Sugar-sweetened beverage consumption and association with weight status in Irish children: a cross-sectional study prior to the introduction of a government tax on sugar-sweetened beverages

Association of Sugar-Sweetened Beverage Consumption and Moderate-to-Vigorous Physical Activity with Childhood and Adolescent Overweight/Obesity: Findings from a Surveillance Project in Jiangsu Province of China

Sugar-sweetened beverage (SSB) consumption and inadequate moderate-to-vigorous physical activity (MVPA) have been suggested as potential contributors to overweight/obesity during childhood or adolescence; however, the results of previous studies are inconsistent. It was crucial to estimate the independent and joint association of SSB consumption and inadequate MVPA for childhood and adolescent overweight/obesity. The "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2021-2022" initiative provided us with representative population-based data that we studied. SSB consumption and inadequate MVPA were determined by self-reported SSB habit and MVPA frequency (days/week). The body mass index for each gender and age subgroup was used to identify those who were overweight or obese. With stratified analyses to ascertain differences in age or gender, we employed the logistic regression model to assess the association of SSB and MVPA with overweight/obesity and applied the likelihood ratio test to explore the interactions. Approximately 38.2% of the study population (119,467 students aged 8-17) were overweight/obese. After adjusting covariates, SSB consumption or inadequate MVPA was associated with overweight/obesity (OR = 1.05, 95% CI = 1.02-1.07; and OR = 1.07, 95% CI = 1.03-1.10). In comparison to students with "no SSB consumption and adequate MVPA", those with "SSB consumption and inadequate MVPA" had a higher risk of being overweight/obese (OR = 1.13, 95% CI = 1.08-1.18). Regardless of age and gender subgroups, the correlation of SSB and MVPA alone and together with being overweight/obese was generally similar, with the adolescent group aged 13-17 years (OR = 1.15, 95% CI = 1.09-1.22) and females (OR = 1.09, 95% CI = 1.02-1.17) being more susceptible. Moreover, there was a significant interaction between SSB consumption and gender (p < 0.001), as well as between SSB consumption and inadequate MVPA (p = 0.008). Hence, SSB consumption in students is significantly associated with overweight/obesity, especially when MVPA is inadequate. In light of the rapidly expanding childhood and adolescent obesity epidemic, proper attention should be given to these modifiable behaviors, particularly SSB and MVPA.

An umbrella review of the effectiveness of fiscal and pricing policies on food and non-alcoholic beverages to improve health

Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review of the effectiveness of FPs on food and non-alcoholic beverages in influencing health or intermediate outcomes like consumption. We considered FPs applied to an entire population within a jurisdiction and included four systematic reviews in our final sample. Quality appraisal, an examination of excluded reviews, and a literature review of recent primary studies assessed the robustness of our results. Taxes and, to some extent, subsidies are effective in changing consumption of taxed/subsidized items; however, substitution is likely to occur. There is a lack of RWE supporting the effectiveness of FPs in improving health but this does not mean that they are ineffective. FPs may be important for improving health but their design is critical. Poorly designed FPs may fail to improve health and could reduce support for such policies or be used to support their repeal. More high-quality RWE on the impact of FPs on health is needed.

Sugar-sweetened beverages intake and the risk of obesity in children: An updated systematic review and dose-response meta-analysis

BACKGROUND

The prevalence of childhood obesity has increased worldwide and has reached alarming proportions. Contradictive results from studies and reviews have fuelled an endless debate on the role of SSBs in the development of childhood obesity.

OBJECTIVE

This study aimed to assess the impact of sugar-sweetened beverages (SSBs) intake on body mass index (BMI), body fat percentage (BFP), and waist circumference (WC) among children.

METHODS

Databases including PubMed/MEDLINE, Scopus, Cochrane Library, EMBASE, and Web of Science were searched up to August 2021. Observational studies reporting the relation between SSBs intake and BMI, BFP, and WC were included. STATA version 15 was used to analyse the data.

RESULTS

In this meta-analysis, 33 studies with 121 282 subjects were included. Excessive SSBs intake was associated with 0.75 kg/m² increase in BMI in children and adolescents (WMD: 0.75; CI 0.35-1.15; p < 0.001). In addition, high SSBs intake was significantly associated with higher WC (WMD: 2.35 cm; 95% CI, 1.34, 3.37; p = 0.016) and BFP (WMD: 2.81; CI 2.21-3.41; p < 0.001). No departure from linearity was detected in dose-response meta-analysis between SSBs consumption and changes in BMI, WC, and BFP.

CONCLUSION

High SSBs consumption was associated with increased BMI, WC, and BFP among children and adolescents. Further large prospective long-term interventions are recommended to confirm the observed relationships.

