Patterns of beverage use across the lifecycle

Hypokalaemia associated with excessive cola-flavoured drinks consumption

We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.

Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal

The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.

The impact of dietary fructose on gut permeability, microbiota, abdominal adiposity, insulin signaling and reproductive function

The excessive intake of fructose in the regular human diet could be related to global increases in metabolic disorders. Sugar-sweetened soft drinks, mostly consumed by children, adolescents, and young adults, are the main source of added fructose. Dietary high-fructose can increase intestinal permeability and circulatory endotoxin by changing the gut barrier function and microbial composition. Excess fructose transports to the liver and then triggers inflammation as well as de novo lipogenesis leading to hepatic steatosis. Fructose also induces fat deposition in adipose tissue by stimulating the expression of lipogenic genes, thus causing abdominal adiposity. Activation of the inflammatory pathway by fructose in target tissues is thought to contribute to the suppression of the insulin signaling pathway producing systemic insulin resistance. Moreover, there is some evidence that high intake of fructose negatively affects both male and female reproductive systems and may lead to infertility. This review addresses dietary high-fructose-induced deteriorations that are obvious, especially in gut permeability, microbiota, abdominal fat accumulation, insulin signaling, and reproductive function. The recognition of the detrimental effects of fructose and the development of relevant new public health policies are necessary in order to prevent diet-related metabolic disorders.

Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy

BACKGROUND

Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated.

DESIGN

Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level.

RESULTS

The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables.

CONCLUSION

SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.

Beverage Consumption Patterns and Nutrient Intake Are Associated with Cardiovascular Risk Factors among Urban Mexican Young Adults

Regular consumption of sugar-sweetened beverages has been related to metabolic diseases. Our objective was to identify beverage consumption patterns, nutrient intake, and their possible association with the prevalence of cardiovascular risk factors among Mexican young adults. A cross-sectional survey was conducted. Beverage consumption patterns were obtained by principal components analysis. Logistic regression models were applied to assess the association between the beverage patterns and cardiovascular risk factors. Four beverage patterns were identified. Higher consumption of alcoholic beverages was associated with lower odds for high body fat percent (OR: 0.371; 95% CI: 0.173-0.798), high blood pressure (OR: 0.318; 95% CI: 0.116-0.871), and high glucose (OR: 0.232; 95% CI: 0.061-0.875). Higher consumption of yogurt was associated with lower odds for high glucose (OR: 0.110; 95% CI: 0.22-0.559). In contrast, highest consumption of juice had greater odds for high triglycerides (OR: 1.084; 95% CI: 1.011-4.656). Higher consumption of milk was associated with greater odds for high glucose (OR: 5.304; 95% CI: 1.292-21.773). Beverage consumption habits in Mexican young adults are associated with increased risk factors for cardiovascular disease. Therefore, intervening during young adulthood should be considered in order to improve current health and prevent cardiovascular mortality in later decades.

Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review

Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described.

METHODS

we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications.

RESULTS

different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents' behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome.

CONCLUSIONS

Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.

Fast-food and obesity: Status among the young adult population in Bangladesh

Increasing rate of fast-food consumption has been associated with different health related concerns (e.g., obesity, heart disease). This study aimed to determine the prevalence of fast-food consumption among young adult students in Chittagong, Bangladesh, and to assess the association of fast-food consumption with obesity. A total of 440 youth was included using a systemic random sampling from universities and colleges in Chittagong in order to perform a cross-sectional analysis. The students who reported frequent fast-food consumption (1-3 times per week) accounted for 30.5% (n=134) of the sample, while 32.5% (n=143) of participants reported consuming fast- food 8-15 times per month. There was a significant (p=0.030) difference between students who consumed and did not consume fast-food. Youth who reported consuming fast-food and soft drinks more than 4 times per week constituted 35.0% (n=154), followed by approximately 27.7% (n=122) who consumed these items 1-3 times per week. In addition, an obesity epidemic was observed among those who reported low levels of physical exercise or lack of sleep. The study illustrates that Bangladeshi youth face an increasing risk of becoming overweight and obese. Prevention is regarded as the most effective way to reduce the prevalence of obesity.

Psychometric properties of the Chinese version of the sugar-sweetened beverages media literacy scale for undergraduates

Specific domains of the Sugar-Sweetened Media Literacy Scale (SSM-ML) have been shown to significantly assess sugar-sweetened beverage (SSB) calorie intake in the US population. This study aimed to describe the psychometric properties of the revised Chinese version of the SSB-ML (C-SSB-ML) and evaluate its validity and reliability. Results from 975 undergraduates at two of the largest universities in a province in southwest China showed that Cronbach's alphas for the overall scale, the three dimensions, and two-halves analysis were satisfactory (0.71-0.92). The criterion-related validity of the C-SSB-ML was positively associated with the e Health literacy scale (eHEALS). Confirmatory factor analysis showed that the three-factor model of the C-SSB-ML had adequate fit indices χ² (153) = 4349.93, p < 0.001; Comparative fit index (CFI), Tucker-Lewis index (TLI), Incremental fit index (IFI) >0.90; Standardized Root Mean Square Residual (SRMR) <0.07; and Root Mean Square Error of Approximation (RMSEA) <0.08. Our findings provide evidence for a valid and reliable tool that can be used to assess sugar-sweetened media literacy in Chinese undergraduates and will help organizations leverage media literacy in strategy formulation to ensure SSB intake is controlled as much as possible through effective efforts on all fronts.

Energy labelling of alcoholic drinks: An important or inconsequential obesity policy?

Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.

Nutrition Guidelines for Improved Clinical Care

Given the importance of poor nutrition as a cause for human chronic disease, it is surprising that nutrition receives so little attention during medical school training and in clinical practice. Specific vitamins, minerals, fatty acids, amino acids and water in the diet are essential for health, and deficiencies lead or contribute to many diseases. Proper use of the dietary guidelines and nutrition facts labeling can improve nutritional status and lead to the consumption of a healthy diet. COVID-19 has altered access to nutritious foods for millions and increased awareness of the importance of diet and immune function. An improved appreciation for nutrition will improve the outcomes of clinical care.

