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Soós R, Bakó C, Gyebrovszki Á, Gordos M, Csala D, Ádám Z, Wilhelm M. Nutritional Habits of Hungarian Older Adults. Nutrients 2024; 16:1203. [PMID: 38674893 PMCID: PMC11053580 DOI: 10.3390/nu16081203] [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: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many nutritional changes that come with aging, mostly as consequences of health regression. Malnutrition and overweight often start with inadequate food consumption, followed by alterations in biochemical indices and body composition. In our study, we aimed to analyze the feeding habits and energy and nutrient intake of a Hungarian elderly population, focusing on macronutrient, water, fruit, and vegetable consumption while searching for possible nutritional factors leading to NCD and many other chronic diseases in this population. Two questionnaires were used. These were the Mini Nutritional Assessment (MNA) and one asking about nutritional habits, and a 3-day feeding diary was also filled. Subjects (n = 179, 111; females (F), 68 males (M), older than 50 years were recruited. Based on MNA results, 78 adults (43.57% of the studied population) were malnourished or at risk of malnutrition, although, according to BMI categories, 69% were overweight and 7.3% were obese among M, while 42.3% were overweight among F. The average daily meal number was diverse. The amount of people consuming fruit (11.7%) and vegetables (8.93%) several times a day was extremely low (15.3% of F and 4.4% of M). Daily fruit consumption in the whole sample was 79.3%. Overall, 36.3% consumed 1 L of liquid and 0.5 L of consumption was found in 15.1% of participants. A significant gender difference was found in water consumption, with F drinking more than M (p ≤ 0.01). In our sample, 27.93% of the respondents took dietary supplements. Further analysis and research are needed to explore the specific health implications of and reasons behind these findings.
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Affiliation(s)
- Rita Soós
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Csilla Bakó
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Gyebrovszki
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Mónika Gordos
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Dávid Csala
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Zoltán Ádám
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Pécs, 7624 Pécs, Hungary;
- Wnt-Signaling Research Group, Szentagothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márta Wilhelm
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
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Emmett P. Effects of Free Sugars Intake on Human Health and Disease. Nutrients 2023; 16:31. [PMID: 38201861 PMCID: PMC10780336 DOI: 10.3390/nu16010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
Calling all researchers with data on dietary intake to consider investigating dietary sugars (added or free sugars) in relation to nutrients and food groups or food classifications [...].
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Affiliation(s)
- Pauline Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK
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3
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Yan RR, Louie JCY. Sugar guidelines should be evidence-based and contain simple and easily actionable messages. Front Nutr 2023; 10:1227377. [PMID: 37649529 PMCID: PMC10464488 DOI: 10.3389/fnut.2023.1227377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Rina Ruolin Yan
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jimmy Chun Yu Louie
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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4
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Evidence does not support the reduction of added sugar intake from all food sources. Nat Rev Cardiol 2022; 19:845. [PMID: 36220969 DOI: 10.1038/s41569-022-00791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Association between added sugar intake and overall diet quality in the Finnish adult population. Br J Nutr 2022; 128:1848-1856. [PMID: 34842126 DOI: 10.1017/s0007114521004736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Added sugar intake has been associated with several health issues, but few studies have examined its association with overall diet quality. We aimed at examining the association between added sugar intake and overall diet quality in Finnish adults. Associations between added sugar intake and sociodemographic factors, lifestyle factors, and BMI were also explored. Our data comprised 5094 adults residing in Finland who participated in the National FinHealth 2017 Study. Dietary intake was assessed by a validated FFQ. Food consumption and nutrient intakes were calculated using the Finnish national food composition database. Added sugar intake was estimated based on food categorisation and identifying naturally occurring sugar sources. Overall diet quality was assessed by the modified Baltic Sea Diet Score. The average added sugar intake was 7·6 E % in women and 8·3 E % in men in this study population. Added sugar intake was inversely associated with education (P = 0·03 women; P = 0·001 men), physical activity (P < 0·0001), and BMI in men (P = 0·003), and directly with smoking (P = 0·002 women; P < 0·0001 men). Added sugar intake was inversely associated with overall diet quality in both sexes (P < 0·0001). No interactions were found except for men's physical activity subgroups, the inverse association being stronger among active men than moderately active or inactive men (Pfor interaction = 0·005). Our findings suggest that high added sugar intake is associated with several unhealthy dietary and lifestyle habits, including poor-quality diets, smoking and leisure-time inactivity in Finnish adults. Efforts to improve diet quality should consider added sugar intake equally in the whole population.
