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Daniel-Weiner R, Cardel MI, Skarlinski M, Goscilo A, Anderson C, Foster GD. Enabling Informed Decision Making in the Absence of Detailed Nutrition Labels: A Model to Estimate the Added Sugar Content of Foods. Nutrients 2023; 15:nu15040803. [PMID: 36839162 PMCID: PMC9961734 DOI: 10.3390/nu15040803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world's population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.
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Affiliation(s)
- Reka Daniel-Weiner
- WW International, Inc., New York, NY 10100, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | - Michelle I. Cardel
- WW International, Inc., New York, NY 10100, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL 32611, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | | | | | | | - Gary D. Foster
- WW International, Inc., New York, NY 10100, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Davies T, Louie JCY, Ndanuko R, Barbieri S, Perez-Concha O, Wu JHY. A Machine Learning Approach to Predict the Added-Sugar Content of Packaged Foods. J Nutr 2022; 152:343-349. [PMID: 34550390 DOI: 10.1093/jn/nxab341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dietary guidelines recommend limiting the intake of added sugars. However, despite the public health importance, most countries have not mandated the labeling of added-sugar content on packaged foods and beverages, making it difficult for consumers to avoid products with added sugar, and limiting the ability of policymakers to identify priority products for intervention. OBJECTIVE The aim was to develop a machine learning approach for the prediction of added-sugar content in packaged products using available nutrient, ingredient, and food category information. METHODS The added-sugar prediction algorithm was developed using k-nearest neighbors (KNN) and packaged food information from the US Label Insight dataset (n = 70,522). A synthetic dataset of Australian packaged products (n = 500) was used to assess validity and generalization. Performance metrics included the coefficient of determination (R2), mean absolute error (MAE), and Spearman rank correlation (ρ). To benchmark the KNN approach, the KNN approach was compared with an existing added-sugar prediction approach that relies on a series of manual steps. RESULTS Compared with the existing added-sugar prediction approach, the KNN approach was similarly apt at explaining variation in added-sugar content (R2 = 0.96 vs. 0.97, respectively) and ranking products from highest to lowest in added-sugar content (ρ = 0.91 vs. 0.93, respectively), while less apt at minimizing absolute deviations between predicted and true values (MAE = 1.68 g vs. 1.26 g per 100 g or 100 mL, respectively). CONCLUSIONS KNN can be used to predict added-sugar content in packaged products with a high degree of validity. Being automated, KNN can easily be applied to large datasets. Such predicted added-sugar levels can be used to monitor the food supply and inform interventions aimed at reducing added-sugar intake.
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Affiliation(s)
- Tazman Davies
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jimmy Chun Yu Louie
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Rhoda Ndanuko
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Oscar Perez-Concha
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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3
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Flieh SM, Moreno LA, Miguel-Berges ML, Stehle P, Marcos A, Molnár D, Widhalm K, Béghin L, De Henauw S, Kafatos A, Leclercq C, Gonzalez-Gross M, Dallongeville J, Molina-Hidalgo C, González-Gil EM. Free Sugar Consumption and Obesity in European Adolescents: The HELENA Study. Nutrients 2020; 12:nu12123747. [PMID: 33291491 PMCID: PMC7762126 DOI: 10.3390/nu12123747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022] Open
Abstract
Few studies have evaluated the association between dietary free sugars intake (FSI) and obesity in adolescents. We examined the relation between FSI and their contributors from the main food groups and obesity in European adolescents. We included 843 adolescents (51.6% male) from the cross-sectional HELENA study with two completed 24 h recalls and anthropometric data. Linear mixed models were applied to investigate the relation between FSI and different anthropometric indices. Odds ratios for having a high body mass index (BMI) were also estimated by multilevel ordinal regression. Total FSI was higher in males than females (102.60 g and 87.58 g, respectively, p < 0.001). No effect was observed between free sugar from the main food groups and BMI. Consumers of FSI from "cakes, pies and biscuits" in males (odd ratio (OR) = 0.455; 95% Confidence interval (CI) 0.251, 0.824) and from "breakfast cereals" in females had a lower probability of having obesity (OR = 0.423; 95%CI 0.204, 0.878), whereas females consuming FSI from 'fruit and vegetables juices' had a higher probability of obesity (OR= 2.733; 95% CI 1.286, 5.810). This study provides no evidence that increased FSI is associated with obesity in adolescents. Further studies are needed to assess the longitudinal exposure to FSI and their effect on obesity development.
