High intake of added sugar among Norwegian children and adolescents

Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'

OBJECTIVE

To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren.

DESIGN

The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups.

SETTING

Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2).

PARTICIPANTS

A total of 153 children aged 5-7 years.

RESULTS

No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002).

CONCLUSION

The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study)

BACKGROUND

Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects.

METHODS

This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays.

RESULTS

Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score.

CONCLUSIONS

The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.

Food portion sizes and their relationship with energy, and nutrient intakes in adolescents: The HELENA study

OBJECTIVES

This study aimed to investigate the associations between portion sizes (PSs) from different food groups and energy, as well as nutrient intakes in European adolescents.

METHODS

A sample of 1631 adolescents (54.2 % girls) were included from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional (HELENA) study. Mean food PS was calculated by dividing the total intake of the items by the number of eating occasions of these consumed items. To determine the key items for analysis, foods were ranked by frequency of consumption. A one-way between-groups analysis of covariance was used to test for significant differences in means across tertiles. A multivariable linear regression analysis was carried out, adjusting for age, sex, maternal education, body mass index, and using country as a level.

RESULTS

Energy intake increased with elevated intakes of energy-dense foods. Large portions of rice and other grains, starch roots and potatoes, and meat substitutes, nuts, and pulses were associated with increased carbohydrate and fiber intake. Larger portions of cheese and butter and animal fat were significantly associated with a higher fat intake. Lower intakes of some vitamins and micronutrients were noticed with consumption of larger portions of high energy-dense foods, such as desserts and pudding, margarine and vegetable oil, and butter and animal fat.

CONCLUSIONS

Large food PSs may be associated with positive energy, as well as macro- and micronutrient intake. Moreover, the findings from this study may help the future development of dietary guidance in general and specific to PSs, and support targeted strategies to address intakes of certain nutrients in European adolescents.

Free sugar intake and associated factors among Sri Lankan preschool children

BACKGROUND

Excessive free sugar intake tends to be associated with unpleasant health consequences, such as dental caries and unhealthy weight gain in children, as well as a number of noncommunicable diseases in adults. The WHO suggests that the best method for addressing these issues is to reduce free sugar consumption throughout life, in order to be successful, these measures should be implemented as early as possible. This makes the early formative years of preschool an important point for possible intervention. To confirm this, baseline information on current sugar intake levels is needed, as well as identification of factors associated with high levels of consumption.

METHODS

This cross-sectional study was conducted in the district of Colombo, Sri Lanka. The probability proportionate to size technique combined with cluster sampling was used to select a representative sample of 813 children aged 4-5-years from 82 preschools. We developed, and validated a quantitative food frequency questionnaire (FFQ) to assess free sugar consumption. Data on correlated factors were collected from caregivers using a pre-tested self-administered questionnaire.

RESULTS

Based on the data, the daily median (IQR) free sugar intake of preschool children was 57.9 (33.2-95.8) grams/day (approximately to 14.5 (8.3-23.9) teaspoons/day) or 21.1% (12.5-34.9%) of their daily energy requirements. The WHO recommends limiting sugar intake to less than 5% of total energy intake; however, the current level is fourfold, and 96% of children consume higher percentage of energy from free sugar than recommended. In terms of total daily sugar consumption, bakery products accounted for 27%, followed by biscuits (15%), and table sugar (15%). Increasing maternal education level significantly reduced sugar intake (p = 0.04). Children of other ethnicities ate more sugar than the Sinhala children (p = 0.01). There was higher sugar intake among those who ate while returning from preschool (p < 0.001), while watching television (p < 0.001), and those who had school-going siblings (p = 0.02).

CONCLUSION

Among preschool children, free sugar consumption levels were very high and most of the children consumed more sugar than is recommended; which warranted urgent actions to curb sugar intake among them.

A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions

Danish children have a much larger intake of sugar-rich foods and drinks than recommended. This study aimed to (1) explore social aspects and practices of pre-school children's intake of sugar-rich foods and drinks and (2) evaluate barriers and parental strategies to reduce their children's intake of sugar-rich foods and drinks employed in connection with the 3.5-month family-centred intervention trial 'Are you too sweet?'. Intervention components included communication of the recommended maximum intake and reduction strategies, supported by resources encouraging and facilitating behavioural changes. A random sample of families (n = 24) from intervention schools participated in post-intervention semi-structured interviews. A thematic content analysis was conducted, revealing three main domains of social practices: (1) 'family treats', including the weekly Danish concept 'Friday sweets', (2) 'everyday treats', such as sweet snacks in lunch packs, between-meals snacks and soft drink habits and (3) 'socialized treats', including treats at special occasions. Parents employed several strategies, most often substitution and portion-size reduction, but also limiting home availability. Families most frequently made changes that were easily adoptable and close to existing routines at home. In conclusion, the intervention components provided families with knowledge and strategies that facilitated behavioural changes towards reducing the intake of sugar-rich foods and drinks.

Comparison of Discretionary Food and Drink Intake Based on a Short Web-Based Sugar-Rich Food Screener and a Validated Web-Based 7-Day Dietary Record

A high consumption of discretionary foods and drinks has been associated with increased risk of multiple adverse health outcomes, including risk of overweight and dental caries. The family-based cluster randomized intervention study “Are you too sweet?” aimed at reducing the intake of discretionary foods and drinks in a population of children starting pre-school. As part of the intervention a new short web-based sugar-rich food screener (SRFS), was developed to make the parents and the school health nurses aware of the children’s intake of discretionary foods and drinks. In addition to the short assessment tool the parents also completed a validated web-based 7-day dietary record for the children. In the present study, estimates for intake of discretionary foods and drinks from the two assessment tools were compared (n = 80). There was significant correlation between estimates from the two assessment tools, but the SRFS provided lower estimates for intake of discretionary foods and drinks compared to the 7-day dietary record. The correlation coefficient between the two assessment tools was 0.49 (p < 0.001) and Kappa coefficient was 0.33. It is concluded that the SRFS can provide a fairly ranking of participants according to their intake of discretionary foods and drinks when compared to a validated 7-day dietary record. The screener may be a useful tool in practical settings, such as school health nurse consultations, in order to gain insight into the child’s sweet intake habits.

Association between Mobile Phone Addiction Index and Sugar-Sweetened Food Intake in Medical College Students Stratified by Sex from Shanghai, China

This study’s objective was to depict sugar-sweetened food (SSF) consumption in medical college students stratified by sex from Shanghai, China, and to explore the association between the Mobile Phone Addiction Index (MPAI) and SSF intake. The data were obtained from 1121 medical college students from the Fudan University, Shanghai, China, who took an online questionnaire investigation in December 2020. Data included demographics, the MPAI, the Nutrition Literacy Assessment Questionnaire (NLAQ), total and food expenditure per month, the International Physical Activity Questionnaire (IPAQ), and a food frequency questionnaire (carbonated beverages (CB), other sugar-based beverages (OSBB), sugar/chocolate). We evaluated the association between the MPAI and three types of SSF intake according to multivariate logistic regression analysis stratified by sex. The mean CB, OSBB, and sugar/chocolate intakes were, respectively, 65.66 mL/d, 74.20 mL/d, and 4.96 g/d in men and 30.42 mL/d, 71.48 mL/d, and 4.99 g/d in women. The MPAI was positively associated with SSF intake, regardless of sex. In men, the CB and OSBB odds ratios (ORs) were, respectively, 1.023 (95% CI: 1.004–1.042), 1.019 (95% CI: 1.001–1.038); and in women, the CB, OSBB, and sugar/chocolate ORs were, respectively, 1.026 (95% CI: 1.013–1.039), 1.020 (95% CI: 1.007–1.033), and 1.019 (95% CI: 1.006–1.032). Age, NLAQ, total expenditure, food expenditure, and total physical activity also were related to SSF intake. Age and the application capacity of the NLAQ were negatively associated with SSF intake, whereas comprehension capacity of the NLAQ, total and food expenditure, and total physical activity were positively associated with SSF intake. This study confirmed that SSF intake is widespread among medical college students from Shanghai, China, even if they have relatively high nutrition health literacy. From a public health perspective, it is necessary to reduce SSF intake in medical college students by decreasing the MPAI, controlling the total and food expenditure per month in high-consumption areas, and improving the application ability of the NLAQ. Further studies are needed to explore the MPAI and other potential factors that may influence SSF intake of college students by expanding the sample size of college students throughout China, and the causal association between them.

