1
|
Ko A, O’Brien D, Rivera P, Mancl L, Hopkins S, Randall C, Nguyen DP, Chi DL. Identifying sources of variation in added sugar intake for Alaska Native children using a hair biomarker. Int J Circumpolar Health 2024; 83:2336286. [PMID: 38560896 PMCID: PMC10986438 DOI: 10.1080/22423982.2024.2336286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Sugars from sugar-sweetened beverages (SSBs) are an important risk factor for tooth decay. The study goal was to determine if there was variation in added sugar intake across communities and between and within households. In this cross-sectional study, intakes of total sugar, added sugar, and sugar-sweetened beverages (SSBs) were estimated for 282 Alaska Native children ages 0-10 years from 131 households in three Yukon-Kuskokwim (YK) Delta communities using biomarker equations based on hair carbon and nitrogen isotope ratios previously developed for the Yup'ik population. ANOVA was used to assess associations between each predictor (community and household) and outcome (estimated total sugars, added sugars, and SSB intake). Between- and within-household variation was estimated using a linear mixed-effects model with a random intercept for households with three or more children. There was no significant difference in mean estimated total sugar (p = 0.29), added sugar (p = 0.24), or SSB intake (p = 0.40) across communities. Significant variations were observed between and within households, with within-household variation amounting to 59% of the between-household variation. Added sugar intake in Alaska Native children from the three study communities is higher than the recommended maximum, and the variation is greater within households than between households.
Collapse
Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Diane O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Patricia Rivera
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Scarlett Hopkins
- Departments of Medicine and Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Cameron Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| |
Collapse
|
2
|
Rogerson G, Whelan M, Gibson R. A systematic review of measurement methods used to estimate fluid and beverage intake in free-living, working-age adults. J Hum Nutr Diet 2022. [PMID: 36514191 DOI: 10.1111/jhn.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to (1) characterise existing fluid intake measurement tools used in the workplace setting or among free-living, healthy adults of working age and (2) report the current validation status of available assessment tools for use in a UK setting. METHODS Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature and reference lists. Eligibility was determined using predefined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed. RESULTS The review identified 105 studies. The most frequently reported beverage assessment methods were total diet diaries/records (n = 22), fluid specific diaries/records (n = 18), food and fluid frequency questionnaires (n = 17), beverage-specific frequency questionnaires (n = 23) and diet recalls (n = 11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage-specific tool. This review identified 18 distinct dietary assessment tools, of which 6 were fluid/beverage specific. Twelve tools published relative validity for a beverage-related variable and seven tools for total daily fluid intake (from whole diet or from beverages only). CONCLUSIONS Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.
Collapse
Affiliation(s)
- Georgia Rogerson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Megan Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
3
|
Johnson JJ, Sági-Kiss V, Palma-Duran SA, Commins J, Chaloux M, Barrett B, Midthune D, Kipnis V, Freedman LS, Tasevska N, O’Brien DM. Evaluating a Model of Added Sugar Intake Based on Amino Acid Carbon Isotope Ratios in a Controlled Feeding Study of U.S. Adults. Nutrients 2022; 14:4308. [PMID: 36296992 PMCID: PMC9611411 DOI: 10.3390/nu14204308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Previous studies suggest that amino acid carbon stable isotope ratios (CIRAAs) may serve as biomarkers of added sugar (AS) intake, but this has not been tested in a demographically diverse population. We conducted a 15-day feeding study of U.S. adults, recruited across sex, age, and BMI groups. Participants consumed personalized diets that resembled habitual intake, assessed using two consecutive 7-day food records. We measured serum (n = 99) CIRAAs collected at the end of the feeding period and determined correlations with diet. We used forward selection to model AS intake using participant characteristics and 15 CIRAAs. This model was internally validated using bootstrap optimism correction. Median (25th, 75th percentile) AS intake was 65.2 g/day (44.7, 81.4) and 9.5% (7.2%, 12.4%) of energy. The CIR of alanine had the highest, although modest, correlation with AS intake (r = 0.32, p = 0.001). Serum CIRAAs were more highly correlated with animal food intakes, especially the ratio of animal to total protein. The AS model included sex, body weight and 6 CIRAAs. This model had modest explanatory power (multiple R2 = 0.38), and the optimism-corrected R2 was lower (R2 = 0.15). Further investigations in populations with wider ranges of AS intake are warranted.
Collapse
Affiliation(s)
- Jessica J. Johnson
- Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK 99775, USA
| | - Virág Sági-Kiss
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | | | - John Commins
- Information Management Services, Inc., Rockville, MD 20850, USA
| | - Matthew Chaloux
- Information Management Services, Inc., Rockville, MD 20850, USA
| | - Brian Barrett
- Information Management Services, Inc., Rockville, MD 20850, USA
| | - Douglas Midthune
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
| | - Victor Kipnis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
| | - Laurence S. Freedman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Natasha Tasevska
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Diane M. O’Brien
- Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK 99775, USA
| |
Collapse
|
4
|
Hedrick VE, Halliday TM, Davy BM, Zoellner JM, Jahren AH. A Single-Carbon Stable Isotope Ratio Model Prediction Equation Can Estimate Self-Reported Added Sugars Intake in an Adult Population Living in Southwest Virginia. Nutrients 2021; 13:3842. [PMID: 34836098 PMCID: PMC8617603 DOI: 10.3390/nu13113842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The δ13C value of blood is a novel proposed biomarker of added sugars (AS) intake. AS prediction equations using either a single- (δ13C) or dual-isotope model (δ13C and δ15N) were previously developed in an adult population with high AS intake living in southwest Virginia (reference group). The purpose of this investigation was to test the δ13C single- and δ13C and δ15N dual-isotope prediction equations for AS intake in adults with a lower mean AS intake and different demographic characteristics (test group). The blood samples for the reference (n = 257 for single-isotope, n = 115 for dual-isotope) and test groups (n = 56) were analyzed for δ13C and δ15N values using natural abundance stable isotope mass spectrometry and were compared to reported dietary AS intake. When the δ13C single-isotope equation was applied to the test group, predicted AS intake was not significantly different from reported AS intake (mean difference ± standard error = -3.6 ± 5.5 g, Z = -0.55, p = 0.51). When testing the dual-isotope equation, predicted AS was different from reported AS intake (mean difference ± SEM = 13.0 ± 5.4 g, Z = -2.95, p = 0.003). δ13C value was able to predict AS intake using a blood sample within this population subset. The single-isotope prediction equation may be an alternative method to assess AS intake and is more objective, cost-feasible, and efficient than traditional dietary assessment methods. However, more research is needed to assess this biomarker with rigorous study designs such as controlled feeding.
Collapse
Affiliation(s)
- Valisa E. Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Tanya M. Halliday
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84112, USA;
| | - Brenda M. Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Jamie M. Zoellner
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA 24073, USA;
| | - A. Hope Jahren
- Centre for Earth Evolution and Dynamics, University of Oslo, 0371 Oslo, Norway;
| |
Collapse
|
5
|
A Systematic Review of Metabolomic Biomarkers for the Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages. Metabolites 2021; 11:metabo11080546. [PMID: 34436487 PMCID: PMC8401376 DOI: 10.3390/metabo11080546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022] Open
Abstract
Intake of added sugars (AS) is challenging to assess compared with total dietary sugar because of the lack of reliable assessment methods. The reliance on self-reported dietary data in observational studies is often cited as biased, with evidence of AS intake in relation to health outcomes rated as low to moderate quality. Sugar-sweetened beverages (SSBs) are a major source of AS. A regular and high intake of SSBs is associated with an overall poor diet, weight gain, and cardiometabolic risks. An elevated intake of low-calorie sweetened beverages (LCSBs), often regarded as healthier alternatives to SSBs, is also increasingly associated with increased risk for metabolic dysfunction. In this review, we systematically collate evidence and provide perspectives on the use of metabolomics for the discovery of candidate biomarkers associated with the intake of SSBs and LCSBs. We searched the Medline, Embase, Scopus, and Web of Science databases until the end of December 2020. Seventeen articles fulfilled our inclusion criteria. We evaluated specificity and validity of the identified biomarkers following Guidelines for Biomarker of Food Intake Reviews (BFIRev). We report that the 13C:12C carbon isotope ratio (δ13C), particularly, the δ13C of alanine is the most robust, sensitive, and specific biomarker of SSBs intake. Acesulfame-K, saccharin, sucralose, cyclamate, and steviol glucuronide showed moderate validity for predicting the short-term intake of LCSBs. More evidence is required to evaluate the validity of other panels of metabolites associated with the intake of SSBs.