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Affiliation(s)
- Sondos M. Flieh
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Correspondence:
| | - María L. Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, D-53115 Bonn, Germany;
| | - Ascensión Marcos
- Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), 28040 Madrid, Spain;
| | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Kurt Widhalm
- Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Laurent Béghin
- Inserm, U1286—INFINITE—Clinical Investigation Center—Institute for Translational Research in Inflammation and CIC 1403, University Lille, CHU Lille, F-59000 Lille, France;
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Anthony Kafatos
- Faculty of Medicine, University of Crete, GR-71003 Crete, Greece;
| | - Catherine Leclercq
- Food and Nutrition Research Centre—Council for Agricultural Research and Economics, 00198 Rome, Italy;
| | - Marcela Gonzalez-Gross
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Jean Dallongeville
- Department of Epidemiology and Public Health, Institut Pasteur de Lille, 59000 Lille, France;
| | - Cristina Molina-Hidalgo
- EFFECTS 262, Department of Physiology, Faculty of Medicine, University of Granada, 18016 Granada, Spain;
| | - Esther M. González-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; (S.M.F.); (M.L.M.-B.); (E.M.G.-G.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Center of Biomedical Research (CIBM), Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, University of Granada, 18071 Granada, Spain
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Amoutzopoulos B, Steer T, Roberts C, Cole D, Collins D, Yu D, Hawes T, Abraham S, Nicholson S, Baker R, Page P. A Disaggregation Methodology to Estimate Intake of Added Sugars and Free Sugars: An Illustration from the UK National Diet and Nutrition Survey. Nutrients 2018; 10:E1177. [PMID: 30154337 PMCID: PMC6164377 DOI: 10.3390/nu10091177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
Various and inconsistent definitions for free and added sugars are used in the consideration and assessment of dietary intakes across public health, presenting challenges for nutritional surveillance, research, and policy. Furthermore, analytical methods to identify those sugars which are not naturally incorporated into the cellular structure of foods are lacking, thus free and added sugars are difficult to estimate in an efficient and accurate way. We aimed to establish a feasible and accurate method that can be applied flexibly to different definitions. Based on recipe disaggregation, our method involved five steps and showed good repeatability and validity. The resulting Free Sugars Database provided data for seven components of sugars; (1) table sugar; (2) other sugars; (3) honey; (4) fruit juice; (5) fruit puree; (6) dried fruit; and (7) stewed fruit, for ~9000 foods. Our approach facilitates a standardized and efficient assessment of added and free sugars, offering benefit and potential for nutrition research and surveillance, and for the food industry, for example to support sugar reduction and reformulation agendas.
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Affiliation(s)
| | - Toni Steer
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Caireen Roberts
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
- NatCen Social Research, London EC1V 0AX, UK.
| | - Darren Cole
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - David Collins
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Dove Yu
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Tabitha Hawes
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | | | | | - Ruby Baker
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Polly Page
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
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Mesana MI, Hilbig A, Androutsos O, Cuenca-García M, Dallongeville J, Huybrechts I, De Henauw S, Widhalm K, Kafatos A, Nova E, Marcos A, González-Gross M, Molnar D, Gottrand F, Moreno LA. Dietary sources of sugars in adolescents' diet: the HELENA study. Eur J Nutr 2018; 57:629-641. [PMID: 27896443 DOI: 10.1007/s00394-016-1349-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report dietary sugars consumption and their different types and food sources, in European adolescents. METHODS Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders. RESULTS Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was 'carbonated, soft and isotonic drinks,' followed by 'non-chocolate confectionary' and 'sugar, honey, jam and syrup.' Older boys and girls had significantly higher intakes of free sugars from 'cakes, pies and biscuits.' Free sugars intake was negatively associated with low socioeconomic status for 'non-chocolate confectionary' and 'sugar, honey and jam' groups; with low maternal educational level for carbonated and 'soft drinks,' 'sugar, honey and jam,' 'cakes and pies' and 'breakfast cereals' groups; and with high paternal educational level for 'carbonated and soft drinks' and 'chocolates' group. CONCLUSIONS The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.
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Affiliation(s)
- M I Mesana
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.
- Instituto Agroalimentario de Aragón (IA2), Saragossa, Spain.
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain.
- Red de Salud Materno-infantil y del Desarrollo (SAMID), Madrid, Spain.
