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Reile R, Oja R. Temporal changes and educational disparities in the frequent consumption of sugar-sweetened beverages among Estonian adults during 2006-2022. PUBLIC HEALTH IN PRACTICE 2024; 8:100536. [PMID: 39263244 PMCID: PMC11389544 DOI: 10.1016/j.puhip.2024.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 09/13/2024] Open
Abstract
Objectives Excessive consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes but is differentiated by socio-economic indicators. The study analyses the educational disparities in adults frequent consumption of sugar-sweetened beverages (SSBs) in Estonia and its temporal changes between 2006 and 2022. Study design Repeated cross-sectional survey. Methods Nationally representative data from 9 biennial cross-sectional surveys on 25-64-year-old Estonian residents (n = 20396) was used for the study. Changes in frequent (on 6-7 days per week) consumption of SSBs by study year, sex, age, and education is analysed using descriptive statistics and binomial logistic regression. Prevalence and odds ratios (OR) with 95 % confidence intervals (CIs) are presented focusing on temporal and educational patterns in frequent SSB consumption. Results The prevalence of frequent SSB consumption among Estonian adults declined consistently from 2006 (14.0 %) to 2018 (5.2 %), followed by statistically non-significant increases in 2020 (6.8 %) and 2022 (7.1 %). Prevalence of frequent SSB consumption was significantly (p < 0.01) higher among adults with primary or lower education (12.4 %) compared to tertiary education group (4.8 %). The educational differences in SSB consumption (12.4 % in primary or lower vs. 4.8 % in tertiary education) were nearly three-fold after adjusting for sex, age, and period effects (OR 2.84, 95 % CI 1.71-4.74) and have been consistent since 2010. Conclusions Although frequent consumption of SSBs has been generally decreasing among Estonian adults, the findings illustrate the persisting educational gradients in exposure that expectedly translates into socio-economic inequalities in adverse health outcomes resulting from excessive SSB consumption.
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Affiliation(s)
- Rainer Reile
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Renata Oja
- Institute of Psychology, University of Tartu, Tartu, Estonia
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Queral J, Wargers A, Tarro L, Llauradó E, Solà R, Jansen W. Changes over time of fruit, vegetable and sweets consumption among European adolescents and associations with sociodemographic characteristics: an HBSC study. J Public Health (Oxf) 2024; 46:392-402. [PMID: 38614469 PMCID: PMC11358633 DOI: 10.1093/pubmed/fdae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/21/2023] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND European adolescents do not eat enough fruits and vegetables and have a high sweets consumption. This study aims to analyse the changes in time of dietary behaviours related to sociodemographic characteristics, among European adolescents. METHODS Health Behaviour in School Age Children data (2013/14 to 2017/18), of European adolescents, aged 11- to15-year-old, were used. Family Affluence Scale identified socioeconomic status (SES). Changes in time of dietary behaviours and associations with sociodemographic characteristics were estimated by binary and multilevel logistic regression. RESULTS 182 719 adolescents were included, and 10/36 European countries showed a significant increase in daily fruit and vegetable consumption and 12/36 countries a significant decrease in sweets consumption over 4 years. The multilevel analysis showed that 13- and 15-year-old adolescents consumed fewer daily fruits and vegetables (P < 0.001) and more daily sweets (P < 0.001) than 11-year-old adolescents. Also, 15-year-old adolescents' sweets consumption change over time was less favourable (P = 0.006). Girls consumed more daily fruits, vegetables and sweets than boys (P < 0.001).Low SES adolescents consumed fewer daily fruits and vegetables than medium/high SES adolescents. Additionally, the low SES adolescents' vegetable consumption change over time was less favourable (P < 0.001). CONCLUSIONS Dietary behaviour policy recommendations should be adapted for the sex, age and SES of the population.
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Affiliation(s)
- Judit Queral
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Avda. Josep Laporte 2, 43204 Reus, Spain
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - Annemieke Wargers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40,3015 GD, Rotterdam, The Netherlands
| | - Lucia Tarro
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Avda. Josep Laporte 2, 43204 Reus, Spain
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - Elisabet Llauradó
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Avda. Josep Laporte 2, 43204 Reus, Spain
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - Rosa Solà
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Avda. Josep Laporte 2, 43204 Reus, Spain
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40,3015 GD, Rotterdam, The Netherlands
- Department of Social Development, City of Rotterdam, Coolsingel 40, 3011 AD Rotterdam, The Netherlands
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Dierckens M, Deforche B, De Clercq B, Weinberg D, Stevens GWJM, Chatelan A, Rouche M, Clays E, Delaruelle K. Country-level sociocultural context and socioeconomic inequalities in adolescent dietary behaviours: A multilevel analysis in 21 European countries. Appetite 2024; 198:107339. [PMID: 38604381 DOI: 10.1016/j.appet.2024.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Studies to date have predominantly focused on countries' socioeconomic conditions (e.g., income inequality) to explain cross-national differences in socioeconomic inequalities in adolescent health (behaviours). However, the potential explanatory role of sociocultural contexts at country-level remains underexamined. This study examined whether the country-level sociocultural context and changes thereof were associated with adolescent socioeconomic inequalities in dietary behaviours. International comparative data of 344,352 adolescents living in 21 countries participating in 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey were combined with aggregated levels of openness-to-change from the European Social Survey (ESS). Four dietary behaviours (i.e., fruit, vegetable, sweets and soft drink consumption) and two measures of socioeconomic status (SES) on the individual level (i.e., family affluence scale [FAS] and occupational social class [OSC]) were studied. Multilevel logistic regression analyses returned contrasting results for the two SES measures used. In countries with higher levels of openness-to-change, smaller FAS inequalities in daily fruit, sweets and soft drink consumption were observed, but no such inequalities were found for vegetable consumption. Conversely, in these countries, larger OSC inequalities in soft drink consumption were found. Country-specific changes in openness-to-change over time were not associated with the magnitude of adolescent dietary inequalities. Findings underscore the importance of including country-level sociocultural contexts to improve the understanding of cross-national differences in socioeconomic inequalities in adolescents' diets. Future studies, spanning a longer timeframe, are required to examine whether such associations exist within countries over time since our timeframe might have been too small to capture these long-term trends.