Examining the policy process of sugar-sweetened beverage taxation in Ireland

Sugar sweetened beverages (SSBs) are a growing source of weight gain, obesity, and type 2 diabetes that contain high added sugar amounts and provide minimal nutritional benefit. Taxing SSBs are effective in reducing sugar consumption and increasing awareness about health effects. The 2014 European Union Action Plan on Childhood Obesity combined with neighboring SSB tax proposals in the U.K. and France helped stimulate political discussions in Ireland. Following this momentum, in 2015, public health groups lead by the Irish Heart Foundation proposed an SSB tax with earmarked funds for public health and worked with the Irish Health Department through a whole-of-government approach to convince the Finance Department to introduce an SSB tax. These efforts resulted in the Finance Department proposing the Sugar Sweetened Drinks Tax (SSDT) in September 2016, which taxes non-alcoholic, water-based and juice-based drinks, which have an added sugar content of 5g per 100mL and above. Opposing stakeholders including the Irish Beverage Council and Food & Drink Industry Ireland argued that the tax would not decrease consumption of SSBs or impact obesity, disproportionately impact individuals with a low socioeconomic background, and create illicit trade. However, health groups argued the tax would reduce sugar consumption, encourage consumers to purchase healthier options, and help reduce obesity levels. These efforts with political will helped Ireland become the 36th country in the world (9th in Europe) to implement an SSB tax policy in May 2018. While the government reportedly raised €16.5 million (20.012 million USD) in 2018 and €33 million (40.024 million USD) in 2019 from the SSDT, the tax was not earmarked for public health purposes nor has it been evaluated despite multiple requests by public health groups representing an important missed opportunity. While other countries should follow Ireland's lead in enacting an SSB tax, it is important to evaluate the tax's impact on reducing sugar consumption and ensure the tax has earmarked funds for public health to further maximize the impact of reducing sugar consumption, promoting health equity and helping curb the NCD epidemic.

Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence

Sugar is widely consumed over the world. Although the mainstream view is that high added or free sugar consumption leads to obesity and related metabolic diseases, controversies exist. This narrative review aims to highlight important findings and identify major limitations and gaps in the current body of evidence in relation to the effect of high sugar intakes on health. Previous animal studies have shown that high sucrose or fructose consumption causes insulin resistance in the liver and skeletal muscle and consequent hyperglycemia, mainly because of fructose-induced de novo hepatic lipogenesis. However, evidence from human observational studies and clinical trials has been inconsistent, where most if not all studies linking high sugar intake to obesity focused on sugar-sweetened beverages (SSBs), and studies focusing on sugars from solid foods yielded null findings. In our opinion, the substantial limitations in the current body of evidence, such as short study durations, use of supraphysiological doses of sugar or fructose alone in animal studies, and a lack of direct comparisons of the effects of solid compared with liquid sugars on health outcomes, as well as the lack of appropriate controls, seriously curtail the translatability of the findings to real-world situations. It is quite possible that "high" sugar consumption at normal dietary doses (e.g., 25% daily energy intake) per se-that is, the unique effect of sugar, especially in the solid form-may indeed not pose a health risk for individuals apart from the potential to reduce the overall dietary nutrient density, although newer evidence suggests "low" sugar intake (<5% daily energy intake) is just as likely to be associated with nutrient dilution. We argue the current public health recommendations to encourage the reduction of both solid and liquid forms of free sugar intake (e.g., sugar reformulation programs) should be revised due to the overextrapolation of results from SSBs studies.

Sugar-Sweetened Beverage Consumption Status and Its Association with Childhood Obesity among Chinese Children Aged 6-17 Years

Objective: There is a remarkable growth in sugar-sweetened (SSB) production and obesity prevalence among school-aged children in China. This paper describes SSB consumption and its association with obesity among Chinese children aged 6–17 years in 2012. Methods: in total, 25,553 children aged 6~17 years enrolled in the China Nutrition and Health Surveillance 2010–2013 were included in this study. Data of SSB consumption frequency and quantity were obtained from a food frequency questionnaire, and the children’s nutritional status was assessed. Multivariate logistic regression was used to evaluate the association between SSB consumption and obesity status. Results: SSB intake was estimated as 181.0 g/day, occurring 2.2 times/week. Older children, males, children from urban areas, and children with higher socioeconomic status were more likely to consume SSBs. Children who consumed SSBs 1~<5 times/week (11.7%) and >5 times/week (12.9%) were more likely to be overweight/obesity than those who consumed SSBs less than once/week. Conclusion: SSB consumption was common among Chinese school-aged children, especially among males, older children, and children from urban areas. High consumption of SSBs was associated with a higher prevalence of overweight/obesity. Actions and plans are required to reduce SSB consumption and control childhood obesity in China.