| | - A Hilbig
- Research Institute of Child Nutrition (FKE), Dortmund, Germany
| | - O Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - M Cuenca-García
- Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
- GALENO Research Group, Department of Physical Education, School of Education, University of Cadiz, Puerto Real, Spain
| | - J Dallongeville
- Service d'Epidémiologie et Santé Publique - INSERM U1167 Institut Pasteur de Lille, Lille, France
| | - I Huybrechts
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - S De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - K Widhalm
- Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - A Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - E Nova
- Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - A Marcos
- Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - M González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Technical University of Madrid, Madrid, Spain
- Institut für Ernährungs- und Lebensmittelwissenschaften - Ernährungphysiologie, Rheinische Friedrich Wilhelms Universität, Bonn, Germany
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - D Molnar
- Department of Paediatrics, Medical Faculty, University of Pécs, Pecs, Hungary
| | - F Gottrand
- Lille Inflammation Research International Center (LIRIC) UMR 995 Inserm, University of Lille, CHU Lille, 59000, Lille cedex, France
| | - L A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain
- Instituto Agroalimentario de Aragón (IA2), Saragossa, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
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Whybrow S, Craig L, Macdiarmid JI. Dietary patterns of households in Scotland: Differences by level of deprivation and associations with dietary goals. Nutr Health 2017; 24:29-35. [PMID: 29224459 DOI: 10.1177/0260106017745389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Foods tend to be consumed in combinations, and dietary pattern analysis and diet-quality scores are often more appropriate methods of assessing overall diet quality than is intakes of individual foods or nutrients. AIM The aim of this study was to evaluate dietary patterns from the food and drink purchases of households in Scotland, and to identify any dietary patterns that were associated with closer adherence to the Revised Dietary Goals for Scotland (RDGS). METHODS We carried out a cross-sectional study of estimated food and drink intakes using Kantar WorldPanel household purchase data in Scotland collected during 2012. The amounts of food and drink purchased were converted to estimated amounts available for consumption per person by adjusting for household waste, household size and composition ( n = 720). Dietary patterns were identified using principal components analysis. A Diet Quality Index (DQI), based on the RDGS, was calculated. RESULTS The mean DQI score was low at 38 out of a possible maximum of 100, indicating that, on average, few of the dietary goals were being met. Six dietary patterns were identified, which explained 35% of the total variance in estimated food and drink intake. Three dietary patterns showed statistically significant associations with lower DQI scores (less healthy diets), and one with significantly higher DQI scores (healthier diets). CONCLUSIONS Investigating dietary patterns to show which foods tend to be purchased together may assist in targeting dietary habits by focussing on key food groups, and in gaining the greatest improvement in diet quality from the most achievable change in diet.
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Affiliation(s)
- S Whybrow
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lca Craig
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, UK
| | - J I Macdiarmid
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, UK
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Moynihan P, Makino Y, Petersen PE, Ogawa H. Implications of WHO Guideline on Sugars for dental health professionals. Community Dent Oral Epidemiol 2017; 46:1-7. [PMID: 29168887 DOI: 10.1111/cdoe.12353] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
The burden of oral disease is high in populations across the world. This is because of high consumption of free sugars. The WHO Guideline on Sugars Intake for Adults and Children recommended limiting free sugars to no more than 5% energy intake to protect oral health throughout the life-course. The objectives of this paper are to consider the implications of the Guideline for dental health practice and to advocate use of the common risk factor approach when providing dietary advice. As part of a broad range of actions needed to reduce free sugars intake, improved education for dental health professionals and supporting patients to eat less free sugars are key actions for the dental profession. All dental health professionals should have the skills and confidence to provide their patients with healthier eating advice, including how to limit free sugars intake. It is therefore important that dental health professionals receive adequate education in diet and nutrition, and there is a need for dental educational regulating bodies to define the content of the dental curriculum with respect to nutrition. All patients, or their parents or carers, should receive dietary advice to reduce free sugars within the context of a healthy diet for the prevention of all NCDs. Dietary advice should: (i) focus on reducing the amount of free sugars consumed; (ii) be tailored according to the patient's body mass status (eg underweight, overweight, normal weight); (iii) encourage the consumption of fresh fruits and vegetables, nuts, seeds, and wholegrain starch-rich foods; (iv) discourage the consumption of foods high in saturated fat and salt; and (v) discourage the consumption of all drinks containing free sugars. The dental health professional has an opportunity to support patients to reduce their intake of free sugars-such advice and support will have positive impacts beyond the mouth.