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6
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Zhang R, Yang Q, Tang Q, Xi Y, Lin Q, Yang L. Is Adolescents' Free Sugar Intake Associated with the Free Sugar Intake of Their Parents? Nutrients 2022; 14:nu14224741. [PMID: 36432428 PMCID: PMC9693973 DOI: 10.3390/nu14224741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
High free sugar intake can lead to increased dental caries, obesity, and other health risks among adolescents. Studies have shown that family factors, especially parents, are one of the primary factors influencing adolescents' sugar intake. This study aims to investigate the influence of adolescent parents' free sugar intake, knowledge, attitude, and practice (KAP) on adolescents' free sugar intake. A total of 1090 pairs of adolescents and their parents from 10 secondary schools in Changsha were enrolled in a cross-sectional study. Free sugar intakes of parents and adolescents were measured using the food frequency questionnaire (FFQ). The current status of parents' knowledge, attitude, and practice in consuming free sugar was investigated using online and offline questionnaires. Parental free sugar intake was 11.55 (5.08, 21.95) g/d, and that of adolescents was 41.13 (19.06, 80.58) g/d. Parental free sugar intake, free sugar knowledge level, intake behavior, and guidance behavior were associated with adolescent free sugar intake. A superior level of parental free sugar knowledge (adjusted OR = 0.726, 95% CI: 0.557~0.946) was a protective factor for adolescent free sugar intake. Moderate and high levels of parental free sugar intake (adjusted OR = 1.706, 95% CI: 1.212~2.401; adjusted OR = 2.372, 95% CI: 1.492~3.773, respectively) were risk factors for free sugar intake in adolescents. Given the importance of parental influence on the adolescent free sugar intake, further limiting parental intake and increasing awareness of free sugars could play an active role in future interventions for adolescents' free sugar intake.
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Affiliation(s)
| | | | | | | | - Qian Lin
- Correspondence: (Q.L.); (L.Y.); Tel.: +86-0731-84805464 (L.Y.)
| | - Lina Yang
- Correspondence: (Q.L.); (L.Y.); Tel.: +86-0731-84805464 (L.Y.)
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7
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Association between Food Sources of Free Sugars and Weight Status among Children and Adolescents in Japan: The 2016 National Health and Nutrition Survey, Japan. Nutrients 2022; 14:nu14173659. [PMID: 36079916 PMCID: PMC9460394 DOI: 10.3390/nu14173659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/20/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
This cross-sectional study aimed to investigate the relationship between food sources of free sugars and weight status among children and adolescents aged 2–19 years in Japan (1438 males and 1340 females) from the 2016 National Health and Nutrition Survey, Japan. We estimated the percentage of energy intake (% E) from free sugars from total food sources (FStotal), solid foods (FSsolids), and beverages (FSliquids), using one-day weighed dietary record data. Weight status was determined based on body mass index (BMI) z-scores and the prevalence of overweight and obesity. The mean energy intakes of FStotal, FSsolids, and FSliquids were 5.8%, 4.1%, and 1.8% in males and 6.2%, 4.6%, and 1.6% in females, respectively. After controlling for potential confounding factors, including energy intake, there was no association of free sugars intake from all food sources with BMI z-scores or with the prevalence of overweight and obesity, except for a marginal association between higher FSsolids and lower estimated BMI z-scores in females (p = 0.05). The present findings indicate that among children and adolescents in Japan, who have a relatively low mean intake of free sugars, consuming free sugars from any food source is unlikely to have an adverse effect on weight status.