Pre-pregnancy maternal BMI classification is associated with preschool childhood diet quality and childhood obesity in the Avon Longitudinal Study of Parents and Children

OBJECTIVE

To explore the effect of maternal BMI class pre-pregnancy (overweight/obese v. healthy weight/underweight) on childhood diet quality and on childhood overweight/obesity risk.

DESIGN

Dietary data were collected using 3-d parental-completed food records for their children at ages 18 and 43 months. An index of diet quality was derived by classification of food items into core and non-core foods. Adjusted multiple linear regression analyses were used to explore the effect of maternal BMI class on diet quality in their children.

SETTING

Avon, UK.

PARTICIPANTS

A 10% subsample of the Avon Longitudinal Study of Parents and Children. Nine-hundred and eighty children provided complete dietary data at 18 months and 769 at 43 months.

RESULTS

Children with overweight/obese mothers consumed greater amounts of energy from non-core foods than children with healthy weight/underweight mothers (0·20 MJ (48 kcal)/d more at 18 months (P < 0·001); 0·19 MJ (45 kcal)/d more at 43 months (P = 0·008)) in adjusted models. Diet quality deteriorated between 18 and 43 months (children reduced their dietary energy intake from core foods (P < 0·001) and increased intake from non-core foods (P < 0·001)). However, this change was not associated with maternal BMI class in adjusted models. Having an overweight/obese mother was associated with an increased odds of the child being overweight/obese at 43 months (OR 1·74 (1·17, 2·58)).

CONCLUSIONS

Children aged 18 and 43 months with overweight/obese mothers are likely to have a poorer quality diet than those with healthy/underweight mothers. Parents should be supported in discouraging the consumption of non-core foods in children at these ages.

Common social determinants for overweight and obesity, and dental caries among adolescents in Northern Norway: a cross-sectional study from the Tromsø Study Fit Futures cohort

BACKGROUND

Non-communicable general and oral health conditions share common risk factors. Studies investigating common social determinants as risk factors for overweight/obesity and dental caries among the same adolescents are scarce and inconclusive.

METHODS

This cross-sectional study included data from 464 girls and 494 boys from the population-based Tromsø study Fit Futures, which included first-year students attending upper secondary school in 2010-2011 from two municipalities in Northern Norway (1038 participants in total, 93% participation rate). Multivariable binary logistic regression analyses stratified by sex were used to investigate the association between socioeconomic position indicators (adolescent's own study program, parents' education and employment status) and overweight/obesity indicated by body weight and waist circumference, untreated dental caries in dentine, and when these conditions were considered simultaneously.

RESULTS

Boys enrolled in the general studies and sports programs (versus vocational) had lower odds of being overweight/obese (POR 0.42, 95% CI 0.20-0.86 and POR 0.24, 95% CI 0.08-0.73, respectively), of having high waist circumference (POR 0.39, 95% CI 0.21-0.75 and POR 0.25, 95% CI 0.10-0.64, respectively), dental caries (POR 0.57, 95% CI 0.32-0.99 and POR 0.47, 95% CI 0.22-0.98, respectively), and being simultaneously overweight/obese, having high waist circumference and dental caries (POR 0.24, 95% CI 0.07-0.81 and POR 0.11, 95% CI 0.01-0.98, respectively). Girls enrolled in the general studies program (versus vocational) had lower odds of having dental caries (POR 0.50, 95% CI 0.30-0.84).

CONCLUSIONS

Adolescent's own study program was identified to be a common social determinant for overweight/obesity and dental caries among boys. These results support the broader concept of social determinants as common risk factors for general and oral health conditions, and call for common health promotion strategies addressing these common social determinants among adolescents. However, there is a need for more studies to investigate and better understand the influence of social determinants on health conditions among adolescents.

Reducing Young Schoolchildren's Intake of Sugar-Rich Food and Drinks: Study Protocol and Intervention Design for "Are You Too Sweet?" A Multicomponent 3.5-Month Cluster Randomised Family-Based Intervention Study

A high consumption of sugar-rich discretionary food and drinks has several health implications, which have been traced from childhood into adulthood. Parents act as primary mediators shaping children's dietary habits, and interventions that engage parents have shown to result in positive outcomes. Further, collaboration with local school health nurses and dentists provides an effective structural frame to support behaviour change and anchor new initiatives. The multicomponent 3.5-month cluster randomised family-focused intervention "Are you too Sweet?" aims to evaluate the effectiveness of communicating new Danish guidelines for sugar-rich discretionary food and drinks for school starters (5-7 years). This paper describes the development, outcomes and process evaluation of the intervention that includes three main components: extended dialogue during a school health nurse consultation, a box with home-use materials, and a social media platform to facilitate interaction among participants. Children (n = 160) and their parents were scheduled for a baseline interview at six different schools. The intervention was developed to increase self-efficacy, knowledge about guidelines, observational learning and reduce impediments for behavioural change. The desired primary outcome was a reduction in intake of sugar-rich food measured through a 7-day dietary record. The results contribute to the evidence on effective health promotion strategies.

Association between added sugar intake and micronutrient dilution: a cross-sectional study in two adult Swedish populations

Background

The evidence on the impact of high sugar consumption on micronutrient dilution does not yet allow for the establishment of clear thresholds of consumption. To establish upper and lower limit intake thresholds for added sugar, more studies from different countries and multiple populations are needed. The aim of this study was to examine the association between the intakes of added sugar and various micronutrients among the adult Swedish population across almost two decades.

Methods

The data were obtained from the samples from two populations: 1) Riksmaten Adults, a national dietary survey (n = 1797, 44% male, aged 18–80 years, data collection from 2010 to 11) that assessed dietary intake using a 4-day web-based food diary; and 2) the Malmö Diet and Cancer Study, a population-based cohort study (n = 12,238, 45% male, aged 45–68 years, data collection from 1991 to 1994) that assessed dietary intake via a combination of a 7-day food diary, a food frequency questionnaire and an interview. The mean daily intake of nine micronutrients (calcium, folate, iron, magnesium, potassium, selenium, vitamin C, vitamin D, and zinc), adjusted for age, sex, BMI and energy intake, were examined across six added-sugar-intake groups (< 5%E, 5–7.5%E, 7.5–10%E, 10–15%E, 15–20%E, and >  20%E).

Results

We observed significant inverse associations between the intake of added sugar and the intake of all micronutrients in both populations. The associations were linear; however, we could not determine the threshold of added sugar intake beyond which the micronutrient intake was clearly compromised.

Conclusions

These findings suggest that in two Swedish populations the higher the intake of added sugar in the diet, the more likely it is that the intake of micronutrients will be compromised, in two Swedish populations. However, although the trends are significant and consistent with those obtained in other studies on the subject, future studies are needed in order to build the necessary scientific knowledge to establish a threshold of added sugar intake based on micronutrient dilution.

Association of Free Sugar Intake Estimated Using a Newly-Developed Food Composition Database With Lifestyles and Parental Characteristics Among Japanese Children Aged 3-6 Years: DONGuRI Study

BACKGROUND

The lack of comprehensive food composition databases for sugar contents in Japanese foods has led to the lack of nutritional epidemiologic studies on sugar intake in Japanese population. This cross-sectional study aimed to investigate the association of free sugar intake estimated using a newly developed food composition database with the characteristics and lifestyles of Japanese children aged 3-6 years.

METHODS

The food composition database contained information on sugars in 2,222 commonly consumed Japanese foods. Using this database, we estimated the sugar (total, added, and free sugars) intakes derived from a 3-day weighed dietary record of 166 boys and 166 girls aged 3-6 years living in 24 prefectures in Japan.

