This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants’ homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children’s water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention.

Results

Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019.

Conclusions

This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions.

International Registered Report Identifier (IRRID)

RR1-10.2196/37200

A Machine Learning Approach to Predict the Added-Sugar Content of Packaged Foods

BACKGROUND

Dietary guidelines recommend limiting the intake of added sugars. However, despite the public health importance, most countries have not mandated the labeling of added-sugar content on packaged foods and beverages, making it difficult for consumers to avoid products with added sugar, and limiting the ability of policymakers to identify priority products for intervention.

OBJECTIVE

The aim was to develop a machine learning approach for the prediction of added-sugar content in packaged products using available nutrient, ingredient, and food category information.

METHODS

The added-sugar prediction algorithm was developed using k-nearest neighbors (KNN) and packaged food information from the US Label Insight dataset (n = 70,522). A synthetic dataset of Australian packaged products (n = 500) was used to assess validity and generalization. Performance metrics included the coefficient of determination (R2), mean absolute error (MAE), and Spearman rank correlation (ρ). To benchmark the KNN approach, the KNN approach was compared with an existing added-sugar prediction approach that relies on a series of manual steps.

RESULTS

Compared with the existing added-sugar prediction approach, the KNN approach was similarly apt at explaining variation in added-sugar content (R2 = 0.96 vs. 0.97, respectively) and ranking products from highest to lowest in added-sugar content (ρ = 0.91 vs. 0.93, respectively), while less apt at minimizing absolute deviations between predicted and true values (MAE = 1.68 g vs. 1.26 g per 100 g or 100 mL, respectively).

CONCLUSIONS

KNN can be used to predict added-sugar content in packaged products with a high degree of validity. Being automated, KNN can easily be applied to large datasets. Such predicted added-sugar levels can be used to monitor the food supply and inform interventions aimed at reducing added-sugar intake.

Evaluation of the 'H2NOE Water Schools' programme to promote water consumption in elementary schoolchildren: a non-randomised controlled cluster trial

OBJECTIVE

This study evaluated a simple environmental intervention called 'Water Schools' in Lower Austria providing free refillable water bottles and educational material.

DESIGN

Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2).

SETTING

Half-day elementary schools in Lower Austria (Austria).

PARTICIPANTS

Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement.

RESULTS

The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings.

CONCLUSIONS

Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

Negative affect, childhood adversity, and adolescents' eating following stress

Obesity commonly emerges by adolescence and is associated with serious health consequences. Emotional eating (consuming calories, fats, and sugars in response to negative affect) may promote obesity; however, evidence is mixed as to whether negative affect increases obesogenic eating. Early-life adversity may shape malleable neurobiological systems that govern inhibitory control, physiological regulation, coping strategies, and eating behavior, contributing to greater obesogenic eating in response to negative affect. Therefore, this study tested whether childhood adversity moderates the association between negative affect and food consumption in a diverse sample of female adolescents. After completing a childhood adversity assessment, 157 female adolescents (13-17 years; 28.7% African American, 39.5% Hispanic/Latina, 31.8% Non-Hispanic White) rated their negative affect in response to a standard social stress paradigm before consuming a buffet lunch, which was evaluated for calories, added sugars, and solid fats consumed. Results did not support that negative affect exerted a main effect on eating behavior. However, negative affect and childhood adversity interacted to predict calories and solid fats consumed, such that negative affect was associated with more obesogenic eating for those with high adversity exposure but not for those with low adversity exposure. Adversity and affect did not interact to predict added sugars consumed. Findings support that eating patterns in response to negative affect may differ by childhood adversity history. Reducing children's adversity exposure and bolstering emotion regulation techniques for adolescents who have been exposed to adversity may provide pathways to protect health and well-being by reducing maladaptive eating patterns.

Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study

BACKGROUND

Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families.

OBJECTIVE

This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods.

METHODS

We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants' diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis.

RESULTS

Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC.

CONCLUSIONS

The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/32441.

Large State Variation in Sugar-Sweetened Beverage Purchases: What We Learn from the Beverage Industry Data

Negative health consequences of excessive sugar-sweetened beverage (SSB) consumption have prompted recommendations for SSB taxation to improve diet and health. Over 40 countries and 8 local US jurisdictions have implemented SSB taxes to date. There is considerable interest in state SSB taxes in the USA, but state-level data on SSB consumption levels is lacking. This article uses proprietary data from the Beverage Marketing Corporation on beverage sales across all US retail channels to estimate state-level per capita SSB purchases in 2021. There is considerable variation in per capita SSB purchases across states, from an estimated annual 23.5 gallons (89.1 L) in Hawaii to 51.8 gallons (196.1 L) in Missouri. Current average levels of SSB purchases at 13 ounces (0.38 L) daily leave little to no room for added sugars from all other sources. Policymakers in states with extra-high SSB purchases, especially in the Midwest, should consider effective evidence-based policies, including fiscal approaches, to increase awareness about SSB risks, encourage healthier beverage choices, and improve population diet.