Collapse
|
6
|
Te Morenga L, Kruimer D, McLean R, Sabadel AJM, van Hale R, Tatin X, Hindmarsh JH, Mann J, Merriman T. Associations Between Sugars Intakes and Urinary Sugars Excretion and Carbon Stable Isotope Ratios in Red Blood Cells as Biomarkers of Sugars Intake in a Predominantly Māori Population. Front Nutr 2021; 8:637267. [PMID: 34277677 PMCID: PMC8278019 DOI: 10.3389/fnut.2021.637267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
Determining the extent to which added sugars intake contribute to non-communicable disease in various populations is challenging because it is difficult to accurately measure intakes. Biomarkers may provide a reliable and easily measured method of assessing intakes. In a predominantly Māori population we compared various sugars intake estimates derived from a 36 item sugar-specific food frequency questionnaire (FFQ) with biomarkers of sugars intake; urinary sugars excretion in random spot collections (n = 153) and carbon stable isotope ratios (n = 36) in red blood cells (RBCs, δ13CRBC) and in the alanine fraction of the RBCs (δ13Calanine). Estimated 24 h urinary sucrose+fructose excretion was statistically significantly correlated with intakes of total sugars (r = 0.23), sucrose (r = 0.26) and added sugars from sugar-sweetened beverages (SSBs; r = 0.26). δ13Calanine was correlated with added sugars (r = 0.40). In log linear multiple regression models adjusted with HbA1C and eGFR δ13Calanine predicted added sugars intakes (r 2 = 0.29) and estimated 24 h urinary sucrose+fructose excretion predicted intakes of total sugars (r 2 = 0.14), sucrose (r 2 = 0.17), added sugars (r 2 = 0.17) and sugars from SSBs (r 2 = 0.14). These biomarkers have potential for improving assessment of sugars intake in New Zealand populations enabling monitoring of the effectiveness of sugar reduction strategies designed to reduce risk of NCDs. However, further validation is required to confirm these preliminary findings.
Collapse
Affiliation(s)
- Lisa Te Morenga
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand.,Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand
| | - Devonia Kruimer
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand
| | - Rachael McLean
- Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Robert van Hale
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | | | | | - Jim Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand.,Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Tony Merriman
- Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Biochemistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
7
|
Johnson JJ, Shaw PA, Oh EJ, Wooller MJ, Merriman S, Yun HY, Larsen T, Krakoff J, Votruba SB, O'Brien DM. The carbon isotope ratios of nonessential amino acids identify sugar-sweetened beverage (SSB) consumers in a 12-wk inpatient feeding study of 32 men with varying SSB and meat exposures. Am J Clin Nutr 2021; 113:1256-1264. [PMID: 33676366 PMCID: PMC8106756 DOI: 10.1093/ajcn/nqaa374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The carbon isotope ratios (CIRs) of individual amino acids (AAs) may provide more sensitive and specific biomarkers of sugar-sweetened beverages (SSBs) than total tissue CIR. Because CIRs turn over slowly, long-term controlled-feeding studies are needed in their evaluation. OBJECTIVE We assessed the responses of plasma and RBC CIRAA's to SSB and meat intake in a 12-wk inpatient feeding study. METHODS Thirty-two men (aged 46.2 ± 10.5 y) completed the feeding study at the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona. The effects of SSB, meat, and fish intake on plasma and RBC CIRAA's were evaluated in a balanced factorial design with each dietary variable either present or absent in a common weight-maintaining, macronutrient-balanced diet. Fasting blood samples were collected biweekly from baseline. Dietary effects on the postfeeding CIR of 5 nonessential AAs (CIRNEAA's) and 4 essential AAs (CIREAA's) were analyzed using multivariable regression. RESULTS In plasma, 4 of 5 CIRNEAA's increased with SSB intake. Of these, the CIRAla was the most sensitive (β = 2.81, SE = 0.38) to SSB intake and was not affected by meat or fish intake. In RBCs, all 5 CIRNEAA's increased with SSBs but had smaller effect sizes than in plasma. All plasma CIREAA's increased with meat intake (but not SSB or fish intake), and the CIRLeu was the most sensitive (β = 1.26, SE = 0.23). CIRs of leucine and valine also increased with meat intake in RBCs. Estimates of turnover suggest that CIRAA's in plasma, but not RBCs, were in equilibrium with the diets by the end of the study. CONCLUSIONS The results of this study in men support CIRNEAA's as potential biomarkers of SSB intake and suggest CIREAA's as potential biomarkers of meat intake in US diets. This trial was registered at clinicaltrials.gov/ct2/show/NCT01237093 as NCT01237093.
Collapse
Affiliation(s)
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Eric J Oh
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew J Wooller
- Alaska Stable Isotope Facility, Water and Environmental Research Center, Institute of Northern Engineering, University of Alaska Fairbanks, Fairbanks, AK, USA,Department of Marine Biology, College of Fisheries and Ocean Sciences, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Sean Merriman
- Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Hee Young Yun
- Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Thomas Larsen
- Department of Archaeology, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Jonathan Krakoff
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA
| | - Susanne B Votruba
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA
| | - Diane M O'Brien
- Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| |
Collapse
|
8
|
Yazbeck R, Howarth GS, Kosek M, Davidson GP, Butler RN. Breath 13CO 2-evidence for a noninvasive biomarker to measure added refined sugar uptake. J Appl Physiol (1985) 2021; 130:1025-1032. [PMID: 33444124 DOI: 10.1152/japplphysiol.00648.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Increased consumption of added sucrose and high-fructose corn syrup in the human diet has been associated with increasing incidence of obesity and metabolic disease. There are currently no reliable, objective biomarkers for added sugar intake that could be used in individuals or population settings. 13C is a stable isotope of carbon, and measurement of blood 13C content has been proposed as a marker of added sugar consumption. This study aimed to determine if breath 13CO2 could represent an alternative, noninvasive biomarker to monitor added sugar intake. We undertook retrospective analyses of eight preclinical and human 13C-breath studies to define baseline breath 13CO2 characteristics. All samples were analyzed using isotope ratio mass spectrometry, and breath 13CO2 was expressed as the delta value, δ expressed as parts per thousand (‰). All data are expressed as mean ± SEM, with statistical significance considered at P < 0.05. Breath δ13CO2 was significantly elevated in a cumulative manner in rats and mice that consumed a diet containing at least 15% sucrose. Mice fed an American rodent chow diet containing 50% sucrose and 15% corn starch had a significantly higher breath δ13CO2 compared with rodents consuming an Australian rodent chow diet. Furthermore, breath δ13CO2 was significantly increased in a dose-dependent manner in humans that ingested a bolus dose of sucrose. These findings suggest application for baseline breath δ13CO2 as a noninvasive biomarker for added sugar consumption, with broad application for longitudinal assessment of population sugar intake and obesity management strategies.NEW & NOTEWORTHY We have found that breath 13CO2 is increased in rats and mice consuming diets high in sucrose. We also found that human breath 13CO2 is increased in humans consuming increasing amounts of sucrose. Our collective findings suggest that breath 13CO2 represents a potential marker of added dietary sugar consumption.
Collapse
Affiliation(s)
- Roger Yazbeck
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Gordon S Howarth
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, South Australia
| | - Margaret Kosek
- Centre for Paediatric and Adolescent Gastroenterology, Children, Youth and Women's Health Service, North Adelaide, South Australia
| | - Geoffrey P Davidson
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Ross N Butler
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia
| |
Collapse
|
9
|
Lacombe RJS, Bazinet RP. Natural abundance carbon isotope ratio analysis and its application in the study of diet and metabolism. Nutr Rev 2020; 79:869-888. [PMID: 33141222 DOI: 10.1093/nutrit/nuaa109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Due to differences in carbon assimilation pathways between plants, there are subtle but distinct variations in the carbon isotope ratios of foods and animal products throughout the food supply. Although it is well understood that the carbon isotope ratio composition of the diet influences that of the consumers' tissues, the application of natural abundance carbon isotope ratio analysis in nutrition has long been underappreciated. Over the past decade, however, several studies have investigated the utility of carbon isotope ratio analysis for evaluation of nutritional biomarker status, primarily focusing on its application as an objective indicator of sugar and animal protein intake. More recently, research investigating the application of natural abundance measurements has been extended to study fatty acid metabolism and has yielded encouraging results. Collectively, data from large-scale observational studies and experimental animal studies highlight the potential for carbon isotope ratio analysis as an additional and effective tool to study diet and metabolism. The purpose of this review is to provide an overview of natural abundance carbon isotope ratio analysis, its application to studying nutrition, and an update of the research in the field.
Collapse
Affiliation(s)
- R J Scott Lacombe
- Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Richard P Bazinet
- Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
10
|
Louie JCY. Objective Biomarkers for Total Added Sugar Intake - Are We on a Wild Goose Chase? Adv Nutr 2020; 11:1429-1436. [PMID: 32805008 PMCID: PMC7666891 DOI: 10.1093/advances/nmaa093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Misreporting of added sugar intake has been the major criticism of studies linking high added sugar consumption to adverse health outcomes. Despite the advancement in dietary assessment methodologies, the bias introduced by self-reporting can never be completely eliminated. The search for an objective biomarker for total added sugar intake has therefore been a topic of interest. In this article, the reasons this search may be a wild goose chase will be outlined and discussed. The limitations and inability of the 2 candidate biomarkers, namely urinary sucrose and fructose and δ¹³C isotope, which are based on the 2 only possible ways (i.e., difference in metabolism and plant sources) to identify added sugar based on current knowledge in human physiology and food and nutritional sciences, are discussed in detail. Validation studies have shown that these 2 candidate biomarkers are unlikely to be suitable for use as a predictive or calibration biomarker for total added sugar intake. Unless advancement in our understanding in human physiology and food and nutritional sciences leads to new potential ways to distinguish between naturally occurring and added sugars, it is extremely unlikely that any accurate objective added sugar biomarker could be found. It may be time to stop the futile effort in searching for such a biomarker, and resources may be better spent on further improving and innovating dietary assessment methods to minimize the bias introduced by self-reporting.