RESULTS

The mean free sugar intake was 26.8 g/d (standard deviation [SD], 12.3 g/d), while the mean value for energy intake was 7.8% (SD, 3.2%). The prevalence of excessive free sugar intake (≥10% of energy intake) was 21.7%. Among the characteristics and lifestyles examined, screen time was most strongly associated with the prevalence of excessive free sugar intake: multivariate adjusted odds ratios for screen time <0.5, ≥0.5 to <1, and ≥1 h/d were 1.0 (reference), 3.81 (95% confidence interval, 1.04-13.98), and 4.36 (95% confidence interval, 1.16-16.35), respectively. Additionally, younger age, shorter sleep, and mothers with office work and service and sales jobs (compared with those with professional and managerial jobs) were significantly associated with a higher prevalence of excessive free sugar intake.

CONCLUSIONS

This study showed the sugar intake of Japanese children aged 3-6 years is positively associated with screen time.

Relative validation of a pre-coded food diary in a group of Norwegian adults - Comparison of underreporters and acceptable reporters

Estimating dietary intake is important for both epidemiological and clinical studies. In large studies, a balance has to be achieved between methods with high accuracy and methods that are easy to use. The aim of the present study was to compare results from a pre-coded scanable food diary (PFD) with results from a weighed record (WR) in a group of Norwegian adults. We also explored differences in day-to-day energy intake and the distribution of energy intake across the day in acceptable reporters (ARs) and underreporters (URs). Participants (n = 114, mean age 35 years, 68% women) recorded dietary intake with the PFD for 7 consecutive days. One week after completing the PFD, participants completed a 7 days WR. No difference in mean energy intake was seen between methods. Few differences were seen for the macronutrients, the most noticeable difference being the percentage of energy (E%) from carbohydrates which was significantly lower with the PFD (47 E%) than with the WR (49 E%). For the micronutrients, intakes of calcium and vitamin A were both significantly higher with the PFD than with the WR. Pearson's correlation coefficient ranged from 0.47 (tocopherol) to 0.76 (E% carbohydrates) for all nutrients. Bread intake was significantly lower with the PFD while the intakes of edible fats, cheese and beverages were higher. Twenty-eight percent of the participants were found to be URs with the PFD. No clear pattern of underreporting at certain recording days or times of the day was seen. In conclusion, the results showed similar energy intakes and few differences in food and nutrient intakes between the PDF and the WR at the group level. Somewhat larger differences between the methods were seen at the individual level. Because of the reduced work load on both participants and researchers, the PFD seems a suitable alternative to the WR.

Intake of free sugar and micronutrient dilution in Australian children and adolescents

PURPOSES

This cross-sectional analysis aimed to investigate the association between free sugar intake and micronutrient intake in Australian children and adolescents and to assess the effectiveness of the cut-off of < 10% energy intake from free sugar (%EFS) as recommended by the World Health Organization (WHO).

METHODS

Dietary data of children and adolescents from the Australian Health Survey 2011-12 were analyzed (n = 1466). Free sugar intake was estimated using a published methodology with modification to suit the definition of free sugar. Six cut-offs for %EFS were created in 5% increments. Participants' mean intakes of 18 micronutrients, as well as their intakes of core (healthy) and discretionary (unhealthy) foods, at different cut-offs were compared using ANCOVA, with age, sex, and socioeconomic status measures as covariates. The odds ratios of not meeting the nutrient reference values (NRVs) for Australia and New Zealand of each micronutrient were calculated using logistic regression.

RESULTS

Micronutrient intake decreased with increasing %EFS and the peak intakes of most micronutrients appeared between 0-15%EFS. The absolute intakes of most micronutrients were not significantly different between participants who consumed < 10%EFS and ≥ 10%EFS. Those with > 20%EFS were less likely to meet the NRVs of more than half of the micronutrients. Additionally, as %EFS increased, intakes of core food groups decreased, while intakes of discretionary food groups increased.

CONCLUSIONS

The dilution effect in micronutrient intake with increasing free sugar intake was evident in Australian children and adolescents. However, meeting the WHO cut-off was associated with limited improvement in micronutrient adequacy.

Parental dietary patterns and social determinants of children's dietary patterns

ABSTRACT Objective To identify dietary patterns in children up to thirty months of age and verify whether they are associated with parental dietary patterns, and socioeconomic and demographic characteristics. Methods This is a cross-sectional study with baseline data from a population-based study composed of 1,085 households from a representative sample of a metropolitan region in Rio de Janeiro, Brazil. The children's food intake was evaluated by two 24-hour recalls, and the dietary patterns were identified by principal component analysis stratified into two groups according to the children's age: 6 to 17 months; and 18 to 30 months. The explanatory variables collected by a structured questionnaire were socioeconomic and demographic characteristics, age at introduction of complementary foods, and parental dietary pattern. A Food Frequency Questionnaire was administered to assess parental dietary pattern, which was determined by principal component analysis. Multivariate linear regression estimated the effect of each explanatory variable on the children's dietary patterns. Results Three dietary patterns were identified in children aged 6-17 months (basic-mixed; mixed-plus; and milk-flours) and two dietary patterns were identified in children aged 18-30 months: basic-mixed and mixed-plus. Multivariate linear regression showed that complementary feeding (b=0.108; p=0.004) was positively associated with the basic-mixed dietary pattern, and family income (b=0.002; p£0.01), with the mixed-plus dietary pattern. A negative association was found between the traditional parental dietary pattern and children's mixed-plus pattern in children aged 6-17 months (b=0.152; p=0.006) and in children aged 18-30 months (b=0.152; p=0.016). In children aged up to 18 months, parental education level (b=0.368; p£0.01) was positively associated with the mixed-plus dietary pattern. Conclusion Family income, parental education level, and parental dietary patterns are associated with children's dietary patterns.

Associations between added sugar (solid vs. liquid) intakes, diet quality, and adiposity indicators in Canadian children

Little is known about the influence of different forms of added sugar intake on diet quality or their association with obesity among youth. Dietary intake was assessed by three 24-h recalls in 613 Canadian children (aged 8-10 years). Added sugars (mean of 3-day intakes) were categorized according to source (solid or liquid). Dietary intake and the Canadian Healthy Eating Index (« HEI-C ») were compared across tertiles of solid and liquid added sugars separately as were adiposity indicators (body mass index (BMI), fat mass (dual-energy X-ray absorptiometry), and waist circumference). Cross-sectional associations were examined in linear regression models adjusting for age, sex, energy intake, and physical activity (7-day accelerometer). Added sugar contributed 12% of total energy intake (204 kcal) on average, of which 78% was from solid sources. Higher consumption of added sugars from either solid or liquid source was associated with higher total energy, lower intake of micronutrients, vegetables and fruit, and lower HEI-C score. Additionally liquid sources were associated with lower intake of dairy products. A 10-g higher consumption of added sugars from liquid sources was associated with 0.4 serving/day lower of vegetables and fruit, 0.4-kg/m(2) higher BMI, a 0.5-kg higher fat mass, and a 0.9-cm higher waist circumference whereas the associations of added sugars from solid sources and adiposity indicators tended to be negative. In conclusion, higher consumption of added sugar from either solid or liquid sources was associated with lower overall diet quality. Adiposity indicators were only positively associated with added sugars from liquid sources.

Dietary intake, leisure time activities and obesity among adolescents in Western Sweden: a cross-sectional study

BACKGROUND

Overweight and obesity among adolescents are increasing worldwide. Risk factors include dietary intake characteristics and high levels of physical inactivity. In Sweden, few large comprehensive population-based surveys of dietary intake and lifestyle among adolescents have been carried out. Thus, the purpose of the current study was to describe dietary intake and food choices as well as leisure time activities in relation to overweight and obesity in a total sample of all schoolchildren aged 15 years in Western Sweden.