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Affiliation(s)
- Paula Moynihan
- School of Dental Sciences, Centre for Oral Health Research, WHO Collaborating Centre for Nutrition and Oral Health, Newcastle University, Newcastle, UK.,Oral Health Programme, WHO Headquarters, Geneva, Switzerland
| | - Yuka Makino
- Oral Health Programme, WHO Headquarters, Geneva, Switzerland
| | - Poul Erik Petersen
- Oral Health Programme, WHO Headquarters, Geneva, Switzerland.,Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, Oral Health Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Hiroshi Ogawa
- Oral Health Programme, WHO Headquarters, Geneva, Switzerland.,Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, WHO Collaborating Centre for Translation of Oral Health Science, Niigata, Japan
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Impact of liver fat on the differential partitioning of hepatic triacylglycerol into VLDL subclasses on high and low sugar diets. Clin Sci (Lond) 2017; 131:2561-2573. [PMID: 28923880 PMCID: PMC6365592 DOI: 10.1042/cs20171208] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/11/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023]
Abstract
Dietary sugars are linked to the development of non-alcoholic fatty liver disease (NAFLD) and dyslipidaemia, but it is unknown if NAFLD itself influences the effects of sugars on plasma lipoproteins. To study this further, men with NAFLD (n = 11) and low liver fat ‘controls’ (n = 14) were fed two iso-energetic diets, high or low in sugars (26% or 6% total energy) for 12 weeks, in a randomised, cross-over design. Fasting plasma lipid and lipoprotein kinetics were measured after each diet by stable isotope trace-labelling. There were significant differences in the production and catabolic rates of VLDL subclasses between men with NAFLD and controls, in response to the high and low sugar diets. Men with NAFLD had higher plasma concentrations of VLDL1-triacylglycerol (TAG) after the high (P<0.02) and low sugar (P<0.0002) diets, a lower VLDL1-TAG fractional catabolic rate after the high sugar diet (P<0.01), and a higher VLDL1-TAG production rate after the low sugar diet (P<0.01), relative to controls. An effect of the high sugar diet, was to channel hepatic TAG into a higher production of VLDL1-TAG (P<0.02) in the controls, but in contrast, a higher production of VLDL2-TAG (P<0.05) in NAFLD. These dietary effects on VLDL subclass kinetics could be explained, in part, by differences in the contribution of fatty acids from intra-hepatic stores, and de novo lipogenesis. The present study provides new evidence that liver fat accumulation leads to a differential partitioning of hepatic TAG into large and small VLDL subclasses, in response to high and low intakes of sugars.
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9
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Whybrow S, Hollis JL, Macdiarmid JI. Social deprivation is associated with poorer adherence to healthy eating dietary goals: analysis of household food purchases. J Public Health (Oxf) 2017; 40:e8-e15. [DOI: 10.1093/pubmed/fdx007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/10/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Whybrow
- Rowett Institute of Nutrition and Health,
University of Aberdeen, UK
| | - J L Hollis
- Rowett Institute of Nutrition and Health,
University of Aberdeen, UK
| | - J I Macdiarmid
- Rowett Institute of Nutrition and Health,
University of Aberdeen, UK
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10
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Markey O, Le Jeune J, Lovegrove JA. Energy compensation following consumption of sugar-reduced products: a randomized controlled trial. Eur J Nutr 2016; 55:2137-49. [PMID: 26349919 PMCID: PMC5009173 DOI: 10.1007/s00394-015-1028-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 08/26/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Consumption of sugar-reformulated products (commercially available foods and beverages that have been reduced in sugar content through reformulation) is a potential strategy for lowering sugar intake at a population level. The impact of sugar-reformulated products on body weight, energy balance (EB) dynamics and cardiovascular disease risk indicators has yet to be established. The REFORMulated foods (REFORM) study examined the impact of an 8-week sugar-reformulated product exchange on body weight, EB dynamics, blood pressure, arterial stiffness, glycemia and lipemia. METHODS A randomized, controlled, double-blind, crossover dietary intervention study was performed with fifty healthy normal to overweight men and women (age 32.0 ± 9.8 year, BMI 23.5 ± 3.0 kg/m(2)) who were randomly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks, separated by 4-week washout period. Body weight, energy intake (EI), energy expenditure and vascular markers were assessed at baseline and after both interventions. RESULTS We found that carbohydrate (P < 0.001), total sugars (P < 0.001) and non-milk extrinsic sugars (P < 0.001) (% EI) were lower, whereas fat (P = 0.001) and protein (P = 0.038) intakes (% EI) were higher on the sugar-reduced than the regular diet. No effects on body weight, blood pressure, arterial stiffness, fasting glycemia or lipemia were observed. CONCLUSIONS Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation.
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Affiliation(s)
- Oonagh Markey
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
- Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
| | - Julia Le Jeune
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK.
- Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK.
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Reliability of a systematic methodology to estimate added sugars content of foods when applied to a recent Australian food composition database. J Food Compost Anal 2016. [DOI: 10.1016/j.jfca.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Evaluation of a nutrient-based diet quality index in UK young children and investigation into the diet quality of consumers of formula and infant foods. Public Health Nutr 2015; 19:1785-94. [PMID: 26522249 DOI: 10.1017/s1368980015003134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To adapt and evaluate a nutrient-based diet quality index (PANDiet) for UK young children and to determine the nutritional adequacy of their diets according to consumption of young child formula (YCF) and commercial infant foods (CIF). DESIGN Content and construct validity of the PANDiet were assessed by studying associations between the PANDiet and its components, energy intake, food intakes, and child and maternal characteristics. Four groups of children were defined according to their intake of YCF and CIF: (i) no consumption; (ii) consumption of YCF; (iii) consumption of CIF; and (iv) consumption of YCF and CIF. Child and maternal characteristics, PANDiet scores and food intakes of these four groups were compared. SETTING Secondary analysis of data from the UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC, 2011). SUBJECTS Young children (n 1152) aged 12-18 months. RESULTS The PANDiet was adapted to the UK based on twenty-five nutrients. A lower PANDiet score was linked to lower intakes of YCF, CIF, vegetables and fruits. Determinants of having a lower score were being older, having siblings and having a younger mother with a lower educational level. Compared with children consuming neither YCF nor CIF, PANDiet scores were higher in children consuming CIF (+1·4), children consuming YCF (+7·2) and children consuming YCF and CIF (+7·8; all P<0·001). CONCLUSIONS The PANDiet is a valid indicator of the nutrient adequacy of the diet of UK young children. Consuming CIF was not found to be associated with lower nutritional adequacy whereas consuming YCF was associated with higher nutritional adequacy.