Collapse
|
11
|
Henze MM, Bemis EA, Seifert JA, Johnson RK, Dong F, Rewers M, Norris JM. Association between change in self-reported sugar intake and a sugar biomarker (δ 13C) in children at increased risk for type 1 diabetes. J Nutr Sci 2020; 9:e16. [PMID: 32477498 PMCID: PMC7232120 DOI: 10.1017/jns.2020.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 01/16/2023] Open
Abstract
We examined whether change in added sugar intake is associated with change in δ13C, a novel sugar biomarker, in thirty-nine children aged 5-10 years selected from a Colorado (USA) prospective cohort of children at increased risk for type 1 diabetes. Reported added sugar intake via FFQ and δ13C in erythrocytes were measured at two time points a median of 2 years apart. Change in added sugar intake was associated with change in the δ13C biomarker, where for every 1-g increase in added sugar intake between the two time points, there was an increase in δ13C of 0⋅0082 (P = 0⋅0053), independent of change in HbA1c and δ15N. The δ13C biomarker may be used as a measure of compliance in an intervention study of children under the age of 10 years who are at increased risk for type 1 diabetes, in which the goal was to reduce dietary sugar intake.
Collapse
Affiliation(s)
- Martha M. Henze
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth A. Bemis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer A. Seifert
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Randi K. Johnson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fran Dong
- Department of Pediatrics, The Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marian Rewers
- Department of Pediatrics, The Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
12
|
Votruba SB, Shaw PA, Oh EJ, Venti CA, Bonfiglio S, Krakoff J, O'Brien DM. Associations of plasma, RBCs, and hair carbon and nitrogen isotope ratios with fish, meat, and sugar-sweetened beverage intake in a 12-wk inpatient feeding study. Am J Clin Nutr 2019; 110:1306-1315. [PMID: 31515553 PMCID: PMC6885477 DOI: 10.1093/ajcn/nqz208] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Naturally occurring carbon and nitrogen stable isotope ratios [13C/12C (CIR) and 15N/14N (NIR)] are promising dietary biomarkers. As these candidate biomarkers have long tissue residence times, long-term feeding studies are needed for their evaluation. OBJECTIVE Our aim was to evaluate plasma, RBCs, and hair CIR and NIR as biomarkers of fish, meat, and sugar-sweetened beverage (SSB) intake in a 12-wk dietary intervention. METHODS Thirty-two men (aged 46.2 ± 10.5 y; BMI: 27.2 ± 4.0 kg/m2) underwent a 12-wk inpatient dietary intervention at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in Phoenix, Arizona. The effects of fish, meat, and SSB intake on CIR and NIR were evaluated using a balanced factorial design, with each intake factor at 2 levels (present/absent) in a common, background diet (50% carbohydrate, 30% fat, 20% protein). Fasting blood samples were taken biweekly from baseline, and hair samples were collected at baseline and postintervention. Data were analyzed using multivariable regression. RESULTS The postintervention CIR of plasma was elevated when diets included meat (β = 0.89, 95% CI: 0.73,1.05) and SSBs (β = 0.48, 95% CI: 0.32, 0.64). The postintervention NIR of plasma was elevated when diets included fish (β = 0.85, 95% CI: 0.64, 1.05) and meat (β = 0.61, 95% CI: 0.42, 0.8). Results were similar for RBCs and hair. Postintervention RBC CIR and NIR had strong associations with baseline, suggesting that turnover to the intervention diets was incomplete after 12 wk. Estimates of isotopic turnover rate further confirmed incomplete turnover of RBCs. CONCLUSIONS CIR was associated with meat and SSBs, and more strongly with meat. NIR was associated with fish and meat, and more strongly with fish. Overall, CIR and NIR discriminated between dietary fish and meat, and to a lesser extent SSBs, indicating their potential utility as biomarkers of intake in US diets. Approaches to make these biomarkers more specific are needed. This trial was registered at clinicaltrials.gov as NCT01237093.
Collapse
Affiliation(s)
- Susanne B Votruba
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA,Address correspondence to SBV (e-mail: )
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric J Oh
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen A Venti
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA
| | - Susan Bonfiglio
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA
| | - Jonathan Krakoff
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases/NIH, Phoenix, AZ, USA
| | - Diane M O'Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| |
Collapse
|
13
|
Trends in sugary drinks in Canada, 2004 to 2015: a comparison of market sales and dietary intake data. Public Health Nutr 2019; 22:2723-2728. [PMID: 31270002 DOI: 10.1017/s1368980019001654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to examine the correspondence between sales data and dietary recall data for sugary drinks in Canada. DESIGN Repeat cross-sectional analysis of sales data for sugary drinks sold in Canada from 2004 to 2015 from two sources: GlobalData (GD) and Euromonitor (EM). Sugary drinks included ten beverage categories containing free sugars. Analyses examined sales volumes over time, with adjustment for population growth. National intake estimates were drawn from the 2004 and 2015 Canadian Community Health Survey (CCHS) Nutrition. SETTING Canada. PARTICIPANTS Not applicable. RESULTS In 2015, daily per capita sugary drinks consumption was estimated as 356 ml (GD) and 443 ml (EM) from sales data sources, and as 277 ml from dietary recall data. Both sales data sources and dietary recall data indicated that per capita sugary drinks consumption decreased from 2004 to 2015, although the magnitude of this change differed: -23 % (GD), -17 % (EM) and -32 % (CCHS Nutrition). Market sales data showed similar trends among categories of sugary drinks, with decreases in sales of traditional beverage categories (e.g. carbonated soft drinks) and increases in novel categories (e.g. sugar-sweetened coffee). CONCLUSIONS All data sources indicate a declining trend in sugary drinks consumption between 2004 and 2015, but with considerable differences in magnitude. Consumption estimates from sales data were substantially higher than estimates from dietary recall data, likely due to under-reporting of beverage intake through dietary recall and the inability of sales data to account for beverages sold but not consumed. Despite the observed decline, sugary drinks sales volumes remain high in Canada.
Collapse
|
14
|
Kuhnle GGC. Stable Isotope Ratios: Nutritional Biomarker and More. J Nutr 2018; 148:1883-1885. [PMID: 30517730 DOI: 10.1093/jn/nxy247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Gunter G C Kuhnle
- Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| |
Collapse
|
15
|
Liu SV, Moore LB, Halliday TM, Jahren AH, Savla J, Hedrick VE, Marinik EL, Davy BM. Short-term changes in added sugar consumption by adolescents reflected in the carbon isotope ratio of fingerstick blood. Nutr Health 2018; 24:251-259. [PMID: 30231801 PMCID: PMC9817487 DOI: 10.1177/0260106018799522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Consumption of added sugars (AS) and sugar-sweetened beverages (SSB) may adversely affect adolescents' weight and cardiovascular disease risk. Reliance on self-reported dietary assessment methods is a common research limitation, which could be overcome by dietary intake biomarkers. AIM The investigation was a proof-of-concept study to evaluate the proposed carbon isotope ratio (δ13C) biomarker of AS intake in adolescents, using a controlled feeding design. METHODS Participants (n = 33, age 15.3 years, 53% female) underwent two seven-day controlled feeding periods in a randomly assigned order. Diets were matched in composition except for AS content (5% or 25% of total energy). Fasting fingerstick blood samples were collected daily during each diet period. RESULTS Fingerstick δ13C values changed from day 1 to 8 by -0.05 ± 0.071‰ on 5% AS, and +0.03 ± 0.083‰ on 25% AS (p ≤ 0.001). Reliability was demonstrated between day 7 and 8 δ13C values on the 5% (ICC = 0.996, p ≤ 0.001) and 25% (ICC = 0.997, p ≤ 0.001) AS diets. CONCLUSIONS Larger scale investigations are warranted to determine if this technique could be applied to population-level research in order to help assess the effectiveness of interventions aimed at reducing the consumption of AS or SSB intake.