METHODS

In 2008, a questionnaire was sent to all 21,651 adolescents born in 1992 in Västra Götaland Region, Sweden. Participation rate was 54.3 % (50.7 % girls/49.3 % boys). The questionnaire included a 73-item semi-quantitative food frequency questionnaire and questions on lifestyle. Results were evaluated against the Nordic Nutrition Recommendations and Swedish indicators of healthy diet and exercise habits. Associations with concurrent overweight and obesity were evaluated in multiple linear regression analysis.

RESULTS

Among girls, 49.5 % reached the goal of consuming fruit and vegetables at least daily, whereas for boys the figure was 34.4 %. Among both sexes, 15 % reached the goal of consuming fish at least twice weekly. Two-thirds of both sexes reached the goal of regular moderate or vigorous physical activity weekly. In total, 12.4 % were overweight and 2.4 % were obese. More girls than boys were underweight, whereas more boys than girls were overweight or obese (p < 0.001). Boys exhibited a more frequent intake of sodas and concentrated fruit juices, milk 3 % fat, bread and potatoes and fast food (p < 0.001). Frequent intake of candies and chocolate was reported by both sexes. Among girls and boys, living in rural areas, living in apartments and reporting no frequent leisure time physical activity were significant risk factors for being overweight or obese, also when adjusted for other risk factors.

CONCLUSIONS

Dietary habits of adolescents in Western Sweden warrant improvements. Public health actions should be taken to increase consumption of fruit, vegetables and fish, and decrease consumption of sodas and candies and also to increase frequency of physical activity. These actions may be helpful in reducing risks for overweight and obesity.

Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context

OBJECTIVE

The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa.

METHODS

Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined.

RESULTS

Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063].

CONCLUSION

Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.

Association between intake of total vs added sugar on diet quality: a systematic review

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.

Consumption of sugar sweetened beverage is associated with incidence of metabolic syndrome in Tehranian children and adolescents

Background

Intakes of high sugar-sweetened beverages (SSBs) in adults can escalate risk of metabolic syndrome (MetS); however, data of longitudinal studies in children and adolescents are lacking. In this study we assessed consumption of SSBs in relation to incidence of MetS among children and adolescents during a 3.6 year follow-up.

Methods

This study was a population-based longitudinal study, in which 424 subjects, aged 6–18 years, from the Tehran Lipid and Glucose Study with complete data on dietary intake, blood pressure, anthropometry, and biochemical indices were followed for 3.6 years. Dietary intake was collected using a valid and reliable food frequency questionnaire. MetS was defined according to the Cook criteria. Sugar sweetened beverages included all kinds of sugar sweetened carbonated soft drinks (SSSDs) and fruit juice drinks.

Results

Average daily intakes of SSSD and fruit juice drinks were 38.5 ± 75.0 and 32.3 ± 60.1 g, respectively. After adjustment for confounders, compared to the first quartile, the odds ratio of incident MetS in the highest quartile of SSB and SSSD was 3.20 (95 % CI: 1.06–9.90) and 3.01 (95 % CI: 1.17–7.74), respectively. Regarding incidence of MetS components, compared with the lowest quartile, the highest quartile of SSSDs showed odds ratios of 2.49 (95 % CI: 1.00–6.53) for abdominal obesity and 2.79 (95 % CI: 1.02–7.64) for hypertension. No significant association was found between consumption of fruit juice drink and SSSD with other components of MetS.

Conclusions

Children and adolescents with high intakes of carbonated beverages could be at increased risk of MetS, abdominal obesity, and hypertension.

Demographic, dietary and physical activity predictors of general and abdominal obesity among university students: a cross-sectional study

BACKGROUND

Obesity has become a disease of global public health concern in both developing and developed countries. We investigated the influence of socio-demographic, dietary habits and physical activity levels on general and abdominal obesity among a sample of university students in Ghana.

METHODS

This cross-sectional study was carried out among a sample of 552 students attending the University for Development Studies, School of Medicine and Health Sciences, Tamale, Ghana. Demographic characteristics were assessed using questionnaire. Dietary habits were measured by means of food frequency questionnaires. Anthropometric measurements were done using appropriate methods. Physical activity levels were measured using the World Health Organization (WHO) global physical activity questionnaire. Spearman's nonparametric correlation coefficient and multinomial logistic regression analysis were used to investigate the determinants of general and abdominal obesity.

RESULTS

The prevalence of general overweight/obesity (25.8 % vs. 5.9 %) and abdominal obesity (40.9 % vs. 0.8 %) was higher in female students than in male students. General overweight/obesity was less likely in students who engaged in vigorous physical activity (Adjusted Odds Ratio (AOR) = 0.3, 95 % CI = 0.1 - 0.7, p = 0.004), but more likely in students who consumed fruits and vegetables > 3 days per week (AOR = 2.6, 95 % CI = 1.2 - 5.4, p = 0.015). Abdominal obesity was also less likely in male students (AOR = 0.0, 95 % CI = 0.0 - 0.5, p = 0.017) but more likely in students who consumed roots and tubers > 3 times per week (AOR = 8.0, 95 % CI = 2.2 - 10.1, p = 0.017) and in those who consumed alcoholic and non-alcoholic beverages > 3 times per week (AOR = 8.2, 95 % CI = 2.2 - 31.1, p = 0.002).

CONCLUSION

Demographic factors, dietary habits and physical activity levels were found to be associated to general overweight/obesity and abdominal obesity. General overweight/obesity was associated to the consumption of fruits and vegetables > 3 times a week. The consumption of roots and tubers > 3 times per week and alcoholic and non-alcohol beverages > 3 times a week was associated to abdominal obesity. Engagement in vigorous physical activity and being male were negatively associated to general overweight/obesity and abdominal obesity respectively. Promotion of active lifestyles in young adults should be encouraged.

Changes in adolescents' and parents' intakes of sugar-sweetened beverages, fruit and vegetables after 20 months: results from the HEIA study - a comprehensive, multi-component school-based randomized trial

Background

Interventions conducted in school-aged children often involve parents, but few studies have reported effects on parents’ own behaviour as a result of these interventions.

Objective

To determine if a multi-component, cluster randomized controlled trial targeting 11–13 year olds influenced their consumption of fruit, vegetables, sugar-sweetened soft drinks and fruit drinks, and to explore whether the results varied by gender, adolescent weight status or parental educational level. A final aim was to assess whether the parents’ intakes were affected by the intervention.

Design

Participants were 1,418 adolescents, 849 mothers and 680 fathers. Baseline and post-intervention data from the 20 months intervention study HEIA (HEalth In Adolescents) were included. Data were collected assessing frequency (and amounts; beverages only).

Results

No significant differences were found at baseline between the intervention and control groups, except for the parental groups (educational level and intakes). At post-intervention, the adolescents in the intervention group consumed fruit more frequently (P<0.001) and had a lower intake of sugar-sweetened fruit drinks compared to the control group (P=0.02). The parental educational level moderated the effect on intake of sugar-sweetened fruit drinks in adolescents. The intake was less frequent in the intervention groups compared to the control groups (P=0.02) for those who had parents with low and medium educational level. Furthermore, the intervention may have affected mothers’ fruit intake and the vegetable intake in higher educated fathers.

Conclusion

Favourable effects in favour of the intervention group were found for intake of fruit and sugar-sweetened fruit drinks among the adolescents in the HEIA study. Our results indicate that it is possible to reduce adolescents’ intake of sugar-sweetened fruit drinks across parental education, and potentially affect sub-groups of parents.

Dietary intake in 6-year-old children from southern Poland: part 2--vitamin and mineral intakes

BACKGROUND

Studies on vitamin and mineral intakes in children are very important: firstly because of the high prevalence of diet-related diseases and secondly because of the widespread consumption of highly processed foods which are characterised by high energy content and low density of essential nutrients. Therefore, the purpose of this study was to analyse vitamin and mineral intakes in 6-year-old children from southern Poland.