Association between the consumption of sugar-sweetened beverages and food markers: National Dietary Survey 2008-2009

We aimed to analyze the association between sugar-sweetened beverage (SSB) consumption with healthy food markers (HFM) and unhealthy food markers (UFM) as well as their impact on these markers in the Brazilian population's diet. Food consumption during two nonconsecutive days of food records of individuals aged ten years or over were investigated in the National Dietary Survey 2008-2009 (n = 32,900) and the caloric contributions of HFM and UFM were distributed according to the categories of SSB consumption. Multiple linear regression was applied to analyze the associations between the consumption of SSB and the impact of a 50% reduction in portion size and dietary markers. The contribution of energy from HFM was higher among individuals who did not consume SSB. A 50% reduction in the average portion of SSB in the population would imply a 6% decrease in energy contribution to the diet and 12% decrease in total energy from added sugar. It would increase the consumption of HFM and dietary fiber by 7g and 4g, respectively. A 50% reduction in SSB serving size is a strategy that could improve the quality of the diet, increase the consumption of HFM and fiber and reduce the consumption of sugar and UFM.

Sugar-sweetened beverage consumption and mortality of chronic kidney disease: results from the US National Health and Nutrition Examination Survey, 1999–2014

Background

The relationship between intake of sugar-sweetened beverages (SSBs) and the risk of death in patients with chronic kidney disease (CKD) is unclear. We evaluated the association between SSB intake and subsequent overall mortality in CKD patients.

Methods

We included data from 3996 CKD patients who participated in the 1999–2014 National Health and Nutrition Examination Survey (NHANES). SSB intake was assessed by a 24-h dietary recall, grouped as none, >0 to <1 serving/day, 1 to <2 servings/day and ≥2 servings/day. After adjusting for demographic variables, lifestyle, diet and comorbidities, Cox proportional risk regressions were applied to analyze the associations between the daily intake of SSBs as well as added sugar from beverages and all-cause mortality.

Results

In the whole research population, the median age at baseline was 67 years, 22% were Black and 54% were female. A total of 42% had stage 3 CKD. During an average follow-up period of 8.3 years, a sum of 1137 (28%) deaths from all causes was recorded. The confounder-adjusted risk of mortality was associated with an increase of 1 serving/day of SSBs, with all-cause mortality of 1.18 [95% confidence interval (95% CI)1.08–1.28], and intakes of increased 20-g added sugar/1000 kcal of total energy per day were associated with all-cause mortality of 1.14 (1.05–1.24). Equivalently substituting 1 serving/day of SSBs with unsweetened coffee [HR (95% CI) 0.82 (0.74–0.91)], unsweetened tea [HR (95% CI) 0.86 (0.76–0.98)], plain water [HR (95% CI) 0.79 (0.71–0.88)], or non- or low-fat milk [HR (95% CI) 0.75 (0.60–0.93)] were related to a 14–25% reduced risk of all-cause mortality.

Conclusion

Findings suggest that in the CKD population, increased SSB intake was associated with a higher risk of mortality and indicated a stratified association with dose. Plain water and unsweetened coffee/tea might be possible alternatives for SSBs to avert untimely deaths.

High Fructose Intake Contributes to Elevated Diastolic Blood Pressure in Adolescent Girls: Results from The HELENA Study

BACKGROUND

The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between fructose consumption and elevated blood pressure in an European adolescent population.

METHODS

A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA-DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score-BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake.

RESULTS

Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17-4.40); p = 0.015) after adjustment for cofounding factors.

CONCLUSIONS

Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.

Feeding pattern, biochemical, anthropometric and histological effects of prolonged ad libitum access to sucrose, honey and glucose-fructose solutions in Wistar rats

BACKGROUND/OBJECTIVES

The exposure to sucrose in rats has mimic abnormalities attributed to metabolic syndrome (MetS). The effects of honey bee and "free" glucose and fructose, have not been explored in this context. The aim was to expose Wistar rodents to sucrose solution (SS), honey solution (HS) and fructose/glucose solution (GFS) at 30% to assess their effects.

SUBJECTS/METHODS

HS (n = 10), SS (n = 10) and GFS (n = 10) groups were formed. Solutions were ad libitum along 14-weeks.

RESULTS

Between solutions consumptions, honey was significantly 42% higher (P = 0.000), while similar consumption was observed among GFS and SS. The feeding pattern of HS consumption was irregular along experiment; while the food intake pattern showed the similar trend among groups along time. Non statistical differences were obtained in any biochemical and anthropometric measure, however, a higher concentration of leptin (721 ± 507 pg/mL), lower concentration of total cholesterol (TC; 48.87 ± 2.41 mg/100 mL), very low density lipoprotein (VLDL; 16.47 ± 6.55 mg/100 mL) and triglycerides (82.37 ± 32.77 mg/100 mL) was obtained in SS group. For anthropometric values, HS showed less total adipose tissue (AT; average 26 vs. 31-33 g) and adiposity index (average 6.11 vs. 7.6). Due to sugar-sweetened beverages consumption increases the risk for the development of chronic diseases; correlations between fluid intake and anthropometric and biochemical parameters were assessed. A moderate correlation was obtained in groups with the weight of total AT and solution intake; for the weight gain in GFS group and for triglycerides in HS and GFS. The highest hepatic tissue damage was observed in SS group with multiple intracytoplasmic vacuoles, atypia changes, moderate pleomorphism and hepatocellular necrosis.

CONCLUSIONS

In spite of the significantly higher consumption of HS, biochemical, anthropometrical and histological effects were not remarkably different in comparision to other sweeteners.

Dietary Habits and their Association with Metabolic Syndrome in a sample of Iranian adults: A population-based study

BACKGROUND

Central obesity, insulin resistance, dyslipidemia, and hypertension are the core components of metabolic syndrome (MetS) which is coincident with unhealthy dietary habits in the Middle-Eastern countries. The aim of this study was to explore the association between dietary habits and MetS of the adult population living in Yazd Greater Area, Iran.

METHODS

This is a cross-sectional study that uses the data of a population-based cohort study on Iranian adults, known as Yazd Health Study (YaHS). The relationship between dietary habits and metabolic syndrome among adults (n = 2,896) was analyzed using multiple logistic regression method.