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Fujiwara A, Omura Y, Oono F, Sugimoto M, Sasaki S, Takimoto H. A Scoping Review of Epidemiological Studies on Intake of Sugars in Geographically Dispersed Asian Countries: Comparison of Dietary Assessment Methodology. Adv Nutr 2022; 13:1947-1973. [PMID: 35641021 PMCID: PMC9526866 DOI: 10.1093/advances/nmac061] [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: 01/03/2022] [Revised: 03/10/2022] [Accepted: 05/26/2022] [Indexed: 01/28/2023] Open
Abstract
Previous systematic reviews, which focused on sugar intake and its relation with health issues, were mainly conducted in Western countries, not Asian countries characterized by differences in dietary habits and disease prevalence. The scarcity of Asian studies may be attributed to the lack of assessment tools for estimating sugar intake. To provide an overview of the epidemiological studies on sugar intake in Asian countries, with a primary focus on dietary assessment methodology for estimating sugar intake, we conducted a scoping review of the epidemiological studies estimating sugar intake in Asian countries (the United Nations' definition) and Taiwan using PubMed and Web of Science. Study quality was evaluated based on its assessment of sugar intake in the whole diet, dietary assessment methods, and data sources used for estimating sugar content. We identified 143 studies from 136 publications from Eastern (n = 63), Southern (n = 30), South-Eastern (n = 26), and Western (n = 24) Asia. Total sugars were investigated in 95 studies, while 23-30 studies investigated sucrose, fructose, added sugars, and free sugars. The main aim of the selected studies was assessment of diet-disease relations (n = 85) and estimation of dietary intake (n = 40), and 62 studies assessed sugars as the primary exposure/outcome. A total of 120 studies assessed sugar intake in the whole diet, and 62 studies used validated FFQs or multiple-day dietary assessment methods. Only 41 studies used country-specific comprehensive food-composition databases or directly measured sugar content. Only 17 studies reported high-quality data. This review elucidated a sufficient number of epidemiological studies estimating sugar intake across Asian countries; however, most studies reported low-quality data. The results from our review showed that both feasible and validated dietary assessment methods, as well as comprehensive country-specific sugar-composition databases, are essential for producing high-quality studies with accurate sugar intake to examine its association with health outcomes.
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Affiliation(s)
- Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan,Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Yuka Omura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumi Oono
- Department of Social and Preventive Epidemiology, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Minami Sugimoto
- Institute for Future Initiatives, University of Tokyo, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
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9
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Yan RR, Chan CB, Louie JCY. Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence. Am J Clin Nutr 2022; 116:15-39. [PMID: 35380611 PMCID: PMC9307988 DOI: 10.1093/ajcn/nqac084] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/01/2022] [Indexed: 01/15/2023] Open
Abstract
Sugar is widely consumed over the world. Although the mainstream view is that high added or free sugar consumption leads to obesity and related metabolic diseases, controversies exist. This narrative review aims to highlight important findings and identify major limitations and gaps in the current body of evidence in relation to the effect of high sugar intakes on health. Previous animal studies have shown that high sucrose or fructose consumption causes insulin resistance in the liver and skeletal muscle and consequent hyperglycemia, mainly because of fructose-induced de novo hepatic lipogenesis. However, evidence from human observational studies and clinical trials has been inconsistent, where most if not all studies linking high sugar intake to obesity focused on sugar-sweetened beverages (SSBs), and studies focusing on sugars from solid foods yielded null findings. In our opinion, the substantial limitations in the current body of evidence, such as short study durations, use of supraphysiological doses of sugar or fructose alone in animal studies, and a lack of direct comparisons of the effects of solid compared with liquid sugars on health outcomes, as well as the lack of appropriate controls, seriously curtail the translatability of the findings to real-world situations. It is quite possible that "high" sugar consumption at normal dietary doses (e.g., 25% daily energy intake) per se-that is, the unique effect of sugar, especially in the solid form-may indeed not pose a health risk for individuals apart from the potential to reduce the overall dietary nutrient density, although newer evidence suggests "low" sugar intake (<5% daily energy intake) is just as likely to be associated with nutrient dilution. We argue the current public health recommendations to encourage the reduction of both solid and liquid forms of free sugar intake (e.g., sugar reformulation programs) should be revised due to the overextrapolation of results from SSBs studies.