METHODS

Vitamin and mineral intakes were estimated from a three-day food record in 120 children, 64 girls and 56 boys, aged 6 years. Nutrient densities were estimated as amounts per 1000 kcal (4185 kJ) of energy intake. Statistical analysis was carried out by means of the IBM SPSS Statistics computer programme, version 19. The studied population was divided according to gender.

RESULTS

Intakes of folic acid (μg/1000 kcal) and vitamin C (mg, mg/1000 kcal) were significantly higher in girls. Nutrient densities for all vitamins were higher in girls, however, these results did not reach statistical significance. Intake of vitamin D was lower than EAR in all of the studied children. Intakes of sodium (mg) and zinc (mg) were significantly higher in boys. Intakes of the remaining minerals were higher in boys, however, these findings did not reach statistical significance. Nutrient densities for all minerals, except for sodium, zinc and manganese, were higher in girls. All of the studied children had sodium intakes above UL.

CONCLUSIONS

Inadequate intakes of vitamin D, calcium and potassium in the studied 6-year-olds along with excessive sodium intake are the risk factors for developing osteoporosis and hypertension. To prevent these diseases in the studied children, educational programmes for both preschool staff and parents should be worked out and implemented.

Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: results of NUTRIKAP survey

BACKGROUND

The aim of this study was to assess knowledge, attitude and practice of urban and rural households toward principles of nutrition in Iran.

METHODS

The study population was Iranian households who live in rural and urban areas in all provinces of the country. The sampling method at households' level in each province was single stage cluster sampling with equal size clusters. The incumbent data was collected by a structured questionnaire and through the interview with the eligible subject in each household.

RESULTS

A total of 14,136 Iranian households were selected as total sample size, 9,149 urban households, and 4,987 rural households. Around 57.2% of urban and 49.5% of rural households was aware of food groups. Respectively in urban and rural households, about 35.1% and 39.7% had correct knowledge toward roles of food groups. Approximately 41.5% and 39.9% of households had accurate knowledge about reason of food eating in urban and rural areas, respectively. The results showed that 79.6% of them had favorable attitudes. The most of the households consumed red meat and poultry weekly whereas fish was eaten rarely. Fruits, vegetables and dairy were consumed daily in the most of households. Sugar intake was daily in the most of households and cream and butter intake was weekly.

CONCLUSION

The most of households had moderate knowledge and good attitudes. Practice of families about food consumption was good. The results of this study can be used for proper intervention for improving of health society.

Test-retest reliability and validity of a web-based food-frequency questionnaire for adolescents aged 13-14 to be used in the Norwegian Mother and Child Cohort Study (MoBa)

Background

The assessment of food intake is challenging and prone to errors; it is therefore important to consider the reliability and validity of the assessment methods.

Objective

The aim of this study was to analyze the reproducibility and validity of a developed food-frequency questionnaire (FFQ) for use among adolescents.

Design

In total, 58 students (aged 13–14) from four different schools in the southern part of Norway participated in the reproducibility study of filling out the FFQ 4 weeks apart. In addition, 93 students participated in the relative validity study where the FFQ was compared to 2×24-hour dietary recalls, while 92 students participated in the absolute validity study where the intakes of fatty acids and vitamin D from the FFQ were compared to fatty acids and 25-hydroxy-vitamin D₃ in whole blood.

Results

The median Spearman correlation coefficient for all nutrients in the test–retest reliability study was 0.57. The median Spearman correlation for all nutrients in the relative validity study was 0.26, while the correlations coefficients were low in the absolute validity study with n-3 fatty acid coefficients ranging from 0.05 to 0.25, and absent for vitamin D (r=0.000).

Conclusion

The test–retest reproducibility was considered good, the relative validity was considered poor to good, and the absolute validity was considered poor. However, the results are comparable to other studies among adolescents.

Development of family and dietary habits questionnaires: the assessment of family processes, dietary habits and adolescents' impulsiveness in Norwegian adolescents and their parents

Background

There is a need for valid and comprehensive measures of parental influence on children’s energy balance-related behaviours (EBRB). Such measures should be based on a theoretical framework, acknowledging the dynamic and complex nature of interactions occurring within a family. The aim of the Family & Dietary habits (F&D) project was to develop a conceptual framework identifying important and changeable family processes influencing dietary behaviours of 13–15 year olds. A second aim was to develop valid and reliable questionnaires for adolescents and their parents (both mothers and fathers) measuring these processes.

Methods

A stepwise approach was used; (1) preparation of scope and structure, (2) development of the F&D questionnaires, (3) the conducting of pilot studies and (4) the conducting of validation studies (assessing internal reliability, test-retest reliability and confirmatory factor analysis) using data from a cross-sectional study.

Results

The conceptual framework includes psychosocial concepts such as family functioning, cohesion, conflicts, communication, work-family stress, parental practices and parental style. The physical characteristics of the home environment include accessibility and availability of different food items, while family meals are the sociocultural setting included. Individual characteristics measured are dietary intake (vegetables and sugar-sweetened beverages) and adolescents’ impulsivity. The F&D questionnaires developed were tested in a test-retest (54 adolescents and 44 of their parents) and in a cross-sectional survey including 440 adolescents (13–15 year olds), 242 mothers and 155 fathers. The samples appear to be relatively representative for Norwegian adolescents and parents. For adolescents, mothers and fathers, the test-retest reliability of the dietary intake, frequencies of (family) meals, work-family stress and communication variables was satisfactory (ICC: 0.53-0.99). Barratt Impulsiveness Scale-Brief (BIS-Brief) was included, assessing adolescent’s impulsivity. The internal reliability (Cronbach’s alphas: 0.77/0.82) and test-retest reliability values (ICC: 0.74/0.77) of BIS-Brief were good.

Conclusions

The conceptual framework developed may be a useful tool in guiding measurement and assessment of the home food environment and family processes related to adolescents’ dietary habits, in particular and for EBRBs more generally. The results support the use of the F&D questionnaires as psychometrically sound tools to assess family characteristics and adolescent’s impulsivity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-014-0130-z) contains supplementary material, which is available to authorized users.

Nutritional challenges and opportunities during the weaning period and in young childhood

The early years of life are a period of very rapid growth and development. In this critical phase, food preferences are formed which carry over into childhood and beyond and foundations are laid for a healthy adult life. Excess energy, imbalances in macronutrient quality, and nutritional deficiencies may form inappropriate nutritional signals, leading to metabolic disturbances and affecting the obesity risk. For instance, the intake of protein and sugar-sweetened beverages in young children has been associated with an increased risk of overweight and obesity. In reality, scientific reports have shown that the dietary intakes of vegetables, α-linolenic acid, docosahexaenoic acid, iron, vitamin D, and iodine are low and the intakes of protein, saturated fatty acids, and added sugar are high in young children living in Europe. A focus on improving feeding habits and approaches to support more balanced nutritional intakes early in life may have significant public health benefits.

A school based study of time trends in food habits and their relation to socio-economic status among Norwegian adolescents, 2001-2009

Background

In recent years, adolescents’ food habits have become a major source of concern, and substantial policy and intervention efforts have been made to influence adolescents to consume more fruit and vegetables and less sweets and soft drink. Particular attention has been devoted to the social gradient in food habits, aiming to reduce dietary inequality. However, few internationally published studies have evaluated trends in teenagers’ food habits, or investigated how dietary inequalities develop.

Methods

We used Norwegian cross-sectional data from the international Health Behaviour in School-Aged Children (HBSC) study, collected via three nationally representative and comparable questionnaire surveys in 2001, 2005 and 2009. Food habits were identified by students’ consumption of fruit, vegetables, sweets and sugar rich soft drink. Socio-economic status (SES) was measured with the Family Affluence Scale (FAS). Multilevel logistic regression was used to analyze the data.