RESULTS

The prevalence of MetS among the participants was 32.2%. Outcomes from logistic regression examination show that breakfast consumption has a significant inverse effect on the occurrence of MetS after adjustment for age, education level, physical activity statue, history of chronic diseases, and smoking (odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.14, 0.97). This effect remains significant even after adjustment for body mass index (BMI) and reveals that odds of having MetS is 69% lower in breakfast consumers in contrast to nonconsumers (OR = 0.31, 95% CI = 0.11, 0.87). However, no significant relationship was observed between other dietary habits including consumption of sweetened drinks, sugar cubes, and fast foods and MetS after adjustment for all potential confounders.

CONCLUSIONS

This study revealed that eating breakfast has an inverse relationship with metabolic syndrome. To find out stronger evidence in relation to dietary habits and MetS, more researches especially population-based cohort studies are needed to be conducted.

Psychometric Analyses of the Eating and Food Literacy Behaviors Questionnaire with University Students

OBJECTIVES

This study developed and validated a questionnaire to measure young adults' perceived food literacy and behaviors toward food and created an explanatory model.

DESIGN

Cross-sectional.

SETTING

Large southeastern US university.

PARTICIPANTS

A total of 1,896 students, aged 18-30 years, were recruited. Data from 1,813 were analyzed.

VARIABLES MEASURED

Health and nutrition, taste, food preparation, planning and decision-making, and convenience.

ANALYSIS

Exploratory factor analysis, test-retest reliability, confirmatory factor analysis, and structural equation modeling were performed.

RESULTS

Exploratory factor analysis returned 5 factors with acceptable internal structure. Test-retest reliability coefficients ranged from 0.63 to 0.92. Confirmatory factor analysis suggested that a 5-factor model was an appropriate fit for the data (χ² = 588.05; degrees of freedom = 142; root mean square error of approximation = 0.06; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; standardized root mean square residual = 0.05). Structural equation modeling revealed relationships from health and nutrition to food preparation (0.25, P < 0.001), planning and/or decision-making (0.57, P < 0.001), taste (-0.14, P < 0.001), and convenience (-0.31, P < 0.001). The structural equation model demonstrated adequate fit (adjusted goodness of fit = 0.91; comparative fit index = 0.93; non-normed fit index = 0.91; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07) and a significant chi-square test (χ² = 628.92; degrees of freedom = 171, P < 0.001).

CONCLUSIONS AND IMPLICATIONS

Young adults consider food literacy-related factors and behavioral concerns when making food choices.

Patterns of beverage purchases amongst British households: A latent class analysis

BACKGROUND

Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are.

METHODS AND FINDINGS

We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home.

CONCLUSIONS

Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.

Cumulative soft drink consumption is associated with insulin resistance in Mexican adults

BACKGROUND

Insulin resistance (IR) is an important risk factor for type 2 diabetes (T2D) and other cardiometabolic diseases. Recent studies suggest that soft drink consumption could increase IR. However, inconsistent findings have been observed.

OBJECTIVE

The aim was to estimate the association between the cumulative consumption of soft drinks and IR by means of the HOMA-IR in Mexican adults.

METHODS

We analyzed the association between cumulative consumption of soft drinks and HOMA-IR change after 7 y of follow-up in participants (n = 1073) of the Health Workers Cohort Study. Soft drink consumption was estimated by food-frequency questionnaires. Insulin was measured by chemiluminescence, and fasting glucose was measured with the enzymatic colorimetric method. HOMA-IR was computed as fasting insulin (mIU/L) × fasting glucose (mmol/L)/22.5. To assess the relation between cumulative soft drink consumption and HOMA-IR change, we performed robust linear regression models. Additionally, we used fixed-effects models to estimate the association between changes in soft drink consumption and change in HOMA-IR.

RESULTS

At baseline, the average age was 44 y. Mean cumulative soft drink consumption was 0.42 servings/d. Median HOMA-IR increased from 1.5 at baseline to 2.0 at follow-up. Soft drink consumption was positively associated with HOMA-IR change. In the multiple linear regression analysis, for each increase in the consumption of 2 (355 mL) soft drinks/d, the average change between baseline and follow-up HOMA-IR showed an increase of 1.11 units (95% CI: 0.74, 1.48).

CONCLUSIONS

Our data support the hypothesis that, in Mexican adults, a higher soft drink consumption is associated with an increase in HOMA-IR, despite known risk factors. These findings support the need for reinforcing policies to reduce soft drink consumption in our population.

Factors associated with sugar-sweetened beverage consumption in adults with children in the home after a statewide health communications program

Background

In 2016, Oklahoma launched "Shape Your Future - Rethink Your Drink" (SYF/RYD), an obesity prevention health communication program targeting parents and caregivers of children. The aims of this study are to compare sugar-sweetened beverage (SSB) consumption before and after the program and to report factors associated with SSB consumption, knowledge, and attitudes.

Methods

This repeated cross-sectional study involved 2656 Oklahoma adults with ≥ one child under 18 years in the home. Weighted prevalence estimates were calculated and the relationship between SSB consumption and covariates of interest were examined using logistic regression techniques appropriate for survey data.

Results

Following the SYF/RYD program, SSB consumption decreased 18.6% (p = 0.0232) and heavy SSB consumption, ≥ three SSB per day, decreased 42.9% (p = 0.0083). Factors associated with SSB consumption, 1 year after the launch of SYF/RYD included high school education or less (AOR = 1.33 with 95% CI = 1.02, 1.73), fair or poor health status (AOR = 2.02 with 95% CI = 1.47, 2.78), drinking less than eight cups of water daily (AOR = 1.77 with 95% CI = 1.39, 2.25), inability to afford healthy foods (AOR = 1.33 with 95% CI = 1.06, 1.67), and self-identifying as American Indian/Alaska Native (AOR = 1.59 with 95% CI = 1.10, 2.29).

Conclusions

Health communication campaigns, such as SYF/RYD, are an evidence-based strategy for health behavior change and likely contributed to the declines observed in SSB consumption. Important differences in SSB consumption by population subgroups persist and have implications for future message development.