Collapse
Affiliation(s)
- Sarah V Liu
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| | - Lori B Moore
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| | - Tanya M Halliday
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| | - A Hope Jahren
- Centre for Earth Evolution and Dynamics, University of Oslo, Norway
| | - Jyoti Savla
- Department of Human Development and Center for Gerontology, Virginia Tech, Blacksburg, USA
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| | - Elaina L Marinik
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, USA
| |
Collapse
|
16
|
Yun HY, Lampe JW, Tinker LF, Neuhouser ML, Beresford SAA, Niles KR, Mossavar-Rahmani Y, Snetselaar LG, Van Horn L, Prentice RL, O'Brien DM. Serum Nitrogen and Carbon Stable Isotope Ratios Meet Biomarker Criteria for Fish and Animal Protein Intake in a Controlled Feeding Study of a Women's Health Initiative Cohort. J Nutr 2018; 148:1931-1937. [PMID: 30239866 PMCID: PMC6280000 DOI: 10.1093/jn/nxy168] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Natural abundance stable isotope ratios are candidate biomarkers of dietary intake that have not been evaluated in a controlled feeding study in a US population. Objectives Our goals were to evaluate dietary associations with serum carbon (CIR), nitrogen (NIR), and sulfur (SIR) isotope ratios in postmenopausal women, and to evaluate whether statistical models of dietary intake that include multiple isotopes and participant characteristics meet criteria for biomarker evaluation. Methods Postmenopausal women from the Women's Health Initiative (n = 153) were provided a 2-wk controlled diet that approximated each individual's habitual food intake. Dietary intakes of animal protein, fish/seafood, red meat, poultry, egg, dairy, total sugars, added sugars, sugar-sweetened beverages (SSBs), and corn products were characterized during the feeding period with the use of the Nutrition Data System for Research (NDS-R). The CIR, NIR, and SIR were measured in sera collected from fasting women at the beginning and the end of the feeding period. Linear models based on stable isotope ratios and participant characteristics predicted dietary intake. The criterion used for biomarker evaluation was R2 ≥ 0.36, based on the study's power to detect true associations with R2 ≥ 0.50. Results The NIR was associated with fish/seafood intake and met the criterion for biomarker evaluation (R2 = 0.40). The CIR was moderately associated with intakes of red meat and eggs, but not to the criterion for biomarker evaluation, and was not associated with intake of sugars (total, added, or SSB). A model of animal protein intake based on the NIR, CIR, and participant characteristics met the criterion for biomarker evaluation (R2 = 0.40). Otherwise, multiple isotopes did not improve models of intake, and improvements from including participant characteristics were modest. Conclusion Serum stable isotope ratios can, with participant characteristics, meet biomarker criteria as measures of fish/seafood and animal protein intake in a sample of postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00000611.
Collapse
Affiliation(s)
- Hee Young Yun
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Shirley A A Beresford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Kristine R Niles
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Diane M O'Brien
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK
| |
Collapse
|
17
|
Rothwell JA, Madrid-Gambin F, Garcia-Aloy M, Andres-Lacueva C, Logue C, Gallagher AM, Mack C, Kulling SE, Gao Q, Praticò G, Dragsted LO, Scalbert A. Biomarkers of intake for coffee, tea, and sweetened beverages. GENES & NUTRITION 2018; 13:15. [PMID: 29997698 PMCID: PMC6030755 DOI: 10.1186/s12263-018-0607-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/08/2018] [Indexed: 01/03/2023]
Abstract
Non-alcoholic beverages are important sources of nutrients and bioactive compounds that may influence human health and increase or decrease the risk of chronic diseases. A wide variety of beverage constituents are absorbed in the gut, found in the systemic circulation and excreted in urine. They may be used as compliance markers in intervention studies or as biomarkers of intake to improve measurements of beverage consumption in cohort studies and reveal new associations with disease outcomes that may have been overlooked when using dietary questionnaires. Here, biomarkers of intake of some major non-alcoholic beverages-coffee, tea, sugar-sweetened beverages, and low-calorie-sweetened beverages-are reviewed. Results from dietary intervention studies and observational studies are reviewed and analyzed, and respective strengths and weaknesses of the various identified biomarkers discussed. A variety of compounds derived from phenolic acids, alkaloids, and terpenes were shown to be associated with coffee intake and trigonelline and cyclo(isoleucylprolyl) showed a particularly high specificity for coffee intake. Epigallocatechin and 4'-O-methylepigallocatechin appear to be the most sensitive and specific biomarkers for green or black tea, while 4-O-methylgallic acid may be used to assess black tea consumption. Intake of sugar-sweetened beverages has been assessed through the measurement of carbon-13 enrichment of whole blood or of blood alanine in North America where sugar from sugarcane or corn is used as a main ingredient. The most useful biomarkers for low-calorie-sweetened beverages are the low-calorie sweeteners themselves. Further studies are needed to validate these biomarkers in larger and independent populations and to further evaluate their specificity, reproducibility over time, and fields of application.
Collapse
Affiliation(s)
- Joseph A. Rothwell
- International Agency for Research on Cancer (IARC), Nutrition and Metabolism Section, Biomarkers Group, 150 Cours Albert Thomas, F-69372 Lyon CEDEX 08, France
| | - Francisco Madrid-Gambin
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Campus Torribera, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Mar Garcia-Aloy
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Campus Torribera, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Cristina Andres-Lacueva
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Campus Torribera, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Caomhan Logue
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, Northern Ireland
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, Northern Ireland
| | - Carina Mack
- Department of Safety and Quality of Fruit and Vegetables, Federal Research Institute of Nutrition and Food, Max Rubner-Institut, Karlsruhe, Germany
| | - Sabine E. Kulling
- Department of Safety and Quality of Fruit and Vegetables, Federal Research Institute of Nutrition and Food, Max Rubner-Institut, Karlsruhe, Germany
| | - Qian Gao
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Giulia Praticò
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars O. Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Augustin Scalbert
- International Agency for Research on Cancer (IARC), Nutrition and Metabolism Section, Biomarkers Group, 150 Cours Albert Thomas, F-69372 Lyon CEDEX 08, France
| |
Collapse
|
18
|
Neme J, Nirmalraj M, Matthews H, Geske J, Khandalavala B. Sugar-Sweetened Beverage Intake Assessment in a Family Medicine Residency Clinic. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2018; 2:8. [PMID: 32818182 DOI: 10.22454/primer.2018.891960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction Sugar-sweetened beverages (SSBs) are a major source of added calories in the American diet, with significant adverse health outcomes. However, intake of SSBs is not commonly assessed in the clinical setting. In some populations with health disparities there is a higher consumption of caloric beverages, contributing to increased cardiometabolic risk. Family medicine residency clinics often provide services for the underserved population, and may encounter additional barriers in nutritional assessment. Methods Our study, conducted at a residency clinic in Omaha, Nebraska, utilized the abbreviated Beverage Intake Questionnaire 15 (BEVQ-15). We surveyed 310 patients over a 3-month period. Results Consumption of SSBs in our sample was significantly higher than that of the nonclinic population of Nebraska (P<0.001). Fifty-six percent of resident clinic respondents reportedly consumed at least one SSB daily, resulting in an average intake of 244 kilocalories. Intake was significantly higher in males, younger patients, those with lower socioeconomic status, and Latinos. While the majority of the study population was obese, there was no direct correlation between weight and SSB intake. The survey required less than 3 minutes to complete. Future interventions may focus on reduction of SSB intake and promotion of water consumption. Conclusions Assessment of SSB intake in a family medicine residency clinic can be easily conducted, providing opportunities for clinical providers to suggest patient-specific modifiable behaviors. As the obesity epidemic continues to progress, point-of-care intervention to reduce SSB consumption may help reduce cardiometabolic risk and improve health outcomes.
Collapse
Affiliation(s)
- Jamil Neme
- Department of Primary Care Sports Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, PA
| | - Maya Nirmalraj
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Haley Matthews
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jenenne Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Birgit Khandalavala
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
19
|
MacDougall CR, Hill CE, Jahren AH, Savla J, Riebl SK, Hedrick VE, Raynor HA, Dunsmore JC, Frisard MI, Davy BM. The δ13C Value of Fingerstick Blood Is a Valid, Reliable, and Sensitive Biomarker of Sugar-Sweetened Beverage Intake in Children and Adolescents. J Nutr 2018; 148:147-152. [PMID: 29378049 PMCID: PMC6251656 DOI: 10.1093/jn/nxx017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022] Open
Abstract
Background Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults. Objective The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents. Methods Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity. Results Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively). Conclusions The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388.
Collapse
Affiliation(s)
- Carly R MacDougall
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Catelyn E Hill
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | | | - Jyoti Savla
- Department of Human Development, Virginia Tech, Blacksburg, VA
| | - Shaun K Riebl
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee at Knoxville, Knoxville, TN
| | | | - Madlyn I Frisard
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| |
Collapse
|
20
|
Smith AD, Fildes A, Forwood S, Cooke L, Llewellyn C. The individual environment, not the family is the most important influence on preferences for common non-alcoholic beverages in adolescence. Sci Rep 2017; 7:16822. [PMID: 29203875 PMCID: PMC5715117 DOI: 10.1038/s41598-017-17020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/13/2017] [Indexed: 11/09/2022] Open
Abstract
Beverage preferences are an important driver of consumption, and strong liking for beverages high in energy (e.g. sugar-sweetened beverages [SSBs]) and dislike for beverages low in energy (e.g. non-nutritive sweetened beverages [NNSBs]) are potentially modifiable risk factors contributing to variation in intake. Twin studies have established that both genes and environment play important roles in shaping food preferences; but the aetiology of variation in non-alcoholic beverage preferences is unknown. 2865 adolescent twins (18-19-years old) from the Twins Early Development Study were used to quantify genetic and environmental influence on variation in liking for seven non-alcoholic beverages: SSBs; NNSBs; fruit cordials, orange juice, milk, coffee, and tea. Maximum Likelihood Structural Equation Modelling established that beverage preferences have a moderate to low genetic basis; from 18% (95% CI: 10%, 25%) for orange juice to 42% (36%, 43%) for fruit cordials. Aspects of the environment that are not shared by twin pairs explained all remaining variance in drink preferences. The sizeable unique environmental influence on beverage preferences highlights the potential for environmental modification. Policies and guidelines to change preferences for unhealthy beverages may therefore be best directed at the wider environment.