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Newens KJ, Walton J. A review of sugar consumption from nationally representative dietary surveys across the world. J Hum Nutr Diet 2015; 29:225-40. [PMID: 26453428 PMCID: PMC5057348 DOI: 10.1111/jhn.12338] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Government and health organisations worldwide have recently reviewed the evidence on the role of dietary sugars in relation to health outcomes. Hence, it is timely to review current intakes of dietary sugars with respect to this guidance and as a benchmark for future surveillance. METHODS This review collates data from nationally representative dietary surveys across the world and reports estimates of intakes of total and added sugars, and sucrose in different population subgroups. Total sugars includes all mono- and disaccharides; namely, glucose, fructose, lactose, sucrose and maltose. Added and free sugars differ in the quantity of natural sugars included in their definitions. Free sugars include sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates, whereas added sugars typically only refer to those added during processing. RESULTS Most countries reported intakes of total sugars, with fewer reporting intakes of added sugars and sucrose. No country reported intakes of free sugars. The available data suggest that total sugars as a percentage of energy were highest in the infant (<4 years), with mean values ranging from 20.0% to 38.4%, and decreased over the lifespan to 13.5-24.6% in adults. Intakes of added sugars were higher in school-aged children and adolescents (up to 19% of total energy) compared to younger children or adults. CONCLUSIONS Further research into the dietary patterns contributing to added sugars intake in children and adolescents is warranted. It would also be beneficial to policy guidance if future dietary surveys employed a uniform way of expressing sugars that is feasible to measure and has public health significance.
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Affiliation(s)
- K J Newens
- Sugar Nutrition UK, Somerset House, Strand, London, UK
| | - J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Louie JCY, Tapsell LC. Association between intake of total vs added sugar on diet quality: a systematic review. Nutr Rev 2015; 73:837-57. [PMID: 26449366 DOI: 10.1093/nutrit/nuv044] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Given its potential effect on nutrient and energy density, the sugar content of the diet is a subject of controversy. OBJECTIVE The aim of this review was to examine the cross-sectional or prospective evidence for associations between the intake of total sugar or added sugar (high vs low intakes) and diet quality or nutrient intakes in the general population. DATA SOURCES The following databases were searched for English-language articles published between 1972 and 2012: CINAHL Plus, EBM Reviews, ERIC, MEDLINE, PREMEDLINE, PsycINFO, PubMed, and ScienceDirect. STUDY SELECTION The search identified studies that examined the association between intake of total sugar and/or added sugar and diet quality (n = 22) or nutrient intakes (n = 30). DATA EXTRACTION The following data were extracted: sample size and population, dietary assessment method, source of added sugar data, source of funding, comparator, association between total sugar or added sugar and diet quality, and the direction and magnitude of the association. DATA SYNTHESIS Of 22 studies, all except 1 found a higher intake of added sugar to be associated with poorer diet quality, and the exceptional study did not adjust for total energy intake. Twenty-one of 30 studies found a negative association between added sugar and micronutrient intakes. The same association was not found for total sugar intake. CONCLUSION Any negative association between dietary sugar and diet quality is better exposed by referring to added sugar rather than total sugar. There was substantial variation in features of study quality, including sample size, so the magnitude of the observed effect was generally small and may not be of clinical significance. Furthermore, the positive influence that core foods such as fruit and milk exert on total sugar values may bias the association between total sugar and diet quality.