Exclusively drinking sucrose or saline early in life alters adult drinking behavior by laboratory rats

Proper fluid balance is critical for life. Learning plays an important role in shaping the appetitive behaviors required for drinking. Children often forego drinking plain water and instead consume beverages such as milk or juice. What effect this may have on adult thirst responses remains an open question. To model aspects of the human condition, we bred Sprague-Dawley rats and prevented the pups from obtaining fluid other than from nursing. Pups were weaned onto either tap water, 5% sucrose, or 0.45% saline, and given access to only that fluid for at least 7 weeks. We then measured intake of water or sucrose/saline in one-bottle tests after mild hypertonic saline (HS) injection, or overnight fluid deprivation, and in two-bottle tests after HS injection while rats were maintained on their respective fluids, and after all subjects had only water to drink for a week. We found that sucrose- and saline-maintained rats drank less water than did controls after the HS challenge. After overnight fluid deprivation, rats maintained on saline drank less water and more saline, but there was no difference in intake between water-maintained and sucrose-maintained rats. Differences in licking patterns, including more licks/burst for sucrose by sucrose-maintained rats were detected, even in cases when total intake was not different. These data provide evidence that adult rat water intake can be reduced by exclusively drinking sucrose or saline early in life.

Correlates of sugar-sweetened beverages consumption among adolescents

Objective:

To identify correlates and underlying beliefs regarding the adolescents’ intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB.

Design:

Correlational study.

Setting:

Region of Chaudière-Appalaches in the province of Quebec, Canada.

Participants:

311 adolescents aged 13–18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured.

Results:

Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13–14 years (β = –0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends’ approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified.

Conclusions:

The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.

Use of auctions to assess consumer value for milk from different packaging

The objective of this study was to evaluate the effect of a sensory experience and educational message on consumer value for fluid milk in different containers: translucent high-density polyethylene (HDPE), white-pigmented HDPE (light-block), and paperboard. We carried out 11 auction sessions (n = 100). Sessions included an explanation of the experiment process; a survey about demographics and milk purchasing and consumption behaviors; a sensory evaluation; an educational message; and 3 rounds of nth price auctions. Consumers were blindly served 2 pairs of milk samples-2% milk from paperboard and translucent HDPE, and skim milk from paperboard and translucent HDPE-and asked to indicate their preference and level of acceptability for each, using a 7-point hedonic scale. Consumers were asked to ascribe a monetary value to each sample. Consumers were also asked to taste and assess a value for 2% and skim milk from light-block HDPE. All milk samples were evaluated simultaneously by a panel of 9 judges who were trained to evaluate milk quality attributes on a 15 cm unstructured line scale. All milk was from the same industry source, processed and stored on the same timeline for each session. Results from the consumer panel on acceptability, trained panel descriptive analysis and consumer bids were analyzed using multi-factor ANOVA. Subjecting responses to pre- and post-surveys to k means cluster analysis revealed 4 bidding populations in each round. Trained panelists detected higher levels of light-oxidized off-flavor in skim milk from translucent HDPE (5.8 cm) than from light-block HDPE (2.42 cm) and in 2% milk from translucent HDPE (5.1 cm) than from paperboard (0.32 cm). Although 84% of participants regularly purchased milk in plastic containers, consumers' acceptability scores for milk of the same fat content but from different packaging were not different. However, consumers gave higher acceptability scores to 2% milk from paperboard (5.2/7.0) than skim milk from paperboard (4.7/7.0). We found no differences in consumer value (US$) for 2% or skim milk in paperboard or translucent HDPE. However, after consumers received an educational message and tasted "Certified Fresh Taste" samples, they were willing to pay more for 2% milk in paperboard ($0.31 more) or HDPE ($0.38 more) packaging with a "Certified Fresh Taste" seal and for skim milk in paperboard ($0.15 more) or HDPE ($0.21 more) packaging with a "Certified Fresh Taste" seal than for milk in packaging without such labeling. Although consumers could not detect a difference in the milk from different packages, they indicated that they would pay more for a "Certified Fresh Taste" seal after hearing about the effects of light on milk in different packaging, demonstrating the importance to consumers of external cues about freshness.

Fast food consumption and its associations with heart rate, blood pressure, cognitive function and quality of life. Pilot study

Background

To investigate the relationship of fast food consumption with cognitive and metabolic function of adults (18-25 years old) in Riyadh, Kingdom of Saudi Arabia.

Materials and Method

This cross-sectional study was conducted at the College of Medicine at King Khalid University Hospital, Riyadh, Saudi Arabia. The conventionally recruited subjects underwent an evaluation that included demographic data, quality of life (wellness, stress, sleepiness, and physical activity), mini-mental status examination, and the frequency of fast food consumption. To investigate metabolic function, blood was drawn to evaluate serum HDL, LDL, cholesterol, and triglyceride levels. Cognitive function was assessed by the Cambridge neuropsychological test automated battery. The participants were divided into 2 groups based on fast food consumption: those who consumed fast food 3 times per week or less (Group 1) and those who consumed fast food more than 3 times per week (Group 2).

Results

The mean diastolic blood pressure in Group 1 and Group 2 was 72 mmHg and 77 mmHg, respectively, a significant difference (p = 0.04). There was no significant difference for cognitive function and quality of life between the two groups. There was significant correlation of HDL with AST correct mean latency and the AST correct mean latency congruent (p = 0.02, p = 0.01, respectively) and TC with diastolic blood pressure (p = 0.003).

Conclusions

We concluded that fast food consumption has an effect on blood pressure but has no direct effect on cognition or quality of life.

Maternal Perceptions of Self-Weight and Child Weight May Influence Milk Choice of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Objective

To examine the association between maternal perceptions of self-weight and child weight status and milk consumption behavior of Hispanic WIC participants.

Methods

Mixed methods design with phone survey (n=529) and one-on-one interviews (n=35). Demographic characteristics, Chi-square, and thematic analyses were conducted.

Results

More than half of overweight mothers misperceived their own weight status as well as those of their children. Mothers who perceived their child to be overweight were more likely to make a healthier food choice for their family, namely, choosing reduced-fat milk instead of whole milk. Qualitative interviews revealed a cultural preference for larger size children, and mothers defined healthy weight for their child as a function of (1) the child's ability to be as active as other children their age, regardless of child's BMI, and (2) the pediatrician's opinion of the child's weight status.

Conclusions

Maternal perception of self-weight and child weight status seems to guide milk choices. Mothers may have some level of recognition of overweight in themselves and their child, thus adopting healthier milk choices. Culturally related perceptions should be considered when designing obesity prevention strategies, and the role of a pediatrician cannot be understated when developing obesity prevention programs for Hispanic families.