Collapse
Affiliation(s)
- Andrea D Smith
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Alison Fildes
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Suzanna Forwood
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lucy Cooke
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Great Ormond Street Hospital, Children NHS Foundation Trust, London, United Kingdom
| | - Clare Llewellyn
- Department of Behavioural Science and Health, University College London, London, United Kingdom.
| |
Collapse
|
21
|
Rollo ME, Williams RL, Burrows T, Kirkpatrick SI, Bucher T, Collins CE. What Are They Really Eating? A Review on New Approaches to Dietary Intake Assessment and Validation. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0182-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
22
|
Influence of an intervention targeting a reduction in sugary beverage intake on the δ13C sugar intake biomarker in a predominantly obese, health-disparate sample. Public Health Nutr 2016; 20:25-29. [PMID: 27297740 DOI: 10.1017/s1368980016001439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Controversy exists surrounding the health effects of added sugar (AS) and sugar-sweetened beverage (SSB) intakes, primarily due to a reliance on self-reported dietary intake. The purpose of the current investigation was to determine if a 6-month intervention targeting reduced SSB intake would impact δ13C AS intake biomarker values. DESIGN A randomized controlled intervention trial. At baseline and at 6 months, participants underwent assessments of anthropometrics and dietary intake. Fasting fingerstick blood samples were obtained and analysed for δ13C value using natural abundance stable isotope MS. Statistical analysis included descriptive statistics, correlational analyses and multilevel mixed-effects linear regression analysis using an intention-to-treat approach. SETTING Rural Southwest Virginia, USA. SUBJECTS Adults aged ≥18 years who consumed ≥200 kcal SSB/d (≥837 kJ/d) were randomly assigned to either the intervention (n 155) or a matched-contact group (n 146). Participants (mean age 42·1 (sd 13·4) years) were primarily female and overweight (21·5 %) or obese (57·0 %). RESULTS A significant group by time difference in δ13C value was detected (P<0·001), with mean (sd) δ13C value decreasing in the intervention group (pre: -18·92 (0·65) ‰, post: -18·97 (0·65) ‰) and no change in the comparison group (pre: -18·94 (0·72) ‰, post: -18·92 (0·73) ‰). Significant group differences in weight and BMI change were also detected. Changes in biomarker δ13C values were consistent with changes in self-reported AS and SSB intakes. CONCLUSIONS The δ13C sugar intake biomarker assessed using fingerstick blood samples shows promise as an objective indicator of AS and SSB intakes which could be feasibly included in community-based research trials.
Collapse
|
23
|
Chi DL, Hopkins S, O'Brien D, Mancl L, Orr E, Lenaker D. Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker. BMC Oral Health 2015; 15:121. [PMID: 26452647 PMCID: PMC4600323 DOI: 10.1186/s12903-015-0101-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup'ik children ages 6-17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay. METHODS A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces. RESULTS The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay. CONCLUSIONS Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup'ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Scarlett Hopkins
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Diane O'Brien
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Eliza Orr
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Dane Lenaker
- Yukon Kuskokwim Health Corporation, Dentistry Department, Bethel, AK, USA.
| |
Collapse
|
24
|
Liu ZM, Wong CKM, Wong SYS, Leung J, Tse LA, Chan R, Woo J. A Healthier Lifestyle Pattern for Cardiovascular Risk Reduction Is Associated With Better Bone Mass in Southern Chinese Elderly Men and Women. Medicine (Baltimore) 2015; 94:e1283. [PMID: 26252299 PMCID: PMC4616577 DOI: 10.1097/md.0000000000001283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/02/2015] [Accepted: 07/08/2015] [Indexed: 01/03/2023] Open
Abstract
Lifestyle factors have been linked to bone health, however little is known about their combined impact on bone. Cardiovascular disease (CVD) and osteoporosis are 2 major public health problems that share some common pathophysiology. We aimed to assess whether higher adherence to American Heart Association diet and lifestyle recommendations (AHA-DLR) was associated with better bone health in Chinese elderly.This was a cross-sectional study using data from the largest population-based study on osteoporosis in Asia (Mr and Ms Os, Hong Kong). The study recruited 4000 independent walking Chinese men and women aged ≥65 year. Information on demographic, health, and lifestyle factors was obtained by standardized questionnaires. An overall lifestyle score was estimated based on a modified adherence index of AHA-DLR. Bone mineral measurements of the whole body, total hip, lumbar spine, and femoral neck were made by dual-energy X-ray absorptiometry.Most lifestyle factors alone were not significantly associated bone mass. Overall lifestyle score in the highest quartile compared with the lowest quartile had significantly better bone mass at all sites in a dose-response manner. Every 10-unit of lifestyle score increase was associated with 0.005, 0.004, and 0.007 g/cm increases of bone mineral density (BMD) at whole body, femur neck, and total hip, respectively (all P < 0.05), and 13.2% (odds ratio 0.868; 95% CI 0.784, 0.961) decreased risk of osteoporosis at total hip after adjustment for potential covariates.Our study suggested that greater adherence to an overall healthy lifestyle for CVD risk reduction was associated with better bone mass among Chinese elderly.
Collapse
Affiliation(s)
- Zhao-Min Liu
- From the Division of Family Medicine and Primary Care (ZmL, CKMW, SYsW); Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care (LAT); Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin (JL); and Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR (RC, JW)
| | | | | | | | | | | | | |
Collapse
|
25
|
Hedrick VE, Zoellner JM, Jahren AH, Woodford NA, Bostic JN, Davy BM. A Dual-Carbon-and-Nitrogen Stable Isotope Ratio Model Is Not Superior to a Single-Carbon Stable Isotope Ratio Model for Predicting Added Sugar Intake in Southwest Virginian Adults. J Nutr 2015; 145:1362-9. [PMID: 25855120 PMCID: PMC4442118 DOI: 10.3945/jn.115.211011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/13/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND An objective measure of added sugar (AS) and sugar-sweetened beverage (SSB) intake is needed. The δ(13)C value of finger-stick blood is a novel validated biomarker of AS/SSB intake; however, nonsweetener corn products and animal protein also carry a δ(13)C value similar to AS sources, which may affect blood δ(13)C values. The δ(15)N value of blood has been proposed as a "correction factor" for animal protein intake. OBJECTIVES The objectives were to 1) identify foods associated with δ(13)C and δ(15)N blood values, 2) determine the contribution of nonsweetener corn to the diet relative to AS intake, and 3) determine if the dual-isotope model (δ(13)C and δ(15)N) is a better predictor of AS/SSB intake than δ(13)C alone. METHODS A cross-sectional sample of southwest Virginian adults (n = 257; aged 42 ± 15 y; 74% overweight/obese) underwent dietary intake assessments and provided finger-stick blood samples, which were analyzed for δ(13)C and δ(15)N values by using natural abundance stable isotope mass spectrometry. Statistical analyses included ANOVAs, paired-samples t tests, and multiple linear regressions. RESULTS The mean ± SD daily AS intake was 88 ± 59 g and nonsweetener corn intake was 13 ± 13 g. The mean δ(13)C value was -19.1 ± 0.9‰, which was significantly correlated with AS and SSB intakes (r = 0.32 and 0.39, respectively; P ≤ 0.01). The δ(13)C value and nonsweetener corn intake and the δ(15)N value and animal protein intake were not correlated. AS intake was significantly greater than nonsweetener corn intake (mean difference = 76.2 ± 57.2 g; P ≤ 0.001). The δ(13)C value was predictive of AS/SSB intake (β range: 0.28-0.35; P ≤ 0.01); however, δ(15)N was not predictive and minimal increases in R(2) values were observed when the δ(15)N value was added to the model. CONCLUSIONS The data do not provide evidence that the dual-isotope method is superior for predicting AS/SSB intakes within a southwest Virginian population. Our results support the potential of the δ(13)C value of finger-stick blood to serve as an objective measure of AS/SSB intake. This trial was registered at clinicaltrials.gov as NCT02193009.