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Affiliation(s)
- Jimmy Chun Yu Louie
- J.C.Y. Louie and L.C. Tapsell are with the School of Medicine, Faculty of Science, Medicine and Health, The University of Wollongong, Australia.J.C.Y. Louie is with the School of Molecular Bioscience, Faculty of Science, The University of Sydney, Australia.
| | - Linda C Tapsell
- J.C.Y. Louie and L.C. Tapsell are with the School of Medicine, Faculty of Science, Medicine and Health, The University of Wollongong, Australia.J.C.Y. Louie is with the School of Molecular Bioscience, Faculty of Science, The University of Sydney, Australia
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Abstract
Estimating trends in dietary intake data is integral to informing national nutrition policy and monitoring progress towards dietary guidelines. Dietary intake of sugars is a controversial public health issue and guidance in relation to recommended intakes is particularly inconsistent. Published data relating to trends in sugars intake are relatively sparse. The purpose of the present review was to collate and review data from national nutrition surveys to examine changes and trends in dietary sugars intake. Only thirteen countries (all in the developed world) appear to report estimates of sugars intake from national nutrition surveys at more than one point in time. Definitions of dietary sugars that were used include 'total sugars', 'non-milk extrinsic sugars', 'added sugars', sucrose' and 'mono- and disaccharides'. This variability in terminology across countries meant that comparisons were limited to within countries. Hence trends in dietary sugars intake were examined by country for the whole population (where data permitted), and for specific or combined age and sex subpopulations. Findings indicate that in the majority of population comparisons, estimated dietary sugars intake is either stable or decreasing in both absolute (g/d) and relative (% energy) terms. An increase in sugars intake was observed in few countries and only in specific subpopulations. In conclusion, the findings from the present review suggest that, in the main, dietary sugars intake are decreasing or stable. A consistent approach to estimation of dietary sugars intake from national nutrition surveys is required if more valid estimates of changes in dietary sugars intakes are required in the future.
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A systematic methodology to estimate added sugar content of foods. Eur J Clin Nutr 2014; 69:154-61. [PMID: 25514896 DOI: 10.1038/ejcn.2014.256] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/09/2014] [Accepted: 10/15/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND/OBJECTIVES The effect of added sugar on health is a topical area of research. However, there is currently no analytical or other method to easily distinguish between added sugars and naturally occurring sugars in foods. This study aimed to develop a systematic methodology to estimate added sugar values on the basis of analytical data and ingredients of foods. SUBJECTS/METHODS A 10-step, stepwise protocol was developed, starting with objective measures (six steps) and followed by more subjective estimation (four steps) if insufficient objective data are available. The method developed was applied to an Australian food composition database (AUSNUT2007) as an example. RESULTS Out of the 3874 foods available in AUSNUT2007, 2977 foods (77%) were assigned an estimated value on the basis of objective measures (steps 1-6), and 897 (23%) were assigned a subjectively estimated value (steps 7-10). Repeatability analysis showed good repeatability for estimated values in this method. CONCLUSIONS We propose that this method can be considered as a standardised approach for the estimation of added sugar content of foods to improve cross-study comparison.
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Do LG, Scott JA, Thomson WM, Stamm JW, Rugg-Gunn AJ, Levy SM, Wong C, Devenish G, Ha DH, Spencer AJ. Common risk factor approach to address socioeconomic inequality in the oral health of preschool children--a prospective cohort study. BMC Public Health 2014; 14:429. [PMID: 24885129 PMCID: PMC4039048 DOI: 10.1186/1471-2458-14-429] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/29/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences. METHODS/DESIGN This investigation will apply an observational prospective study design to a cohort of socioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers' general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted. DISCUSSION This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.
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Affiliation(s)
- Loc G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | | | | | - John W Stamm
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ching Wong
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | | | - Diep H Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - A John Spencer
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
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Tasevska N, Park Y, Jiao L, Hollenbeck A, Subar AF, Potischman N. Sugars and risk of mortality in the NIH-AARP Diet and Health Study. Am J Clin Nutr 2014; 99:1077-88. [PMID: 24552754 PMCID: PMC3985213 DOI: 10.3945/ajcn.113.069369] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/29/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although previous studies have linked intake of sugars with incidence of cancer and other chronic diseases, its association with mortality remains unknown. OBJECTIVE We investigated the association of total sugars, added sugars, total fructose, added fructose, sucrose, and added sucrose with the risk of all-cause, cardiovascular disease, cancer, and other-cause mortality in the NIH-AARP Diet and Health Study. DESIGN The participants (n = 353,751), aged 50-71 y, were followed for up to 13 y. Intake of individual sugars over the previous 12 mo was assessed at baseline by using a 124-item NIH Diet History Questionnaire. RESULTS In fully adjusted models (fifth quartile compared with first quartile), all-cause mortality was positively associated with the intake of total sugars [HR (95% CI): 1.13 (1.06, 1.20); P-trend < 0.0001], total fructose [1.10 (1.04, 1.17); P-trend < 0.0001], and added fructose [1.07 (1.01, 1.13); P-trend = 0.005) in women and total fructose [1.06 (1.01, 1.10); P-trend = 0.002] in men. In men, a weak inverse association was found between other-cause mortality and dietary added sugars (P-trend = 0.04), sucrose (P-trend = 0.03), and added sucrose (P-trend = 0.006). Investigation of consumption of sugars by source showed that the positive association with mortality risk was confined only to sugars from beverages, whereas the inverse association was confined to sugars from solid foods. CONCLUSIONS In this large prospective study, total fructose intake was weakly positively associated with all-cause mortality in both women and men, whereas added sugar, sucrose, and added sucrose intakes were inversely associated with other-cause mortality in men. In our analyses, intake of added sugars was not associated with an increased risk of mortality. The NIH-AARP Diet and Health Study was registered at clinicaltrials.gov as NCT00340015.