Beverage consumption patterns and energy contribution from beverages per meal type: results from a national dietary survey in Sweden

OBJECTIVE

Many studies of food intake have been performed and published in Sweden, but to our knowledge no studies have extensively explored the beverage consumption of the Swedish adult population. The present study aimed to describe the beverage consumption and the contribution of beverage energy (including alcohol energy) to total energy intake according to gender, region of living, meal type and day for a Swedish adult population.

DESIGN

National dietary survey Riksmaten (2010-2011), collected by the Swedish National Food Agency.

SETTING

Sweden.

SUBJECTS

A total of 1682 participants (57 % women) reported dietary intake data during four consecutive days, specified by portion size, meal, time point, day of the week and venue. Meals were categorized as breakfast, lunch, dinner and 'other'.ResultThe beverage reported to be consumed the most was water (ml/d), followed by coffee. Men had a higher consumption of juice, soft drinks, beer, spirits and low-alcohol beer, while the consumption of tea and water was higher for women. For both genders, milk contributed the most to beverage energy intake. Energy percentage from beverages was higher at lunch and dinner during weekends for both genders. Participants from the biggest cities in Sweden had a higher consumption of wine for both genders and tea for men than participants from other regions.

CONCLUSIONS

A considerable part of total energy intake was contributed by beverages, especially for men. Beverages can contribute to a more enjoyable diet, but at the same time provide energy, sugar and alcohol in amounts that do not promote optimal health.

The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China

PURPOSE

To investigate the amounts and contributions of total drinking fluids and water from food to total water intake (TWI), to explore the drinking pattern, and to compare the amount of TWI with the recommendations of China and EFSA among young adults.

METHODS

A cross-sectional study was implemented with 159 young adults aged 18-23 years from Hebei, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and the duplicate portion method, respectively. Differences between groups stratified according to the distribution of TWI were compared using one-way ANOVA and Kruskal-Wallis H test. General linear models were used to identify the variations in TWI due to total drinking fluids and water from food.

RESULTS

In total, 156 subjects (80 males and 76 females) completed the study. Approximately 80.1% of them did not meet the TWI recommended by China, while 50.0% did not meet that recommended by the EFSA. Participants with higher TWI had greater amounts of total drinking fluids, water rom food and water than their counterparts with lower TWI. The regression between total drinking fluids and TWI was R² = 0.8526 (P < 0.05) and that between water from food and TWI was R² = 0.4650 (P < 0.05).

CONCLUSIONS

A large proportion of young adults have insufficient TWI. Participants with lower TWI would not compensate with water from food. The variances in TWI among participants were mainly due to differences in total drinking fluids. There is an urgent need to improve the fluids intake behaviors of young adults.

Beverage Consumption among Adults in the Balearic Islands: Association with Total Water and Energy Intake

The paper seeks to describe beverage consumption and examine the association between beverage consumption and total water intake and total energy intake of the adult population in the Balearic Islands. Beverage consumption, total water intake, and total energy intake were obtained by using two 24-h diet recalls from a cross-sectional nutritional survey carried out in the Balearic Islands (n = 1386). The contribution of beverages to total water intake and total energy intake were also assessed. Beverages accounted for 65–71% of total water intake and 29–35% of it provided by drinking water. Food moisture contributed 31–37% of total water intake. The mean daily total water intake from all sources was around 2.2 L for men and 1.9 L for women and slightly lower than the proposed adequate intake (AI) recommendations of the European Food Safety Authority (EFSA). The mean total energy intake was 2222 kcal/day and beverages contributed 10.3% of total energy intake for men and 9.5% for women. Energy intake from beverages varied with age. In both sexes, milk was the main beverage contributed to total energy intake. The energy contribution of caloric soft drinks was 1.8% for men and 1.2% for women and energy intake from these beverages was significantly higher among younger adults. Water was the main beverage in the diet, followed by milk and hot beverages. Beverages were mainly consumed in the main meal times (breakfast, lunch, and dinner) in both sexes. The main findings of this study indicate that consumption of sugar-sweetened beverages (caloric soft drinks and commercial fruit juice) is higher among young adults, consumption of alcoholic beverages is higher among males aged 26 and older, and TWI (total water intake) is lower than the EFSA recommendations. These findings may be used to develop effective, healthy eating and drinking policies and campaigns.

Ethnic disparities of beverage consumption in infants and children 0-5 years of age; National Health and Nutrition Examination Survey 2011 to 2014

BACKGROUND

Dietary patterns, including beverage consumption, that are developed during a child's first few years of life have been shown to impact dietary choices made later in life. Authoritative sources provide beverage recommendations for infants and children; however, it is unclear if these guidelines are followed and what, if any, the differences are among races/ethnicities. The objective of this study was to examine beverage consumption to recommendations among children 0-5 months, 6-11 months, 12-23 months, 2-3 years, and 4-5 years. Additionally, examine how these beverage patterns associate with nutrient intake and to determine if differences exist in beverage consumption among race/ethnic groups (Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian) in children aged 0-23 months, 2-3 years, and 4-5 years.

METHODS

Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) for children 0-5 years were analyzed (n = 2445). Beverages were classified as follows; milk, 100% juice, diet beverages, sugar sweetened beverages (SSB), and water.

RESULTS

Our results show that regardless of race/ethnicity, dietary recommendation were not always followed. Prior to 6 months, 10% of infants consumed any amount of 100% juice; from 6 to 11 months, 17% of young children were drinking any amount of milk. SSB consumption rapidly increased with age, whereas intake of milk and 100% juice declined after 2 to 3 years of age. Non-Hispanic Black young children consumed the most 100% juice from 2 to 3 years and up, exceeding recommended amounts, and throughout all age groups they consumed the least milk and most SSBs. The decreased intake of nutrient-rich beverages with age was associated with lower intakes of under-consumed nutrients of public health concern. By 4-5 years, 32.7% and 93.8% of children were consuming

CONCLUSIONS

Dietary recommendations for both the introduction of beverages and amounts consumed were not consistently followed for American infants and children 0-5 years. Race/ethnic disparities exist in beverage consumption with Non-Hispanic Black children consuming the least amount of milk and most SSBs. Improving beverage consumption patterns could help improve overall diet quality which directly contributes to overall childhood health.