Maternal Diet During Pregnancy and Lactation and Child Food Preferences, Dietary Patterns, and Weight Outcomes: a Review of Recent Research

PURPOSE OF REVIEW

Efforts to promote children's preferences for healthy foods hold much potential for improving diet quality and preventing obesity. The purpose of this review was to summarize recent evidence for associations between maternal diet during pregnancy and lactation and child food preferences, dietary patterns, and weight outcomes.

RECENT FINDINGS

Recent research illustrates greater maternal vegetable intakes during pregnancy and lactation predict greater child preferences for and intakes of vegetables. Recent randomized clinical trials to improve maternal weight outcomes during the perinatal period via behavioral lifestyle interventions that included dietary components have yielded mixed findings for effects on child weight outcomes. There is strong evidence that maternal diet during pregnancy and lactation shapes flavor preferences during infancy; more research is needed to understand factors that facilitate versus hinder the translation of these preferences to later dietary patterns and weight outcomes.

Association of a Sweetened Beverage Tax With Soda Consumption in High School Students

Importance

Sweetened beverage taxes are one policy approach to reduce intake of added sugars. Soda is the leading source of added sugars in the US diet, but few studies have examined how such taxes influence sweetened beverage intake in youth.

Objective

To estimate the association between the Philadelphia, Pennsylvania, beverage tax and adolescent soda intake.

Design, Setting, and Participants

This economic evaluation of school district-level Youth Risk Behavior Surveillance System data from September 2013 to December 2019 compared weekly soda intake in high school students in Philadelphia, a city with a sweetened beverage tax, with that in 7 comparison cities without beverage taxes. Difference-in-differences regression modeling was used to estimate change in soda intake in Philadelphia compared with control cities. Secondary analyses compared 100% juice and milk intake to explore potential substitution associations. Subgroup analyses evaluated differences by race and ethnicity and weight status (obesity and overweight or obesity). Analyses were performed between August 20 and October 20, 2020. School districts that had weighted data and a survey question on weekly soda intake from 2013 to 2019 were included. The study included high school students, grades 9 to 12, in school districts participating in the Youth Risk Behavior Surveillance System from 2013 to 2019.

Exposures

Implementation of a sweetened beverage tax in Philadelphia, Pennsylvania, in January 2017.

Main Outcomes and Measures

Reported weekly servings of soda, 100% juice, and milk.

Results

A total of 86 928 participants (weighted mean [SD] age, 15.8 [1.3] years; 49% female) from 8 US cities (including Philadelphia) were included. Before the tax, adolescents in the 7 comparison cities had a mean intake of 4 servings of soda per week compared with 5.4 servings per week in Philadelphia. Philadelphia's tax was associated with a reduction of 0.81 servings of soda per week (95% CI, -1.48 to -0.14 servings; P = .02) 2 years after tax implementation. There was no significant difference in 100% juice or milk intake, although Philadelphia adolescents consumed more juice than those in nontaxed cities. In subgroup analyses, the tax was associated with a reduction of 1.13 servings per week in Hispanic/Latinx adolescents (95% CI, -2.04 to -0.23 servings; P = .01) and 1.2 servings per week in adolescents with obesity (95% CI, -2.33 to -0.13 servings; P = .03).

Conclusions and Relevance

This economic evaluation found that a sweetened beverage tax was associated with a reduction in soda intake among adolescents, providing evidence that such taxes can improve dietary behaviors.

Trends in Added Sugars Intake and Sources Among US Children, Adolescents, and Teens Using NHANES 2001-2018

BACKGROUND

Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens.

OBJECTIVES

The present study provides a comprehensive time-trends analysis of added sugars intakes and contributing sources in the diets of US children, adolescents, and teens (2-18 years) from 2001-2018, focusing on variations according to sociodemographic factors (age, sex, race and ethnicity, income), food assistance, and health-related factors (physical activity level, body weight status).

METHODS

Data from 9 consecutive 2-year cycles of the NHANES were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001-2018 for the overall age group (2-18 years) and for 2 age subgroups (2-8 and 9-18 years). Trends were also examined on subsamples stratified by sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White), income (household poverty income ratio), food assistance, physical activity level, and body weight status.

RESULTS

From 2001-2018, added sugars intakes decreased significantly (P < 0.01), from 15.6% to 12.6% kcal among children (2-8 years) and from 18.4% to 14.3% kcal among adolescents and teens (9-18 years), mainly due to significant declines in added sugars from sweetened beverages, which remained the top source. Declines in added sugars intakes were observed for all strata, albeit to varying degrees.

CONCLUSIONS

Declines in added sugars intakes were observed among children, adolescents, and teens from 2001-2018, regardless of sociodemographic factors, food assistance, physical activity level, or body weight status, but variations in the magnitudes of decline suggest persistent disparities related to race and ethnicity and to income. Despite these declines, intakes remain above the DGA recommendation; thus, continued monitoring is warranted.