Collapse
Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA; and
| | - Jamie M Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA; and
| | - A Hope Jahren
- School of Earth and Ocean Science and Technology, University of Hawaii at Manoa, Honolulu, HI
| | - Natalie A Woodford
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA; and
| | - Joshua N Bostic
- School of Earth and Ocean Science and Technology, University of Hawaii at Manoa, Honolulu, HI
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA; and
| |
Collapse
|
26
|
Bostic JN, Palafox SJ, Rottmueller ME, Jahren AH. Effect of baking and fermentation on the stable carbon and nitrogen isotope ratios of grain-based food. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2015; 29:937-947. [PMID: 26407308 DOI: 10.1002/rcm.7178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/17/2015] [Accepted: 02/21/2015] [Indexed: 06/05/2023]
Abstract
RATIONALE Isotope ratio mass spectrometry (IRMS) is used extensively to reconstruct general attributes of prehistoric and modern diets in both humans and animals. In order to apply these methods to the accurate determination of specific intakes of foods/nutrients of interest, the isotopic signature of individually consumed foods must be constrained. For example, 86% of the calories consumed in the USA are derived from processed and prepared foods, but the relationship between the stable isotope composition of raw ingredients and the resulting products has not been characterized. METHODS To examine the effect of common cooking techniques on the stable isotope composition of grain-based food items, we prepared yeast buns and sugar cookies from standardized recipes and measured bulk δ(13) C and δ(15) N values of samples collected throughout a 75 min fermentation process (buns) and before and after baking at 190°C (buns and cookies). Simple isotope mixing models were used to determine if the isotopic signatures of 13 multi-ingredient foods could be estimated from the isotopic signatures of their constituent raw ingredients. RESULTS No variations in δ(13) C or δ(15) N values were detected between pre- and post-baked yeast buns (pre: -24.78‰/2.61‰, post: -24.75‰/2.74‰), beet-sugar cookies (pre: -24.48‰/3.84‰, post: -24.47‰/3.57‰), and cane-sugar cookies (pre: -19.07‰/2.97‰, post: -19.02‰/3.21‰), or throughout a 75 min fermentation process in yeast buns. Using isotopic mass balance equations, the δ(13) C/δ(15) N values of multi-ingredient foods were estimated from the isotopic composition of constituent raw ingredients to within 0.14 ± 0.13‰/0.24 ± 0.17‰ for gravimetrically measured recipes and 0.40 ± 0.38‰/0.58 ± 0.53‰ for volumetrically measured recipes. CONCLUSIONS Two common food preparation techniques, baking and fermentation, do not substantially affect the carbon or nitrogen isotopic signature of grain-based foods. Mass-balance equations can be used to accurately estimate the isotopic signature of multi-ingredient food items for which quantitative ingredient information is available.
Collapse
Affiliation(s)
- Joshua N Bostic
- Department of Geology and Geophysics, University of Hawaii at Manoa, Honolulu, HI, 96822, USA
| | - Sherilyn J Palafox
- Department of Geology and Geophysics, University of Hawaii at Manoa, Honolulu, HI, 96822, USA
| | - Marina E Rottmueller
- Department of Geology and Geophysics, University of Hawaii at Manoa, Honolulu, HI, 96822, USA
| | - A Hope Jahren
- Department of Geology and Geophysics, University of Hawaii at Manoa, Honolulu, HI, 96822, USA
| |
Collapse
|
27
|
Abstract
Diet is a leading modifiable risk factor for chronic disease, but it remains difficult to measure accurately due to the error and bias inherent in self-reported methods of diet assessment. Consequently, there is a pressing need for more objective biomarkers of diet for use in health research. The stable isotope ratios of light elements are a promising set of candidate biomarkers because they vary naturally and reproducibly among foods, and those variations are captured in molecules and tissues with high fidelity. Recent studies have identified valid isotopic measures of short- and long-term sugar intake, meat intake, and fish intake in specific populations. These studies provide a strong foundation for validating stable isotopic biomarkers in the general US population. Approaches to improve specificity for specific foods are needed; for example, by modeling intake using multiple stable isotope ratios or by isolating and measuring specific molecules linked to foods of interest.
Collapse
Affiliation(s)
- Diane M O'Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology and Department of Biology and Wildlife, University of Alaska, Fairbanks, Alaska 99775-7000;
| |
Collapse
|
28
|
Evaluation of a novel biomarker of added sugar intake (δ 13C) compared with self-reported added sugar intake and the Healthy Eating Index-2010 in a community-based, rural U.S. sample. Public Health Nutr 2015; 19:429-36. [PMID: 25901966 DOI: 10.1017/s136898001500107x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The δ 13C value of human blood is an emerging novel biomarker of added sugar (AS) intake for adults. However, no free-living, community-based assessments of comparative validity of this biomarker have been conducted. The purpose of the present investigation was to determine if Healthy Eating Index-2010 (HEI-2010) score, SoFAAS score (HEI-2010 sub-component for solid fat, alcohol and AS), AS and sugar-sweetened beverage (SSB) intakes were associated with δ 13C value of fingerstick blood in a community-based sample of adults, while controlling for relevant demographics. DESIGN A cross-sectional analysis of data obtained from assessments of BMI, dietary intake using 24 h recalls and a fingerstick blood sample was completed. Statistical analyses included descriptive statistics, multiple linear regression and one-way ANOVA. SETTING Rural Southwest Virginia, U.S.A. SUBJECTS Adults (n 216) aged >18 years who consumed at least 837 kJ/d (200 kcal/d) from SSB. RESULTS This sample of adult participants with low socio-economic status demonstrated a mean HEI-2010 score of 43.4 (sd 12.2), mean SoFAAS score of 10.2 (sd 5.7), mean AS intake of 93 (sd 65) g/d and mean blood δ 13C value of -18.88 (sd 0.7) ‰. In four separate regression models, HEI-2010 (R 2=0.16), SoFAAS (R 2=0.19), AS (R 2=0.15) and SSB (R 2=0.14) predicted δ 13C value (all P≤0.001). Age was also predictive of δ 13C value, but not sex or race. CONCLUSIONS These findings suggest that fingerstick δ 13C value has the potential to be a minimally invasive method for assessing AS and SSB intake and overall dietary quality in community-based settings. Strengths, limitations and future areas of research for using an objective δ 13C biomarker in diet-related public health studies are discussed.
Collapse
|
29
|
Gibbons H, McNulty BA, Nugent AP, Walton J, Flynn A, Gibney MJ, Brennan L. A metabolomics approach to the identification of biomarkers of sugar-sweetened beverage intake. Am J Clin Nutr 2015; 101:471-7. [PMID: 25733631 DOI: 10.3945/ajcn.114.095604] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The association between sugar-sweetened beverages (SSBs) and health risks remains controversial. To clarify proposed links, reliable and accurate dietary assessment methods of food intakes are essential. OBJECTIVE The aim of this present work was to use a metabolomics approach to identify a panel of urinary biomarkers indicative of SSB consumption from a national food consumption survey and subsequently validate this panel in an acute intervention study. DESIGN Heat map analysis was performed to identify correlations between ¹H nuclear magnetic resonance (NMR) spectral regions and SSB intakes in participants of the National Adult Nutrition Survey (n = 565). Metabolites were identified and receiver operating characteristic (ROC) analysis was performed to assess sensitivity and specificity of biomarkers. The panel of biomarkers was validated in an acute study (n = 10). A fasting first-void urine sample and postprandial samples (2, 4, 6 h) were collected after SSB consumption. After NMR spectroscopic profiling of the urine samples, multivariate data analysis was applied. RESULTS A panel of 4 biomarkers-formate, citrulline, taurine, and isocitrate-were identified as markers of SSB intake. This panel of biomarkers had an area under the curve of 0.8 for ROC analysis and a sensitivity and specificity of 0.7 and 0.8, respectively. All 4 biomarkers were identified in the SSB sample. After acute consumption of an SSB drink, all 4 metabolites increased in the urine. CONCLUSIONS The present metabolomics-based strategy proved to be successful in the identification of SSB biomarkers. Future work will ascertain how to translate this panel of markers for use in nutrition epidemiology.
Collapse
Affiliation(s)
- Helena Gibbons
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Breige A McNulty
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Anne P Nugent
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Janette Walton
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Albert Flynn
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Michael J Gibney
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Lorraine Brennan
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| |
Collapse
|
30
|
Sugar-sweetened beverages and dental caries in adults: A 4-year prospective study. J Dent 2014; 42:952-8. [DOI: 10.1016/j.jdent.2014.04.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/20/2022] Open
|
31
|
Fakhouri THI, Jahren AH, Appel LJ, Chen L, Alavi R, Anderson CAM. Serum carbon isotope values change in adults in response to changes in sugar-sweetened beverage intake. J Nutr 2014; 144:902-5. [PMID: 24717368 PMCID: PMC4018953 DOI: 10.3945/jn.113.186213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Serum carbon isotope values [13C-to-12C serum carbon isotope ratio (δ(13)C)], which reflect consumption of corn- and cane-based foods, differ between persons consuming high and low amounts of sugar-sweetened beverages (SSBs). In this study, we determined whether serum δ(13)C changes in response to change in SSB intake during an 18-mo behavioral intervention trial. Data were from a subset of 144 participants from the PREMIER trial, a completed behavioral intervention (Maryland, 1998-2004). SSB intake was assessed using 2 24-h dietary recall interviews. Blinded serum samples were assayed for δ(13)C by natural abundance stable isotope mass spectroscopy. Multiple linear regression models with generalized estimating equations and robust variance estimation were used. At baseline, mean SSB intake was 13.8 ± 14.2 fl oz/d, and mean δ(13)C serum value was -19.3 ± 0.6 units per mil (designated ‰). A reduction of 12 oz (355 mL)/d SSB (equivalent to 1 can of soda per day) was associated with 0.17‰ (95% CI: 0.08‰, 0.25‰ P < 0.0001) reduction in serum δ(13)C values over 18 mo (equivalent to a 1% reduction in δ(13)C from baseline). After adjusting for potential confounders, a reduction of 12 oz/d SSB (equivalent to 1 can of soda per day), over an 18-mo period, was associated with 0.12‰ (95% CI: 0.01‰, 0.22‰ P = 0.025) reduction in serum δ(13)C. These findings suggest that serum δ(13)C can be used as a measure of dietary changes in SSB intake.