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Affiliation(s)
- Maxim Dierckens
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Movement and Nutrition for Health and Performance Research Group, Department of Movement and Sports Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Bart De Clercq
- Mensura R&D Department, Mensura EDPB, Italiëlei 2, 2000, Antwerpen, Belgium
| | - Dominic Weinberg
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
| | - Angeline Chatelan
- Research Centre in Epidemiology, Biostatistics and Clinical Trials, School of Public Health, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Manon Rouche
- Research Centre in Epidemiology, Biostatistics and Clinical Trials, School of Public Health, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Katrijn Delaruelle
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Sociology, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
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Smith L, López Sánchez GF, Tully MA, Rahmati M, Oh H, Kostev K, Butler LT, Barnett Y, Keyes H, Shin JI, Koyanagi A. Temporal trends of carbonated soft-drink consumption among adolescents aged 12-15 years from eighteen countries in Africa, Asia and the Americas. Br J Nutr 2024; 131:1633-1640. [PMID: 38225928 DOI: 10.1017/s0007114524000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.
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Affiliation(s)
- Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Guillermo Felipe López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, Northern Republic of Ireland, UK
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Laurie T Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Helen Keyes
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de Llobregat, Barcelona, Spain
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Mekonnen T, Papadopoulou E, Lien N, Andersen LF, Pinho MGM, Havdal HH, Andersen OK, Gebremariam MK. Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income. Nutr J 2023; 22:43. [PMID: 37697383 PMCID: PMC10494387 DOI: 10.1186/s12937-023-00872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents' soft drink intake through potential mediators. METHODS Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. RESULTS Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents' higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. CONCLUSIONS Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.
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Affiliation(s)
- Teferi Mekonnen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eleni Papadopoulou
- Division of Health Service, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Gabriela Matias Pinho
- Department Environmental Sciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, the Netherlands
| | - Hanne Hennig Havdal
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Mekdes K Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Malik VS, Hu FB. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol 2022; 18:205-218. [PMID: 35064240 PMCID: PMC8778490 DOI: 10.1038/s41574-021-00627-6] [Citation(s) in RCA: 260] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/08/2023]
Abstract
Sugar-sweetened beverages (SSBs) are a major source of added sugars in the diet. A robust body of evidence has linked habitual intake of SSBs with weight gain and a higher risk (compared with infrequent SSB consumption) of type 2 diabetes mellitus, cardiovascular diseases and some cancers, which makes these beverages a clear target for policy and regulatory actions. This Review provides an update on the evidence linking SSBs to obesity, cardiometabolic outcomes and related cancers, as well as methods to grade the strength of nutritional research. We discuss potential biological mechanisms by which constituent sugars can contribute to these outcomes. We also consider global trends in intake, alternative beverages (including artificially-sweetened beverages) and policy strategies targeting SSBs that have been implemented in different settings. Strong evidence from cohort studies on clinical outcomes and clinical trials assessing cardiometabolic risk factors supports an aetiological role of SSBs in relation to weight gain and cardiometabolic diseases. Many populations show high levels of SSB consumption and in low-income and middle-income countries, increased consumption patterns are associated with urbanization and economic growth. As such, more intensified policy efforts are needed to reduce intake of SSBs and the global burden of obesity and chronic diseases.
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Affiliation(s)
- Vasanti S Malik
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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The Dose-Response Associations of Sugar-Sweetened Beverage Intake with the Risk of Stroke, Depression, Cancer, and Cause-Specific Mortality: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients 2022; 14:nu14040777. [PMID: 35215425 PMCID: PMC8875574 DOI: 10.3390/nu14040777] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
The associations between sugar-sweetened beverage (SSB) consumption and the risk of stroke, depression, cancer, and cause-specific mortality have not been determined, and the quantitative aspects of this link remain unclear. This meta-analysis therefore conducted a systematic review and dose-response analysis to determine their causal links. The database searches were conducted in PubMed, Cochrane library, Embase, Web of Science up to 10 November 2021. The intervention effects were evaluated by relative risk (RR) with 95% confidences (CI). Thirty-two articles met the inclusion criteria. Higher levels of SSB consumption significantly increased the risk of stroke (RR 1.12, 95% CI 1.03–1.23), depression (1.25, 1.11–1.41), cancer (1.10, 1.03–1.17), and all-cause mortality (1.08, 1.05–1.11) compared with none or lower SSB intake. The associations were dose-dependent, with per 250 mL increment of SSB intake daily increasing the risk of stroke, depression, cancer, and all-cause mortality by RR 1.09 (1.03–1.15), 1.08 (1.06–1.10), 1.17 (1.04–1.32), and 1.07 (1.03–1.11), respectively. The link was curved for depression and cancer risk (pnon-linear < 0.05). Subgroup analysis suggested that higher SSB intake increased ischemic stroke by 10%, CVD-caused mortality by 13%, and cancer-caused mortality by 6.0% than none or lower SSB consumption. It is suggested that SSB accounts for a leading risk factor of stroke, depression, cancer, and mortality, and that the risk rises in parallel with the increment of SSB intake (and is affected by participant characteristics).
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