Results

The analyses indicated an overall positive trend in food habits among adolescents in Norway. Students were more likely to consume fruit (OR 1.76, CI 1.61-1.92) and vegetables (OR 1.51, CI 1.37-1.66) daily in 2005 as compared to 2001, and were less likely to consume sweets (OR 0.58, CI 0.51-0.66 resp. OR 0.77, CI 0.67-0.90) and soft drink (OR 0.55, CI 0.49-0.62 resp. OR 0.84, CI 0.73-0.96) daily when comparing, respectively, 2005 with 2001 and 2009 with 2005. Across all survey years, students with higher SES were more likely to eat fruit (OR 1.47, CI 1.32-1.65) and vegetables (OR 1.40, CI 1.24-1.58) daily than did students with lower SES. Our analyses indicated that the socio-economic differences were stable in the period 2002 - 2010, with uniform improvement in fruit and vegetable consumption across all SES levels. No significant associations between SES and intake of sweets and sugar-added soft drink were found.

Conclusion

The study identifies an overall improvement in diet among adolescents over a period characterized by onset of as well as ongoing initiatives targeting young people’s food habits. However, the observed socio-economic gradient in fruit and vegetable consumption remained unchanged.

Food portion sizes and dietary quality in Irish children and adolescents

Objective

To describe relationships between the portion sizes of a range of foods commonly consumed by Irish children and adolescents and key indicators of dietary quality on the days they were consumed.

Design

Cross-sectional data from the Irish National Children’s Food Survey (2003–2004; 7 d weighed record) and National Teens’ Food Survey (2005–2006; 7 d semi-weighed record) were used to compare mean values for a number of dietary quality indicators (e.g. energy-adjusted intakes of saturated fat, dietary fibre and Na) across portion size tertiles for a range of foods, on the days the foods were consumed.

Setting

The Republic of Ireland.

Subjects

Nationally representative samples of children aged 5–12 years (n594) and adolescents aged 13–17 years (n441).

Results

Relationships between food portion sizes and indicators of dietary quality on the days the foods were consumed were similar in both children and adolescents. Lower dietary energy density and saturated fat intakes, and higher dietary fibre intakes, were observed on the days larger portions of fruit and boiled potatoes were consumed. Higher dietary energy density and lower micronutrient intakes were observed on the days larger portions of sugar-sweetened beverages were consumed. Higher Na intakes were observed on the days larger portions of frying meats were consumed.

Conclusions

The current work identifies foods for which larger portion sizes may be associated with positive dietary attributes, as well as the opposite. Findings will form an evidence base from which more specific dietary guidance relating to portion size may be developed for Irish children and adolescents.

The long-term effectiveness of the International Child Development Programme (ICDP) implemented as a community-wide parenting programme

Short-term effectiveness of the International Child Development Programme (ICDP) for parents in the general population has been studied. The aim of this paper was to investigate the longer term impact of the ICDP programme on parents looking for sustained changes 6–12 months after the programme. For this, a non-clinical caregiver group attending the ICDP programme (N = 79) and a non-attending comparison group (N = 62) completed questionnaires on parenting, psychosocial functioning, and child difficulties before, on completion and 6–12 months after the ICDP programme. Analyses compare changes in scores over time. The results revealed that the ICDP group showed significantly improved scores on parenting measures, less loneliness, and trends towards improved self-efficacy compared to the comparison group 6–12 months after programme completion. The ICDP group also reported that their children spent significantly less time on television and computer games and a trend towards fewer child difficulties. Key positive effects sustained over time but at a somewhat lower level, supporting community-wide implementation of ICDP as a general parenting programme. It is concluded that more intensive training with follow-up sessions should be considered to sustain and boost initial gains.

Dietary intake in 6-year-old children from southern Poland: part 1--energy and macronutrient intakes

Background

The studies on dietary intake in Polish children are sparse and the information about dietary intake in 6-year-olds in Europe is limited. The published studies on dietary intake in children rarely provide information on the intake of animal protein, plant protein and water. The purpose of the study was to analyse energy and macronutrient intakes in 6-year-old children from southern Poland.

Methods

The studied population comprised 120 children, 64 girls and 56 boys. Energy and macronutrient intakes were estimated from a three-day food record. Weight and height were measured, and body mass index was calculated.

Results

Intakes of energy (kJ, kcal), plant protein (g), total fat (g), saturated fatty acids (g, % of energy, g/1000 kcal), monounsaturated fatty acids (g) and starch (g, % of energy, g/1000 kcal) were significantly higher in boys, while intakes of sucrose (% of energy, g/1000 kcal) and total water (g/1000 kcal) were significantly higher in girls. The children’s diets were characterised by excessive intake of total fat, saturated fatty acids, sucrose, and by inadequate intake of polyunsaturated fatty acids, available carbohydrates and starch.

Conclusions

The observed adverse characteristics of the children’s diets are similar to those observed in the diets of children in other European countries and show the need to work out a common educational programme to improve nutrition in young European children. It is also important to provide the lacking information about the intake of animal protein, plant protein and water in young children.

Sugars consumption in a low-income sample of British young people and adults

OBJECTIVE

To report the consumption of non-milk extrinsic sugars (NMES) among a low-income UK sample, compare it with nationally representative estimates and examine the association between socioeconomic position and NMES consumption among low income adults.Design Secondary analysis of the Low Income Diet and Nutrition Survey (LIDNS) data.

SETTING AND SUBJECTS

Two thousand, seven hundred and ninety-six adults and 415 young people from 2,477 households.Main outcome measures Mean NMES intakes (grams) and their percentage contribution to food energy, from dietary data collected via a 24-hour recall 'multiple pass' method.

RESULTS

The low income sample consumed more NMES than the general population sample. The percentage of food energy from NMES exceeded the 11% target, especially among adolescents (17.2% in males, 16.3% in females). After adjusting for age, men who finished full-time education aged 16 years consumed significantly more sugar (p = 0.028), whereas those who finished aged 18 consumed significantly less sugar (p = 0.023) than the reference group (finished aged 15). No significant associations were found between NMES and socioeconomic variables in women.

CONCLUSION

Compared to the general population, the nutritional disadvantage of the most deprived segments of society relates primarily to excessive NMES consumption. In men, higher educational level appears to play a protective role against high sugar intakes.

Validation of a pre-coded food diary used among 60-80 year old men: comparison of self-reported energy intake with objectively recorded energy expenditure

Objective

To validate energy intake (EI) estimated from a pre-coded food diary (PFD) against energy expenditure (EE) measured with a valid physical activity monitor (SenseWear Pro₃ Armband) and to evaluate whether misreporting was associated with overweight/obesity in a group of elderly men.

Methods

Forty-seven healthy Norwegian men, 60–80 years old, completed the study. As this study was part of a larger intervention study, cross-sectional data were collected at both baseline and post-test. Participants recorded their food intake for four consecutive days using food diaries and wore SenseWear Pro₃ Armband (SWA) during the same period. Only participants with complete data sets at both baseline and post-test were included in the study.

Results

The group average EI was 17% lower at baseline and 18% lower at post-test compared to measured EE. Mean difference from Bland-Altman plot for EI and EE was −1.5 MJ/day (±1.96 SD: −7.0, 4.0 MJ/day) at baseline and −1.6 MJ/day (−6.6, 3.4 MJ/day) at post-test. The intraclass correlation coefficient (ICC) was 0.30 (95% CI: 0.02, 0.54, p = 0.018) at baseline and 0.34 (0.06, 0.57, p = 0.009) at post-test. Higher values of underreporting was shown among overweight/obese compared to normal weight participants at both baseline and post-test (p≤ 0.001), respectively.

Conclusions

The results indicate that the PFD could be a useful tool for estimating energy intake in normal weight elderly men. On the other hand, the PFD seems to be less suitable for estimating energy intake in overweight/obese elderly men.