Collapse
Affiliation(s)
| | - A. Hope Jahren
- School of Earth and Ocean Science and Technology, University of Hawaii, Honolulu, HI
| | - Lawrence J. Appel
- Department of Epidemiology and,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Liwei Chen
- Program of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA; and
| | - Reza Alavi
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Cheryl A. M. Anderson
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA,To whom correspondence should be addressed. E-mail:
| |
Collapse
|
32
|
Kong APS, Choi KC, Chan RSM, Lok K, Ozaki R, Li AM, Ho CS, Chan MHM, Sea M, Henry CJ, Chan JCN, Woo J. A randomized controlled trial to investigate the impact of a low glycemic index (GI) diet on body mass index in obese adolescents. BMC Public Health 2014; 14:180. [PMID: 24552366 PMCID: PMC3937245 DOI: 10.1186/1471-2458-14-180] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/12/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The role of a low glycemic index (GI) diet in the management of adolescent obesity remains controversial. In this study, we aim to evaluate the impact of low GI diet versus a conventional Chinese diet on the body mass index (BMI) and other obesity indices of obese adolescents. METHODS Obese adolescents aged 15-18 years were identified from population-recruited, territory-wide surveys. Obesity was defined as BMI ≥95th percentile of Hong Kong local age- and sex-specific references. Eligible subjects were randomized to either an intervention with low GI diet (consisting of 45-50% carbohydrate, 30-35% fat and 15-20% protein) or conventional Chinese diet as control (consisting of 55-60% carbohydrate, 25-30% fat and 10-15% protein). We used random intercept mixed effects model to compare the differential changes across the time points from baseline to month 6 between the 2 groups. RESULTS 104 obese adolescents were recruited (52 in low GI group and 52 in control group; 43.3% boys). Mean age was 16.7 ± 1.0 years and 16.8 ±1.0 years in low GI and control group respectively. 58.7% subjects completed the study at 6 months (65.4% in low GI group and 51.9% in control group). After adjustment for age and sex, subjects in the low GI group had a significantly greater reduction in obesity indices including BMI, body weight and waist circumference (WC) compared to subjects in the control group (all p <0.05). After further adjustment for physical activity levels, WC was found to be significantly lower in the low GI group compared to the conventional group (p = 0.018). CONCLUSION Low GI diet in the context of a comprehensive lifestyle modification program may be an alternative to conventional diet in the management of obese adolescents. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Ref. No: NCT01278563.
Collapse
Affiliation(s)
| | - Kai Chow Choi
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, Shatin, N,T,, Hong Kong, SAR, China.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Nash SH, Kristal AR, Hopkins SE, Boyer BB, O’Brien DM. Stable isotope models of sugar intake using hair, red blood cells, and plasma, but not fasting plasma glucose, predict sugar intake in a Yup'ik study population. J Nutr 2014; 144:75-80. [PMID: 24198311 PMCID: PMC3861795 DOI: 10.3945/jn.113.182113] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/21/2013] [Accepted: 10/16/2013] [Indexed: 11/14/2022] Open
Abstract
Objectively measured biomarkers will help to resolve the controversial role of sugar intake in the etiology of obesity and related chronic diseases. We recently validated a dual-isotope model based on RBC carbon (δ(13)C) and nitrogen (δ(15)N) isotope ratios that explained a large percentage of the variation in self-reported sugar intake in a Yup'ik study population. Stable isotope ratios can easily be measured from many tissues, including RBCs, plasma, and hair; however, it is not known how isotopic models of sugar intake compare among these tissues. Here, we compared self-reported sugar intake with models based on RBCs, plasma, and hair δ(13)C and δ(15)N in Yup'ik people. We also evaluated associations of sugar intake with fasting plasma glucose δ(13)C. Finally, we evaluated relations between δ(13)C and δ(15)N values in hair, plasma, RBCs, and fasting plasma glucose to allow comparison of isotope ratios across tissue types. Models using RBCs, plasma, or hair isotope ratios explained similar amounts of variance in total sugar, added sugar, and sugar-sweetened beverage intake (∼53%, 48%, and 34%, respectively); however, the association with δ(13)C was strongest for models based on RBCs and hair. There were no associations with fasting plasma glucose δ(13)C (R(2) = 0.03). The δ(13)C and δ(15)N values of RBCs, plasma, and hair showed strong, positive correlations; the slopes of these relations did not differ from 1. This study demonstrates that RBC, plasma, and hair isotope ratios predict sugar intake and provides data that will allow comparison of studies using different sample types.
Collapse
Affiliation(s)
- Sarah H. Nash
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| | | | | | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| |
Collapse
|
34
|
Isotopic estimates of sugar intake are related to chronic disease risk factors but not obesity in an Alaska native (Yup'ik) study population. Eur J Clin Nutr 2013; 68:91-6. [PMID: 24219893 PMCID: PMC3947290 DOI: 10.1038/ejcn.2013.230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 11/09/2022]
Abstract
Background Sugar intake may be causally associated with chronic disease risk, either directly or by contributing to obesity. However, evidence from observational studies is mixed, in part due to the error and bias inherent in self-reported measures of sugar intake. Objective biomarkers may clarify the relationship between sugar intake and chronic disease risk. We have recently validated a biomarker of sugar intake in an Alaska Native (Yup’ik) study population that incorporates red blood cell carbon and nitrogen isotope ratios in a predictive model. Objective This study tested associations of isotopic estimates of sugar intake with BMI, waist circumference (WC), and a broad array of other physiological and biochemical measures of chronic disease risk in Yup’ik people. Subjects/Methods In a cross-sectional sample of 1076 Yup’ik people, multiple linear regression was used to examine associations of sugar intake with BMI, WC and other chronic disease risk factors. Results Isotopic estimates of sugar intake were not associated with BMI (P = 0.50) or WC (P = 0.85). They were positively associated with blood pressure, triglycerides, and leptin, and inversely associated with total-, HDL- and LDL-cholesterol and adiponectin. Conclusions Isotopic estimates of sugar intake were not associated with obesity, but were adversely associated with other chronic disease risk factors in this Yup’ik study population. This first use of stable isotope markers of sugar intake may influence recommendations for sugar intake by Yup’ik people; however, longitudinal studies are required to understand associations with chronic disease incidence.
Collapse
|
35
|
Choy K, Nash SH, Kristal AR, Hopkins S, Boyer BB, O’Brien DM. The carbon isotope ratio of alanine in red blood cells is a new candidate biomarker of sugar-sweetened beverage intake. J Nutr 2013; 143:878-84. [PMID: 23616504 PMCID: PMC3652884 DOI: 10.3945/jn.112.172999] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An objective dietary biomarker would help clarify the contribution of sugar-sweetened beverage (SSB) intake to obesity and chronic disease risk. Previous studies have proposed the carbon isotope ratio (δ(13)C) as a biomarker of SSB intake but found associations that were of modest size and confounded by other components of the diet. We investigated whether the δ(13)C values of nonessential amino acids (δ(13)CNEAA) in RBCs could provide valid biomarkers that are more specific to SSBs. We assessed the associations of RBC δ(13)CNEAA with SSB intake in a study population of 68 Yup'ik people, using gas chromatography/combustion/isotope ratio mass spectrometry to measure δ(13)CNEAA and four 24-h dietary recalls to assess intake. Among RBC nonessential amino acids, alanine δ(13)C (δ(13)Calanine) was strongly correlated with intake of SSBs, added sugar, and total sugar (r = 0.70, 0.59, and 0.57, respectively; P < 0.0001) but uncorrelated with other dietary sources of elevated δ(13)C. We also evaluated whether sweetener intake could be noninvasively assessed using hair δ(13)Calanine in a subset of the study population (n = 30). Hair δ(13)Calanine was correlated with RBC δ(13)Calanine (r = 0.65; P < 0.0001) and showed similar associations with SSB intake. These results show that δ(13)Calanine in RBCs provides a valid and specific biomarker of SSB intake for the Yup'ik population and suggest RBCs and hair δ(13)Calanine as candidate biomarkers of SSB intake for validation in the general U.S. population. Ultimately, these biomarkers could clarify our understanding of whether and how SSB intake contributes to chronic disease.