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Key Words

• 100% juice
• Beverage
• Children
• Ethnic disparities
• Infants
• Milk
• Nutrient intake
• Recommendations
• Sugar sweetened beverage

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MESH Headings

• Black or African American/statistics & numerical data
• Animals
• Beverages/statistics & numerical data
• Child, Preschool
• Diet/methods
• Ethnicity/statistics & numerical data
• Female
• Fruit and Vegetable Juices/statistics & numerical data
• Humans
• Infant
• Infant, Newborn
• Male
• Milk/statistics & numerical data
• Nutrition Surveys/statistics & numerical data
• United States
• White People/statistics & numerical data

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Grants

• National Dairy Council

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Affiliation(s)

Elieke Demmer National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Christopher J. Cifelli National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Jenny A. Houchins National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Victor L. Fulgoni Nutrition Impact, LLC, Battle Creek, MI 49014 USA

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Water Fluoridation and Dental Caries in U.S. Children and Adolescents

Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S.

POPULATION

This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Sugar Sweetened Beverage Consumption Among Adults With Children in the Home

Introduction: Consumption of sugar sweetened beverages (SSB)s has been linked with adult and childhood obesity, an increasing health burden in the United States. The aim of this study was to examine factors associated with the consumption of SSBs among Oklahoma adults with children in the home. Methods: A random sample of 1,118 Oklahoma adults with children in the home participated in a survey about their SSB consumption between August and October, 2015. We calculated weighted prevalence estimates and examined the relationship between types of SSBs consumed and covariates of interest using logistic regression techniques appropriate for survey data. Outcome variables included three categories of SSB consumption: consuming ≥1 sugar-sweetened sodas daily, consuming ≥1 other SSBs daily, and total daily SSB consumption, defined as ≥1 SSB of any kind. Heavy consumers were those who drank ≥3 SSBs per day. Results: Almost half (44%) of adults with children in the home consumed ≥1 total SSBs daily; 29% consumed ≥1 sugar-sweetened sodas and 28% consumed ≥1 other SSBs not including soda daily. The odds of consuming ≥1 SSBs daily was four times higher among those with a high school education or less (AOR = 4.06, 95% CI = 2.34, 7.04); almost three times higher for those who perceived their diet as somewhat healthy, or not very healthy (AOR = 2.72, 95% CI = 1.27, 5.82), more than double among those aged 18-34 years (AOR = 2.41, 95% CI = 1.08, 5.40), and almost double among those who consume <8 cups of water daily (AOR = 1.78, 95% CI = 1.06, 2.99). Conclusion: Because SSBs have been linked with obesity, understanding factors associated with consumption is important, especially among parents and caregivers of children. These findings have implications for developing and targeting messages to prevent SSB consumption among those most at risk.

Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs

PURPOSE OF REVIEW

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives.

RECENT FINDINGS

Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

The individual environment, not the family is the most important influence on preferences for common non-alcoholic beverages in adolescence

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.

Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries

We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m² (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m². Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.

Beverage consumption in Australian children

BACKGROUND/OBJECTIVES

While beverages are an important dietary source of water and some essential nutrients, consumption of sweet beverages has increasingly been linked to adverse health outcomes. Currently there is a paucity of longitudinal consumption data on beverage consumption in Australian children.

SUBJECTS/METHODS

The Longitudinal Study of Australian Children has run biennially since 2004. Twenty four-hour recall data collected over 6 waves from the birth cohort (aged 0-1 year at baseline) was analysed and demographics were assessed for associations.

RESULTS

Five thousand one hundred and seven children participated at baseline, with a 71-90% retention of participants at each wave. Water consumption remained consistent with age over time, with more than 90% consuming more than one glass in the last 24-h. Proportions of fruit juice consumers decreased overall. Soft drink and cordial consumer proportions increased from 1% (0-1 year), to 28% (2 years) and 43% (10 years). Between 2 and 10 years, proportions of consumption of full-cream milk decreased by 8% and for skim milk this proportion increased by 51%. High proportions of consumers of soft drink/cordial was significantly associated with older children, males, children with a medical condition, living in a rural area, low socio-economic status and Indigenous Australians.

CONCLUSIONS

Water consumption remained consistently high across the ages, while fruit juice was commonly introduced into the diet early childhood. While proportions of fruit juice consumers decreased after the age of 2 years, proportions of soft drink consumers increased. The findings from this study should assist with surveillance data and inform policy and interventions aimed at reducing consumption of sweet beverages.

Trends in Fast-Food and Sugar-Sweetened Beverage Consumption and Their Association with Social Environmental Status in South Korea

BACKGROUND

As South Korea has enjoyed rapid economic development, Koreans' diet, particularly consumption of fast food (FF) and sugar-sweetened beverages (SSBs), has changed.

OBJECTIVE

To examine time trends in FF and SSB consumption and their associations with social environmental status (SEnS) in South Korea.

DESIGN

Korean National Health and Nutrition Examination Surveys (KNHANES) were a series of population-based cross-sectional surveys.

PARTICIPANTS

Data from the KNHANES conducted in 1998, 2001, 2005, and 2007-2009 for 49,826 Koreans aged ≥1 year were used.

MAIN OUTCOME MEASURES

Consumption of FF and SSBs were assessed by a 24-hour recall. We defined two FF categories (Western-style and Korean-style) and one SSB category. Sex, age, household income, and residence regions were investigated.

STATISTICAL ANALYSES PERFORMED

The primary sampling units, strata, and sampling weights were taken into account using SAS survey-related procedures. Logistic regression models were used to test associations between SEnS and FF consumption.

RESULTS

Over an 11-year period, the proportion of participants' who consumed Western FF and SSBs on the surveyed day doubled (P<0.05). Per capita energy contribution from Western FF also increased in adults, men, and low-income groups. SSB consumption doubled (per capita: 32 to 82 kcal/day, only consumers: 123 to 166 kcal/day), but consumption of Korean-style FF decreased (P<0.05). Compared with the low-income rural resident group, the high-income urban resident group was much more likely to consume Western FF (OR=26.7[3.7, 193.4]) and SSBs (odds ratio [OR]=3.1 [2.4, 4.1]) in 1998. However, in recent years, the patterns changed; the high-income urban resident group was more likely to consume Korean-style FF (OR=2.0[1.3, 2.9]) and SSBs (OR=1.7[1.3, 2.1]).

CONCLUSIONS

In South Korea, people who reported consuming Western FF and SSBs on the surveyed day almost doubled during 1998-2009, whereas those who consumed Korean FF decreased. SEnS was related to FF and SSB consumption.