The association between food patterns and adiposity among Canadian children at risk of overweight

Identifying food patterns related to obesity can provide information for health promotion in nutrition. Food patterns and their relation with obesity among Canadian children have not been reported to date. Our aim was to identify and describe food patterns associated with obesity in children at risk of overweight. Caucasian children (n = 630) with at least 1 obese biological parent recruited into the Quebec Adiposity and Lifestyle Investigation in Youth (QUALITY) cohort were studied in cross-sectional analyses. Measures of adiposity (body mass index (BMI), waist circumference, body fat mass percentage measured by dual-energy X-ray absorptiometry), screen time, physical activity (accelerometer over 7 days), and dietary intake (three 24-h food recalls) were collected. Factor analysis was used to identify food patterns. The relationships between food patterns and overweight were investigated in logistic and multiple linear regression models. Three food patterns were retained for analysis: traditional food (red meats, main dishes–soups, high-fat dairy products, tomato products, dressings, etc.); healthy food (low-fat dairy products, whole grains, legumes–nuts–seeds, fruits, vegetables); and fast food (sugar-sweetened beverages, fried potatoes, fried chicken, hamburgers–hot dogs–pizza, salty snacks). Higher scores on the fast food pattern were associated with overweight (BMI ≥ 85th percentile), and other measures of adiposity (BMI, waist circumference, body fat mass percentage) after adjustment for age, sex, physical activity, screen time, sleep time, family income, and mother’s obesity (p < 0.05). Controlling for energy intake did not change these relationships. Our results provide further evidence of a link between fast food intake and obesity in children.

[Daily consumption of soft drinks, sweets and fried foods among adolescents in the northeast of Brazil]

A school-based cross-sectional study in 2007 evaluated the prevalence and associated factors of daily consumption of soft drinks, sweets and fried foods among adolescents (15 to 20 years of age) in public schools in Caruaru in the state of Pernambuco. To evaluate the factors associated with the daily consumption of the above foods, a multivariate and hierarchical analysis was conducted using Poisson regression, with social and demographic variables at the first hierarchical level, behavioral variables at the second level and dietary standards at the third level. Consumption of soft drinks, sweets and fried foods at least once a week was declared by 90.9%, 95.4% and 89.6% of the adolescents, respectively. The corresponding prevalence of the daily consumption of these items was 30.2%, 42% and 28.3%. The daily consumption of sweets was 21% higher among girls and 25% higher among adolescents who ate rice and beans daily. With respect to fried foods, girls mentioned 37% greater consumption than boys. Adolescents who consumed meat every day admitted a 43% higher daily consumption of fried foods. The consumption of soft drinks, sweets and fried foods among the adolescents from Caruaru was high and showed a homogeneous consumption standard for most variables analyzed.

A nutrition intervention with a main focus on vegetables and bread consumption among young men in the Norwegian National Guard

BACKGROUND

Young men are difficult to reach with conventional nutrition information and they have a low intake of vegetables and whole grain cereals. Few intervention studies have focused on improving young men's consumption of vegetables and whole grains.

OBJECTIVE

A 5-month intervention focusing on a combination of increased availability of healthy foods and nutritional information was developed to stimulate the intake of vegetables and semi-whole grain bread among a group of young men in the Norwegian military.

SUBJECTS

A total of 376 recruits in the intervention group and 105 recruits in the control group participated in the entire study.

RESULTS

The average daily increase in consumption of vegetables was 82 g (p<0.001), and semi-whole grain bread 47 g (p<0.001) between baseline and follow-up in the intervention group. No significant changes were observed in the control group. Differences between intervention and control group at follow-up were significant (p<0.001) for vegetables and semi-whole grain bread, when controlling for baseline values, and seasonal variation for vegetables. The recruits in the intervention group received higher scores on the questions concerning nutritional knowledge after the intervention, compared to baseline (p<0.001). There was a significantly higher increase in the intake of vegetables among the recruits who increased the number of correct answers to the knowledge questions (β-value: 0.14, p<0.05) than among the others. There was no significant change in scores of food satisfaction after the intervention.

CONCLUSION

The combination of increased availability of healthy food items and nutrition information was an effective way to increase the intake of vegetables and semi-whole grain bread, without a reduction in food satisfaction, among young men in the military.

Changes and tracking of fruit, vegetables and sugar-sweetened beverages intake from 18 months to 7 years in the Norwegian Mother and Child Cohort Study

BACKGROUND

A few studies have investigated tracking of dietary patterns or nutrient intake in pre-school children, but no studies have been identified examining tracking of sugar-sweetened beverages (SSB), fruit and vegetable intakes in early childhood (1-7 year olds). The purpose of this study was to investigate changes and tracking of intakes of fruit, vegetables and SSB, and association between maternal education and dietary tracking, from 18 months to 7 years of age.

METHODS

Longitudinal data from the nation-wide Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health were used, including 9025 children participating at three time points (18 months, 36 months and 7 years). Frequencies of fruit, vegetables and SSB were assessed by questionnaire. Slightly different questions were used at each time point to collect information about intake. Maternal education was categorized into ≤ 12 years, 13-16 years, ≥ 17 years. Cross-tabulation, Spearman's rho and multinomial logistic regression were used for assessing change, tracking and differences by maternal education.

RESULTS

Analyses by gender indicated largest changes for intake of fruit and SSB from age 18 months to 7 years. Fair to moderate tracking coefficients (Spearman's rho = 0.23-0.46) for intake of fruit, vegetables and SSB were found and children assigned to low, medium and high frequency of consumption at 18 months continued to be in the same group at age 36 months and 7 years. Children of mothers with low education consumed fruit and vegetables less often and SSB more often compared to children of mothers with high education at 18 months of age. Children with higher educated mothers had lower odds for increasing fruit intake or decreasing SSB intake, compared to children with lower educated mothers showing a stable intake.

CONCLUSIONS

The tracking coefficients for intakes were fair to moderate and differences in intakes according to maternal education were found already at age 18 months. This suggests that promotion of healthy dietary behaviours at an early age is important to prevent unfavourable dietary behaviours later in childhood. Moreover, it seems important to target mothers in nutrition interventions for improving dietary habits among children.

Factors associated with added sugars intake among adolescents living in São Paulo, Brazil

OBJECTIVE

To measure added sugars intake among adolescents and describe its demographic, socioeconomic, and nutritional status determinants.

DESIGN

The study was conducted based on a household survey carried out between March and December 2003. Food intake was assessed through 24-hour food recalls, and an adjustment approach was applied using external variance estimates derived from 195 adolescents of the same age in 2007.

SETTING

Population-based cross-sectional study, city of São Paulo, Brazil.

SUBJECTS

Seven hundred and ninety-three male (n = 410) and female (n = 383) adolescents aged 10-19 years. MEASURE OF OUTCOME: Foods with greater contributions toward the added sugars intake were identified. Multiple linear regression analysis was performed, with calories from added sugars as the dependent continuous variable and the remaining factors (socioeconomic, demographic, lifestyle, household condition, and food intake) as independent variables.

RESULTS

The average contribution of added sugars to total energy value was 12.28% (95% confidence interval [CI]: 11.87-12.70) with no statistically significant sex difference (p > 0.05). Soft drinks were a major source of added sugars among the adolescents (34.2% among males and 32.0% among females), followed by sugars (sucrose and honey) and chocolate powder (around 11%). In the multiple linear regression analysis, the head of household's education level and calories from protein, fats, and carbohydrates other than sugars had an independent effect on added sugars intake.

CONCLUSIONS

This study showed that the percentage contribution of added sugars to energy intake among adolescents in the city of São Paulo, Brazil, was above the current recommended levels. Socioeconomic condition (represented by the head of the household's education level) and macronutrient intake were shown to be determinants of sugars intake.

Self-reported learning difficulties and dietary intake in Norwegian adolescents

Aim: The academic performance of children impacts future educational attainment which may increase socioeconomic status which again influences their health. One of several factors that might affect academic performance is the diet. The aim of this study was to investigate the cross sectional relation between diet and self-reported reading-, writing-, and mathematical difficulties in Norwegian adolescents. Methods: In total, 475 ninth- and tenth-grade students out of 625 eligible ones from four different secondary schools in three different municipalities in Vest-Agder County, Norway, participated, giving a participation rate of 77%. The students filled in a questionnaire with food frequency questions of selected healthy and unhealthy food items, questions of meal frequency and different learning difficulties. Results: Regular breakfast was significantly associated with decreased odds of both writing and reading difficulties (OR: 0.44 (0.2–0.8), p = 0.01) and mathematical difficulties (OR: 0.33 (0.2–0.6), p ≤ 0.001). In addition, having lunch, dinner and supper regularly were associated with decreased odds of mathematical difficulties. Further, a high intake of foods representing a poor diet (sugar-sweetened soft drinks, sweets, chocolate, savory snacks, pizza and hot dogs) was significantly associated with increased odds of mathematical difficulties. Conclusions: Having a less-frequent intake of unhealthy foods and not skipping meals are associated with decreased odds of self-reported learning difficulties in Norwegian adolescents in this study. The results of this study support the need for a larger study with a more representative sample.