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Affiliation(s)
- Natasha Tasevska
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD (NT, AFS, and NP); the Nutrition Program, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ (NT); the Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD (YP and LJ); the Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX (LJ); and the AARP, Washington, DC (AH)
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Tasevska N, Jiao L, Cross AJ, Kipnis V, Subar AF, Hollenbeck A, Schatzkin A, Potischman N. Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. Int J Cancer 2012; 130:159-69. [PMID: 21328345 PMCID: PMC3494407 DOI: 10.1002/ijc.25990] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 01/26/2011] [Indexed: 12/13/2022]
Abstract
Prospective epidemiologic data on the effects of different types of dietary sugars on cancer incidence have been limited. In this report, we investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies. Participants (n = 435,674) aged 50-71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ). Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) in multivariable models adjusted for confounding factors pertinent to individual cancers. We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma (HR(Q5 vs. Q1) : 1.62, 95% CI: 1.07-2.45; p(trend) = 0.01), added fructose was associated with risk of small intestine cancer (HR(Q5 vs. Q1) : 2.20, 95% CI: 1.16-4.16; p(trend) = 0.009) and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer. Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.
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Affiliation(s)
- Nataša Tasevska
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7242, USA.
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Revision of food-based dietary guidelines for Ireland, Phase 2: recommendations for healthy eating and affordability. Public Health Nutr 2011; 15:527-37. [PMID: 21914254 DOI: 10.1017/s1368980011002084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To revise the food-based dietary guidelines for Ireland and assess the affordability of healthy eating. DESIGN An iterative process was used to develop 4 d food intake patterns (n 22) until average intakes met a range of nutrient and energy goals (at moderate and sedentary activity levels) that represented the variable nutritional requirements of all in the population aged 5 years and older. Dietary guidelines were formulated describing the amounts and types of foods that made up these intake patterns. Foods required for healthy eating by typical households in Ireland were priced and affordability assessed as a proportion of relevant weekly social welfare allowances. SETTING Government agency/community. SUBJECTS General population aged 5+ years. RESULTS Food patterns developed achieved energy and nutrient goals with the exception of dietary fibre (inadequate for adults with energy requirements <9·2 MJ) and vitamin D (inadequate for everyone). A new food group to guide on fats/oils intake was developed. Servings within the Bread, Cereal and Potato group were sub-categorized on the basis of energy content. Recommendations on numbers of servings from each food group were developed to guide on energy and nutrient requirements. Healthy eating is least affordable for families with children who are dependent on social welfare. CONCLUSION Daily supplementation with vitamin D is recommended. Wholemeal breads and cereals are recommended as the best source of energy and fibre. Low-fat dairy products and reduced-fat unsaturated spreads are prioritized to achieve saturated fat and energy goals. Interventions are required to ensure that healthy eating is affordable.
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Abstract
There is increasing concern that high intakes of added sugars promote micronutrient dilution. However, the overall conclusion to emerge from the existing evidence base is that associations between reported intakes of added sugars and intakes of micronutrients are inconsistent and often non-linear, both across and within age groups, and between the genders. If a nutrient displacement effect does exist, a high consumption of added sugar does not necessarily compromise overall micronutrient intakes and similarly, consuming less added sugar is no guarantee that micronutrient intakes will be optimized. Clarification of this issue has been beset by methodological and conceptual difficulties. The observed associations between added sugars and micronutrient intake have been heavily contingent on both the definition of sugars chosen and the analytical approach used for adjusting for differences in reported energy intake. These issues have been further compounded by mis-reporting of food intake of unknown direction and magnitude and the cut-offs used to determine 'inadequate' micronutrient intakes which vary over time and between studies and countries. In the absence compelling evidence that micronutrient intakes are compromised by a high consumption of added sugars, it may now be appropriate to question the legitimacy of the nutrient dilution hypothesis as it is highly likely that it is oversimplifying more subtle and complex dietary issues. Recommendations for further research are made to help bring resolution to these issues.
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Affiliation(s)
- M B E Livingstone
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK.