Dietary practices of quota and non-quota students at a Brazilian public university

Dietary practices of college students were described and examined according to the means by which they were admitted to the university (quota and non-quota students). A cross-sectional study was conducted with undergraduates (n = 1336) at a public university using a self-administered and identified questionnaire that inquired about their habits of eating breakfast and substituting lunch and/or dinner with snacks as well as the regular consumption (≥ 5 times a week) of markers for healthy and unhealthy eating. Analysis of the association between means of admission to the university and dietary practices was done using univariate and multivariate logistic regression models. It was observed that significant proportions of the students did not eat breakfast; substituted dinner with snacks; had low fruit, vegetable and bean consumption; and frequently consumed sugary beverages, sweets, cookies and packaged salty snacks. The quota students were found to more frequently consume beans, cookies and packaged salty snacks and less frequently substitute dinner with snacks and consume vegetables and fruits. Quota and non-quota students had some similarities in their dietary practices that were unhealthy. The differences observed between the two groups were largely more unfavorable for the quota students, with the exception of bean consumption.

Flavored Milk Consumers Drank More Milk and Had a Higher Prevalence of Meeting Calcium Recommendation Than Nonconsumers

BACKGROUND

Some schools are removing flavored milk because of the perception that it negatively impacts children's overall diet. This study assessed the contribution of flavored milk to their diets.

METHODS

Individual usual intakes (IUI) were calculated from 24-hour dietary recalls of children 2-18 years (N = 20,329) participating in National Health and Nutrition Examination Survey (NHANES) 2001-2012. IUI of >0.25 cup equivalent of flavored dairy milk defined consumers (N = 3564; 56% boys). Covariate-adjusted regression analyses using appropriate sample weights were calculated. Estimated Average Requirements (EAR) and Adequate Intakes (AI) determined the relation to dietary recommendations. Consumers were compared to nonconsumers (p ≤ .001).

RESULTS

Flavored milk consumers consumed more milk. Consumers aged 2-3 years had higher mean added sugars intakes. Consumers aged between 2-3 and 9-13 years had a higher saturated fat (SFA) intake. Consumers aged 14-18 years had higher percent energy from SFA. Consumers had a lower mean percentage of children meeting AI for fiber and a higher percentage meeting the EAR for calcium. Consumers aged 4-8 and 9-13 years had a higher mean percentage of children meeting the EAR for magnesium.

CONCLUSIONS

Consumption of flavored milk has the potential to increase milk consumption and reduce the percentage of children below the EAR for calcium; the percentage meeting AI for fiber was lower.

Consumption of Sugar-Sweetened Beverages in Mississippi: Is There A Disparity? Behavioral Risk Factor Surveillance System, 2012

Although consumption of sugar-sweetened beverages (SSBs) is a key contributor to epidemic obesity and has dramatically increased over the past decade in the United States, little is known about its prevalence and associated factors. Data from the 2012 Behavior Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of SSB consumption and to explore the associations between socio-demographic characteristics, behavioral factors and SSB intake in Mississippi (n = 7220). Descriptive statistics, Chi-square tests and logistic regressions were conducted using SAS Proc Survey procedures, to account for the BRFSS's multistage complex survey design and sample weights. Overall prevalence of self-reported daily SSB intake was 41.1%. Our findings showed that males (aOR = 1.4, 95% CI: 1.2-1.7, ref = female), blacks (aOR = 1.7, 95% CI: 1.4-2.1, ref = whites), adults aged 18-24 years (aOR = 5.0, 95% CI: 3.4-7.5, ref = 65 years or older), those with less than high school education (aOR = 1.9, 95% CI: 1.4-2.6, ref = college graduate), annual income <$25,000 (aOR = 1.3, 95% CI: 1.1-1.7, ref ≥ $50,000) and $25,000-49,999 (aOR = 1.3, 95% CI: 1.1-1.6, ref ≥ $50,000), those with no physical activity (OR = 1.3, 95% CI: 1.1-1.6, ref = physically active), daily smokers (aOR = 2.2, 95% CI: 1.7-2.7, ref = non-smokers), and those who reported eating at fast food or chain restaurants (aOR = 1.8, 95% CI: 1.2-2.5, ref = do not eat at fast food or chain restaurants) were more likely to consume SSBs, raising concerns about overweight and obesity in Mississippi.

Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review

Objective

To verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions.

Design

Systematic review of interventions targeting adolescents and/or the school environment.

Setting

The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials.

Subjects

Adolescents were defined as individuals between the ages of 12 and 17 years.

Results

A total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %).

Conclusions

School-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.

Consumption of milk and dairy products: Facts and figures

OBJECTIVES

Consumption of milk has been declining sharply in recent decades, particularly in developed countries. One of the reasons for this decline is the diagnosis or perception of lactose intolerance. The aim of this study was to investigate average consumption of milk and dairy products in the Campania region of Italy, one of the main producers of dairy products in the country.

METHODS

Individuals aged 18 to 75 y and living in Campania were invited to answer an online questionnaire regarding their average consumption of milk and dairy products. The questionnaire was posted on the public access hospital site, as well as on several Facebook pages of friends and hospital personnel.

RESULTS

The study found that 22.2% (260 of 1173) of responders from Campania do not drink milk, and 18.1% (213 of 1173) drink lactose-free milk, mainly because of gastrointestinal symptoms. The vast majority of the sample population chose to avoid consuming milk without undergoing the breath test for lactose intolerance or consulting a doctor. Women and underweight people drink more lactose-free milk than milk containing lactose. The population sample does not avoid dairy products; rather, they seem to be consumed quite frequently.

CONCLUSION

The data support the need for mandatory implementation of a nutritional campaign to increase understanding regarding, for example, unnecessary avoidance of milk and excessive consumption of cheese.

Adults Who Order Sugar-Sweetened Beverages: Sociodemographics and Meal Patterns at Fast Food Chains

INTRODUCTION

Approximately 30% of adults consume sugar-sweetened beverages (SSBs) daily, many at fast food restaurants. Researchers examined fast food purchases to better understand which consumers order SSBs, particularly large SSBs.

METHODS

Fast food customers in New York City and New Jersey provided receipts and participated in a survey during 2013-2014 (N=11,614). Logistic regression analyses predicted three outcomes: ordering no beverage or a non-SSB, a small/medium SSB, or a large SSB. Among respondents who ordered a beverage (n=3,775), additional analyses predicted number of beverage calories and odds of ordering an SSB. Covariates included demographic and behavioral factors.