Collapse
Affiliation(s)
- Kyungcheol Choy
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| | | | - Scarlett Hopkins
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute of Arctic Biology, and
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and,To whom correspondence should be addressed. E-mail:
| |
Collapse
|
36
|
Nash SH, Kristal AR, Bersamin A, Hopkins SE, Boyer BB, O’Brien DM. Carbon and nitrogen stable isotope ratios predict intake of sweeteners in a Yup'ik study population. J Nutr 2013; 143:161-5. [PMID: 23256142 PMCID: PMC3542907 DOI: 10.3945/jn.112.169425] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The carbon isotope ratio (δ¹³C) is elevated in corn- and cane sugar-based foods and has recently shown associations with sweetener intake in multiple U.S. populations. However, a high carbon isotope ratio is not specific to corn- and sugar cane-based sweeteners, as other foods, including meats and fish, also have elevated δ¹³C. This study examines whether the inclusion of a second marker, the nitrogen isotope ratio (δ¹⁵N), can control for confounding dietary effects on δ¹³C and improve the validity of isotopic markers of sweetener intake. The study participants are from the Yup'ik population of southwest Alaska and consume large and variable amounts of fish and marine mammals known to have elevated carbon and nitrogen isotope ratios. Sixty-eight participants completed 4 weekly 24-h recalls followed by a blood draw. RBC δ¹³C and δ¹⁵N were used to predict sweetener intake, including total sugars, added sugars, and sugar-sweetened beverages. A model including both δ¹³C and δ¹⁵N explained more than 3 times as much of the variation in sweetener intake than did a model using only δ¹³C. Because carbon and nitrogen isotope ratios are simultaneously determined in a single, high-throughput analysis, this dual isotope marker provides a simple method to improve the validity of stable isotope markers of sweetener intake with no additional cost. We anticipate that this multi-isotope approach will have utility in any population where a stable isotope biomarker is elevated in several food groups and there are appropriate "covariate" isotopes to control for intake of foods not of research interest.
Collapse
Affiliation(s)
- Sarah H. Nash
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and,To whom correspondence should be addressed. E-mail:
| | | | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| | | | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, and,Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK; and
| |
Collapse
|
37
|
Hedrick VE, Dietrich AM, Estabrooks PA, Savla J, Serrano E, Davy BM. Dietary biomarkers: advances, limitations and future directions. Nutr J 2012; 11:109. [PMID: 23237668 PMCID: PMC3568000 DOI: 10.1186/1475-2891-11-109] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 12/12/2012] [Indexed: 01/24/2023] Open
Abstract
The subjective nature of self-reported dietary intake assessment methods presents numerous challenges to obtaining accurate dietary intake and nutritional status. This limitation can be overcome by the use of dietary biomarkers, which are able to objectively assess dietary consumption (or exposure) without the bias of self-reported dietary intake errors. The need for dietary biomarkers was addressed by the Institute of Medicine, who recognized the lack of nutritional biomarkers as a knowledge gap requiring future research. The purpose of this article is to review existing literature on currently available dietary biomarkers, including novel biomarkers of specific foods and dietary components, and assess the validity, reliability and sensitivity of the markers. This review revealed several biomarkers in need of additional validation research; research is also needed to produce sensitive, specific, cost-effective and noninvasive dietary biomarkers. The emerging field of metabolomics may help to advance the development of food/nutrient biomarkers, yet advances in food metabolome databases are needed. The availability of biomarkers that estimate intake of specific foods and dietary components could greatly enhance nutritional research targeting compliance to national recommendations as well as direct associations with disease outcomes. More research is necessary to refine existing biomarkers by accounting for confounding factors, to establish new indicators of specific food intake, and to develop techniques that are cost-effective, noninvasive, rapid and accurate measures of nutritional status.
Collapse
Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods and Exercise, 221 Wallace Hall (0430), Virginia Tech, Blacksburg, Virginia 24061, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Hedrick VE, Savla J, Comber DL, Flack KD, Estabrooks PA, Nsiah-Kumi PA, Ortmeier S, Davy BM. Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): sugar-sweetened beverages and total beverage energy intake. J Acad Nutr Diet 2012; 112:840-9. [PMID: 22709811 DOI: 10.1016/j.jand.2012.01.023] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Energy-containing beverages, specifically sugar-sweetened beverages, may contribute to weight gain and obesity development. Yet, no rapid assessment tools are available which quantify habitual beverage intake (grams, energy) in adults. OBJECTIVE Determine the factorial validity of a newly developed beverage intake questionnaire (BEVQ) and identify potential to reduce items. METHODS Participants from varying economic and educational backgrounds (n=1,596, age 43±12 years, body mass index [calculated as kg/m(2)] 31.5±0.2) completed a 19-item BEVQ (BEVQ-19). Beverages that contributed <10% to total beverage, or sugar-sweetened beverages, energy and grams were identified for potential removal. Factor analyses identified beverage categories that could potentially be combined. Regression analyses compared BEVQ-19 outcomes with the reduced version's (BEVQ-15) variables. Inter-item reliability was assessed using Cronbach's α. Following BEVQ-15 development, a subsequent study (n=70, age 37±2 years; body mass index 24.5±0.4) evaluated the relative validity of the BEVQ-15 through comparison of three 24-hour dietary recalls' beverage intake. RESULTS Three beverage items were identified for elimination (vegetable juice, meal replacement drinks, and mixed alcoholic drinks); beer and light beer were combined into one category. Regression models using BEVQ-15 variables explained 91% to 99% of variance in the four major outcomes of the BEVQ-19 (all P<0.001). Cronbach's α ranged .97 to .99 for all outcomes. In the follow-up study, BEVQ-15 and three 24-hour dietary recalls' variables were significantly correlated with the exception of whole milk; BEVQ-15 sugar-sweetened beverages (R(2)=0.69), and total beverage energy (R(2)=0.59) were more highly correlated with three 24-hour dietary recalls' than previously reported for the BEVQ-19. The BEVQ-15 produced a lower readability score of 4.8, which is appropriate for individuals with a fourth-grade education or greater. CONCLUSIONS The BEVQ-19 can be reduced to a 15-item questionnaire. This brief dietary assessment tool will enable researchers and practitioners to rapidly (administration time of ∼2 minutes) assess habitual beverage intake, and to determine possible associations of beverage consumption with health-related outcomes, such as weight status.
Collapse
Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Pomeranz JL. The bittersweet truth about sugar labeling regulations: they are achievable and overdue. Am J Public Health 2012; 102:e14-20. [PMID: 22594751 PMCID: PMC3477992 DOI: 10.2105/ajph.2012.300732] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2012] [Indexed: 11/04/2022]
Abstract
The recent Institute of Medicine recommendation to the Food and Drug Administration to include added sugar in a new front-of-package system provides new justification for reviewing outdated regulations pertinent to sugar and analyzing whether the government's previous resistance to sugar labeling remains valid given new and robust science. I have provided an overview of US sugar consumption, its public health implications, and the science related to added sugar detection. I reviewed US and international sugar intake recommendations and suggested revised regulations to better inform and protect consumers. I concluded by noting new directions in the area of sugar research for future public health policy.
Collapse
Affiliation(s)
- Jennifer L Pomeranz
- Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT 06520-8369, USA.
| |
Collapse
|
40
|
Nash SH, Bersamin A, Kristal AR, Hopkins SE, Church RS, Pasker RL, Luick BR, Mohatt GV, Boyer BB, O’Brien DM. Stable nitrogen and carbon isotope ratios indicate traditional and market food intake in an indigenous circumpolar population. J Nutr 2012; 142:84-90. [PMID: 22157543 PMCID: PMC3237231 DOI: 10.3945/jn.111.147595] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The transition of a society from traditional to market-based diets (termed the nutrition transition) has been associated with profound changes in culture and health. We are developing biomarkers to track the nutrition transition in the Yup'ik Eskimo population of Southwest Alaska based on naturally occurring variations in the relative abundances of carbon and nitrogen stable isotopes (δ(15)N and δ(13)C values). Here, we provide three pieces of evidence toward the validation of these biomarkers. First, we analyzed the δ(15)N and δ(13)C values of a comprehensive sample of Yup'ik foods. We found that δ(15)N values were elevated in fish and marine mammals and that δ(13)C values were elevated in market foods containing corn or sugar cane carbon. Second, we evaluated the associations between RBC δ(15)N and δ(13)C values and self-reported measures of traditional and market food intake (n = 230). RBC δ(15)N values were correlated with intake of fish and marine mammals (r = 0.52; P < 0.0001). RBC δ(13)C values were correlated with intake of market foods made from corn and sugar cane (r = 0.46; P < 0.0001) and total market food intake (r = 0.46; P < 0.0001). Finally, we assessed whether stable isotope ratios captured population-level patterns of traditional and market intake (n = 1003). Isotopic biomarkers of traditional and market intake were associated with age, community location, sex, and cultural identity. Self-report methods showed variations by age and cultural identity only. Thus, stable isotopes show potential as biomarkers for monitoring dietary change in indigenous circumpolar populations.
Collapse
Affiliation(s)
- Sarah H. Nash
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife,To whom correspondence should be addressed. E-mail:
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | - Alan R. Kristal
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Rebecca S. Church
- Center for Alaska Native Health Research, Institute of Arctic Biology
| | - Renee L. Pasker
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | | | - Gerald V. Mohatt
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Psychology, University of Alaska, Fairbanks, AK; and
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology,Department of Biology and Wildlife
| |
Collapse
|