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Abstract
Dietary carbohydrates are a group of chemically defined substances with a range of physical and physiological properties and health benefits. As with other macronutrients, the primary classification of dietary carbohydrate is based on chemistry, that is character of individual monomers, degree of polymerization (DP) and type of linkage (alpha or beta), as agreed at the Food and Agriculture Organization/World Health Organization Expert Consultation in 1997. This divides carbohydrates into three main groups, sugars (DP 1-2), oligosaccharides (short-chain carbohydrates) (DP 3-9) and polysaccharides (DP> or =10). Within this classification, a number of terms are used such as mono- and disaccharides, polyols, oligosaccharides, starch, modified starch, non-starch polysaccharides, total carbohydrate, sugars, etc. While effects of carbohydrates are ultimately related to their primary chemistry, they are modified by their physical properties. These include water solubility, hydration, gel formation, crystalline state, association with other molecules such as protein, lipid and divalent cations and aggregation into complex structures in cell walls and other specialized plant tissues. A classification based on chemistry is essential for a system of measurement, predication of properties and estimation of intakes, but does not allow a simple translation into nutritional effects since each class of carbohydrate has overlapping physiological properties and effects on health. This dichotomy has led to the use of a number of terms to describe carbohydrate in foods, for example intrinsic and extrinsic sugars, prebiotic, resistant starch, dietary fibre, available and unavailable carbohydrate, complex carbohydrate, glycaemic and whole grain. This paper reviews these terms and suggests that some are more useful than others. A clearer understanding of what is meant by any particular word used to describe carbohydrate is essential to progress in translating the growing knowledge of the physiological properties of carbohydrate into public health messages.
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Sources of total, non-milk extrinsic, and intrinsic and milk sugars in the diets of older adults living in sheltered accommodation. Br J Nutr 2008; 99:649-52. [PMID: 18254986 DOI: 10.1017/s0007114507803989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The WHO recommends limiting non-milk extrinsic sugars (NMES) consumption to < or = 10 % energy to reduce the risk of unhealthy weight gain and dental caries, and to restrict frequency of intake to < or = 4 times/d to reduce risk of dental caries. Older adults, especially those from low-income backgrounds, are at increased risk of dental caries, yet there is little information on sugars intake (frequency of intake and food sources) in this age group. The aim of this report is to present baseline data from a community-based dietary intervention study of older adults from socially deprived areas of North East England, on the quantity and sources of total sugars, NMES, and intrinsic and milk sugars, and on frequency of NMES intake. Dietary intake was assessed using two 3-d estimated food diaries, completed by 201 participants (170 female, thirty-one male) aged 65-85 years (mean 76.7 (sd 5.5) years) recruited from sheltered housing schemes. Total sugars represented 19.6 %, NMES 9.3 %, and intrinsic and milk sugars 10.3 % of daily energy intake. Eighty-one (40.3 %) exceeded the NMES intake recommendation. Mean frequency of NMES intake was 3.4 times/d. The fifty-three participants (26.4 %) who exceeded the frequency recommendation ( < or = 4 times/d) obtained a significantly greater percentage of energy from NMES compared with those participants who met the recommendation. The food groups 'biscuits and cakes' (18.9 %), 'soft drinks' (13.1 %) and 'table sugar' (11.1 %) made the greatest contributions to intakes of NMES. Interventions to reduce NMES intake should focus on limiting quantity and frequency of intake of these food groups.
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Rennie KL, Livingstone MBE. Associations between dietary added sugar intake and micronutrient intake: a systematic review. Br J Nutr 2007; 97:832-41. [PMID: 17408523 DOI: 10.1017/s0007114507617206] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is increasing concern that high intakes of added sugars might compromise intakes of micronutrients. The objectives of this systematic review were (1) to determine whether dietary added sugar intake was associated with micronutrient intakes, and if so, whether there was evidence of micronutrient dilution as a result of higher dietary added sugar intake and (2) if micronutrient dilution was present, to determine whether there was sufficiently robust evidence to support a threshold effect above which there was a significant decline in micronutrient intake or status relative to the recommended intakes. A systematic computerised literature search was undertaken, limited to studies written in English published from 1980 onwards and further studies identified through hand searching papers. Fifteen studies that assessed associations between intakes of added sugars or non-milk extrinsic sugars and micronutrients were included. Overall, there are insufficient data and inconsistency between studies in relationships between added sugars and micronutrient intakes, with no clear evidence of micronutrient dilution or a threshold for a quantitative amount of added sugar intake for any of the micronutrients investigated. The current evidence base is considerably constrained by methodological issues. Further research is required to determine which food products high in added sugars might adversely affect micronutrient intakes by displacing other food items from the diet. Analyses should take into account the magnitude of any observed associations to determine their true biological significance.
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Affiliation(s)
- Kirsten L Rennie
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine BT52 ISA, UK.
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