RESULTS

Respondents aged 18-29 years were 88% more likely to order a large SSB than a non-SSB or no beverage, as compared with respondents aged ≥50 years (p<0.001). Among respondents who purchased a beverage, respondents ordered more beverage calories with a large combination meal (+85.13 kcal, p=0.001) or if the restaurant had a large cup size >30 ounces (+36.07 kcal, p=0.001). Hispanic and Asian respondents were less likely to order a large SSB (AOR=0.49 and 0.52, respectively, both p≤0.026) than non-Hispanic white respondents. Odds of ordering a large SSB were higher for respondents who ate in the restaurant (AOR=1.66, p<0.001) or stated that they chose beverage based on price (AOR=2.02, p<0.001).

CONCLUSIONS

Young adults and customers of restaurants with a larger cup size were more likely to purchase SSBs, and their beverage calories increased with meal size. Increased understanding of these factors is an important step toward limiting unhealthy SSB consumption.

Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow-up from the Blue Mountains Eye Study

BACKGROUND

The trend of added sugar (AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up.

METHODS

Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992-94 to 2007-09) using a 145-item food frequency questionnaire (FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling.

RESULTS

In men, the mean (SEM) percentage of energy provided by AS intake (EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up (P_trend = 0.028). Women's mean (SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively (P_trend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years (P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up (P_trend < 0.001).

CONCLUSIONS

An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians.

Frequent Consumption of Sugar- and Artificially Sweetened Beverages and Natural and Bottled Fruit Juices Is Associated with an Increased Risk of Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Disease Risk

BACKGROUND

The relation between the consumption of sweetened beverages and metabolic syndrome (MetS) is controversial.

OBJECTIVE

This analysis evaluated the associations between intakes of sugar-sweetened beverages (SSBs), artificially sweetened beverages, and natural and bottled fruit juices and the incidence of MetS in elderly individuals at high risk of cardiovascular disease (CVD) and without MetS at baseline.

METHODS

We prospectively examined 1868 participants free of MetS at baseline from the PREDIMED (PREvención con DIeta MEDiterránea) study. MetS was defined by using the updated harmonized criteria of the International Diabetes Federation, the American Heart Association, and National Heart, Lung, and Blood Institute. Energy and nutrient intakes were evaluated at baseline and then yearly by using a validated 137-item food-frequency questionnaire. Multivariable-adjusted HRs for MetS and its components were estimated from mean intakes during follow-up. We compared the 2 highest consumption categories (1-5 and >5 servings/wk) with the lowest category (<1 serving/wk).

RESULTS

A total of 930 incident cases of MetS were documented during a median follow-up of 3.24 y. When we compared consumption of >5 servings/wk with consumption of <1 serving/wk, multivariable HRs (95% CIs) for MetS incidence were 1.43 (1.00, 2.15), 1.74 (1.26, 2.41), 1.30 (1.00, 1.69), and 1.14 (1.04, 1.65) for SSBs, artificially sweetened beverages, natural fruit juices, and bottled fruit juices, respectively.

CONCLUSIONS

The occasional consumption of SSBs and artificially sweetened beverages (1-5 servings/wk) was not associated with the incidence of MetS in middle-aged and elderly individuals at high risk of CVD. The consumption of >5 servings/wk of all of the types of beverages analyzed was associated with an increased risk of MetS and some of its components. However, for SSBs and bottled fruit juices these associations must be interpreted with caution because of the low frequency of consumption in this population. This trial was registered at clinicaltrials.gov as ISRCTN35739639.

Mediating effects of dietary intake on associations of TV viewing, body mass index and metabolic syndrome in adolescents

Objective

Evidence suggests that TV viewing is associated with body mass index (BMI) and metabolic syndrome (MetS) in adolescents. However, it is unclear whether dietary intake mediates these relationships.

Methods

A cross‐sectional analysis was conducted in adolescents (12–19 years) participating in the 2003–2006 United States National Health and Nutrition Examination Survey. BMI z scores (zBMI) (n = 3,161) and MetS (n = 1,379) were calculated using age‐ and sex‐specific criteria for adolescents. TV viewing (h/day) was measured via a self‐reported questionnaire, and dietary intake was assessed using two 24‐h recalls. Using the MacKinnon method, a series of mediation analyses were conducted examining five dietary mediators (total energy intake, fruit and vegetable intake, discretionary snacks, sugar‐sweetened beverages and diet quality) of the relationships between TV viewing and zBMI and MetS.

Results

Small positive relationships were observed between TV viewing and zBMI (β = 0.99, p < 0.001) and TV viewing and MetS (OR = 1.18, p = 0.046). No dietary element appeared to mediate the relationship between TV viewing and zBMI. However, sugar‐sweetened beverage consumption and fruit and vegetable intake partially mediated the relationship between TV viewing and MetS, explaining 8.7% and 4.1% of the relationship, respectively.

Conclusions

These findings highlight the complexity of the relationships between TV viewing, dietary intake and cardiometabolic health outcomes, and that TV viewing should remain a target for interventions.

Beverage Consumption Patterns and Micronutrient and Caloric Intake from Beverages in Older Adults with Mild Cognitive Impairment

The purpose of this study was to determine total water intake and patterns of beverage consumption, and its contribution to total daily micronutrients and calories in older adults with mild memory decline. A descriptive, cross-sectional study was used with 60 independent community-dwelling older adults (71.7 ± 5.4 years) with mild cognitive impairment, who were mostly female, well-educated, and white. Three-day food records were analyzed using the Nutrition Data Systems for Research. Descriptive statistics were conducted for a summary of demographics, the average intakes of beverages, and the contribution of beverages to total calorie and micronutrient intakes. Total daily water intake was 53.6 ± 26.7 fl oz and milk, plain water, and tea/coffee were beverages consumed most frequently. Beverage consumption contributed substantially to the intake of vitamin D (29.4%), calcium (26.4%), riboflavin (22.0%), magnesium (18.9%), and vitamin C (18.1%), but constituted only ∼12.5% of total energy. These findings suggest that nutrient-dense beverages play a fundamental role in overall micronutrient intake, despite comprising a small component of daily caloric intake. Incorporating adequate amounts of such beverages in meals and snacks may help older adults meet their nutrient recommendations.