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Affiliation(s)
- Rina Ruolin Yan
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chi Bun Chan
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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10
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Brand-Miller J. Editorial: What Level of Added or Free Sugar Is Commensurate With Good Health Outcomes? Front Nutr 2021; 8:752534. [PMID: 34568410 PMCID: PMC8455925 DOI: 10.3389/fnut.2021.752534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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11
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MORTAŞ H, BİLİCİ S. Contribution of beverages to daily added sugar intake: compliance with guidelines’ recommendations. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.941938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Association between free sugar intake and nutrient dilution among Japanese children and adolescents: the 2016 National Health and Nutrition Survey, Japan. Br J Nutr 2021; 125:1394-1404. [PMID: 32943121 DOI: 10.1017/s0007114520003657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The influence of free sugar intake on nutrient intake remains unclear in Japanese children and adolescents with relatively low free sugar intake. This cross-sectional study aimed to investigate the relationship between free sugar and selected nutrient intakes using data from the 2016 National Health and Nutrition Survey, Japan, based on the WHO recommendations (<5 % or <10 % of energy (%E)) for free sugar intake. A 1-d weighed dietary record was assessed in Japanese children and adolescents (aged 1-19 years; n 2919). Mean intakes for selected nutrients and food groups were compared according to free sugar intake categories (<2·5 %E, 2·5 to <5 %E, 5 to <10 %E and ≥10 %E) with adjustment for sex, age and weight status. Inverse associations were observed between intakes of free sugars and twenty-one of twenty-four micronutrients assessed, except for vitamins A and C and Ca. Significantly reduced intakes were identified for twenty-two and fourteen micronutrients in the ≥10 %E and 5 to <0 %E categories, respectively, compared with the lower categories. Mean micronutrient intakes at the <2·5 %E category did not differ from those at the 2·5 to <5 %E category. Free sugar intake had positive associations with intakes of sugars and jams, confectioneries, fruit and vegetable juices, and soft drinks and negative associations with intakes of pulses and nuts and vegetables. This study showed that nutrient dilution was associated with higher free sugar intake among Japanese children and adolescents. The findings suggest that the WHO recommendations might help prevent nutrient dilution in Japanese children and adolescents.
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13
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Bergeron A, Labonté MÈ, Brassard D, Laramée C, Robitaille J, Desroches S, Provencher V, Couillard C, Vohl MC, Bélanger M, Lamarche B, Lemieux S. Associations of Intake of Free and Naturally Occurring Sugars from Solid Foods and Drinks with Cardiometabolic Risk Factors in a Quebec Adult Population: The PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) Study. J Nutr 2021; 151:1561-1571. [PMID: 33758943 PMCID: PMC8243855 DOI: 10.1093/jn/nxab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented. OBJECTIVE The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada. METHODS Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates. RESULTS In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models. CONCLUSIONS Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.
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Affiliation(s)
- Amélie Bergeron
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Didier Brassard
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Catherine Laramée
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada
| | - Julie Robitaille
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Sophie Desroches
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Véronique Provencher
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Charles Couillard
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Marie-Claude Vohl
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Mathieu Bélanger
- Department of Family Medicine, Université de
Sherbrooke, Moncton, Canada
| | - Benoît Lamarche
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
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14
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Janzi S, Ramne S, González-Padilla E, Johnson L, Sonestedt E. Associations Between Added Sugar Intake and Risk of Four Different Cardiovascular Diseases in a Swedish Population-Based Prospective Cohort Study. Front Nutr 2020; 7:603653. [PMID: 33425973 PMCID: PMC7786303 DOI: 10.3389/fnut.2020.603653] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
Aims: Although diet is one of the main modifiable risk factors of cardiovascular disease, few studies have investigated the association between added sugar intake and cardiovascular disease risk. This study aims to investigate the associations between intake of total added sugar, different sugar-sweetened foods and beverages, and the risks of stroke, coronary events, atrial fibrillation and aortic stenosis. Methods: The study population consists of 25,877 individuals from the Malmö Diet and Cancer Study, a Swedish population-based prospective cohort. Dietary data were collected using a modified diet history method. National registers were used for outcome ascertainment. Results: During the mean follow-up of 19.5 years, there were 2,580 stroke cases, 2,840 coronary events, 4,241 atrial fibrillation cases, and 669 aortic stenosis cases. Added sugar intakes above 20 energy percentage were associated with increased risk of coronary events compared to the lowest intake category (HR: 1.39; 95% CI: 1.09–1.78), and increased stroke risk compared to intakes between 7.5 and 10 energy percentage (HR: 1.31; 95% CI: 1.03 and 1.66). Subjects in the lowest intake group for added sugar had the highest risk of atrial fibrillation and aortic stenosis. More than 8 servings/week of sugar-sweetened beverages were associated with increased stroke risk, while ≤2 servings/week of treats were associated with the highest risks of stroke, coronary events and atrial fibrillation. Conclusion: The results indicate that the associations between different added sugar sources and cardiovascular diseases vary. These findings emphasize the complexity of the studied associations and the importance of considering different added sugar sources when investigating health outcomes.