The relationship between parental education and adolescents' soft drink intake from the age of 11-13 years, and possible mediating effects of availability and accessibility

The present study examined the prospective relationship between parental education and adolescents' soft drink intake over 20 months, and possible mediating effects of adolescents' availability and accessibility of soft drinks at home. A total of 866 adolescents, with data on two time points in the Norwegian HEalth In Adolescents (HEIA) cohort study (2007-9), were included in the analyses. Data on intake and determinants of soft drinks were collected from adolescents and both parents by questionnaires. Mediation analyses using linear regression investigated the total and direct effects of parental education on adolescents' soft drink intake from the age of 11-13 years. In order to investigate prospective relationships, two models were set up to measure the (1) prediction and (2) change in consumption over 20 months. Possible mediation effects of availability and perceived accessibility at home were further examined in both models. The results showed that a lower level of parental education predicted a higher intake of soft drinks among adolescents after 20 months, and that higher perceived accessibility of soft drinks reported by adolescents and mothers explained 39 % of the total effect. No relationship was observed between parental education and the change in adolescents' intake of soft drinks over 20 months. Interventions aimed at families with low parental education should target the perceived accessibility of soft drinks at home in order to diminish social differences in adolescents' soft drink consumption.

Correlates of weight status among Norwegian 11-year-olds: The HEIA study

Background

The underlying mechanisms of overweight and obesity in adolescents are still not fully understood. The aim of this study was to investigate modifiable and non-modifiable correlates of weight status among 1103 Norwegian 11-year-old adolescents in the HEalth in Adolescents (HEIA) study, including demographic factors such as gender and parental education, and behavioral factors such as intake of sugar-sweetened beverages, snacks and breakfast consumption, watching TV and playing computer games, physical activity and sedentary time.

Methods

Weight and height were measured objectively, body mass index (BMI) was calculated and International Obesity Task Force cut-offs were used to define weight status. Physical activity and sedentary time were measured by accelerometers. Other behavioral correlates and pubertal status were self-reported by questionnaires. Parental education was reported by the parents on the consent form for their child. Associations were investigated using logistic regressions.

Results

There were gender differences in behavioral correlates of weight status but not for weight status itself. Adolescents with parents in the highest education category had a 46% reduced odds of being overweight compared to adolescents with parents in the lowest education category. Adolescents with parents with medium education had 42% lower odds of being overweight than adolescents with parents with the lowest education category. Level of parental education, breakfast consumption and moderate to vigorous physical activity were positively associated with being normal weight, and time watching TV was positively associated with being overweight for the total sample. Gender differences were detected; boys had a doubled risk of being overweight for every additional hour of watching TV per week, while for girls there was no association.

Conclusions

The present study showed a social gradient in weight status in 11-year-olds. Both breakfast consumption and moderate to vigorous physical activity were inversely associated with weight status. No associations were found between intake of sugar-sweetened beverages and snacks, playing computer games and weight status. Watching TV was positively associated with weight status for boys but not for girls. Interventions are needed to gain more insight into the correlates of change in weight status.

Dietary intake of macro- and micronutrients in Slovenian adolescents: comparison with reference values

BACKGROUND

Data on a nationally representative dietary intake in Central Europe is lacking. We investigated the diet of adolescents in Slovenia.

METHODS

Dietary habits were assessed using a food frequency questionnaire (n = 2,661), and present nutrition was assessed using a 3-day weighted dietary protocol (n = 197) for validation purposes. Dietary intake was calculated and compared with Central European [German (D), Austrian (A), and Swiss (CH); D-A-CH] recommendations and World Health Organization/Food and Agriculture Organization (WHO/FAO) recommendations.

RESULTS

Adolescents consumed exceeding reference intake values of free sugars (boys 16% of energy, girls 17%), saturated fatty acids (SFA; 13% of energy), and sodium (boys 203%, girls 210% of the WHO/FAO upper limit), but below-reference intake values of polyunsaturated fatty acids (PUFA; boys 5% of energy; girls 6%), water (boys 1,786 ml/day, girls 2,016 ml/day), and fiber density (only girls 2.8 g/MJ, p < 0.001). Among micronutrients, below-reference intakes (% of D-A-CH: boys and girls, respectively, p < 0.05) were reported for folate (64 and 69%), fluoride (28 and 31%), and calcium (91 and 97%), as well as for vitamin D (20 and 20%).

CONCLUSIONS

The dietary habits of Slovenian adolescents are less than optimal. They are characterized by exceeding reference intake values of free sugars, salt, and SFA, and a below-reference intake of PUFA, water, and several micronutrients.

Introduction of a school fruit program is associated with reduced frequency of consumption of unhealthy snacks

BACKGROUND

A diet high in fruit and vegetables (FV) is inversely related to chronic diseases, and some studies suggest that increasing the intake of FV reduces the intake of unhealthy snacks.

OBJECTIVES

The objectives were to analyze changes in the frequency of consumption of unhealthy snacks (soda, candy, and potato chips) from 2001 to 2008 in Norwegian children, to assess whether being part of a school fruit program reduces the frequency of unhealthy snack consumption, and to explore differences in sex and socioeconomic status.

DESIGN

Within the project Fruits and Vegetables Make the Marks, 1488 sixth- and seventh-grade pupils from 27 Norwegian elementary schools completed a questionnaire in 2001, and 1339 sixth- and seventh-grade pupils from the same schools completed the same questionnaire in 2008. In 2001, none of the schools had any organized school fruit program. In 2008, 15 schools participated in a program and 12 did not participate in any program.

RESULTS

From 2001 to 2008, the frequency of unhealthy snack consumption decreased from 6.9 to 4.6 times/wk (P < 0.001). The decrease was largest in the schools that had been included in the national free school fruit program (-2.8 times/wk). The effect of the school fruit programs was significant in reducing the frequency of unhealthy snack consumption in children of parents without higher education (from 7.8 to 4.0 times/wk; P = 0.004).

CONCLUSIONS

The frequency of unhealthy snack consumption decreased from 2001 to 2008 in schoolchildren in Norway. The decrease was most evident among children at schools participating in the national free school fruit program and in children with a low socioeconomic status.

Does the school food environment influence the dietary behaviours of Norwegian 11-year-olds? The HEIA study

AIMS

The aim of the study is to investigate the influence of the school food environment on the dietary behaviours of 11-year-old Norwegian children in elementary schools.

METHODS

Baseline data from a school-based intervention study: the Health In Adolescents study was used. A total of 1425 11-year-old children from 35 schools from the eastern part of Norway were included. School administrators provided information on the physical, political, and sociocultural school food environment and students reported their intake of fruits, vegetables, sugar-sweetened beverages (SSB), and snacks. Multilevel modelling was used to assess the school-level variance in dietary behaviours and to investigate the association of school food environmental factors with these dietary behaviours.

RESULTS

After adjustment for student characteristics, the school level accounted for a small proportion (1.1%-3.0%) of the variance in the dietary behaviours investigated. None of the investigated school food environmental factors were found to be related to the children's reported intake of fruits, vegetables, snacks or SSB.

CONCLUSIONS

Most of the variance in the dietary behaviours investigated was at the personal level. Thus in this sample, the investigated school-level factors do not appear to exert a strong influence on the dietary behaviours of children. Longitudinal studies using validated measures of the school food environment are needed.