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Affiliation(s)
- Suzanne Janzi
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Stina Ramne
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Esther González-Padilla
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Linda Johnson
- Cardiovascular Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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15
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Association of Free Sugars Intake with Cardiometabolic Risk Factors among Japanese Adults: The 2016 National Health and Nutrition Survey, Japan. Nutrients 2020; 12:nu12123624. [PMID: 33255814 PMCID: PMC7761430 DOI: 10.3390/nu12123624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022] Open
Abstract
The relationship between free sugars intake and cardiometabolic risk factors is unclear in Japanese adults. This cross-sectional study aimed to investigate this association using data from the 2016 National Health and Nutrition Survey, Japan. The percentage of energy intake from free sugars was estimated based on the 1-day weighed dietary record data of Japanese men (n = 4071) and women (n = 5794) aged ≥ 20 years. Associations between free sugars intake and cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures, glycated haemoglobin (HbA1c) level and levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, were investigated using linear regression and Dunnett’s test, with the lowest category of quartiles as a reference. After adjustment for potential confounding factors, free sugars intake was inversely associated with blood pressures (men only) and HDL-cholesterol level (both sexes) and positively associated with total-cholesterol level (women only) and LDL-cholesterol level (both sexes), whereas no association was observed for BMI, WC, and HbA1c level. This study identified both positive and inverse associations of free sugars intake with cardiometabolic risk factors in Japanese adults.
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16
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Fulgoni VL, Gaine PC, Scott MO. Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy. Nutrients 2020; 12:E2816. [PMID: 32938005 PMCID: PMC7551971 DOI: 10.3390/nu12092816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.
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Affiliation(s)
| | - P. Courtney Gaine
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
| | - Maria O. Scott
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
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Louie JCY. Objective Biomarkers for Total Added Sugar Intake - Are We on a Wild Goose Chase? Adv Nutr 2020; 11:1429-1436. [PMID: 32805008 PMCID: PMC7666891 DOI: 10.1093/advances/nmaa093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Misreporting of added sugar intake has been the major criticism of studies linking high added sugar consumption to adverse health outcomes. Despite the advancement in dietary assessment methodologies, the bias introduced by self-reporting can never be completely eliminated. The search for an objective biomarker for total added sugar intake has therefore been a topic of interest. In this article, the reasons this search may be a wild goose chase will be outlined and discussed. The limitations and inability of the 2 candidate biomarkers, namely urinary sucrose and fructose and δ¹³C isotope, which are based on the 2 only possible ways (i.e., difference in metabolism and plant sources) to identify added sugar based on current knowledge in human physiology and food and nutritional sciences, are discussed in detail. Validation studies have shown that these 2 candidate biomarkers are unlikely to be suitable for use as a predictive or calibration biomarker for total added sugar intake. Unless advancement in our understanding in human physiology and food and nutritional sciences leads to new potential ways to distinguish between naturally occurring and added sugars, it is extremely unlikely that any accurate objective added sugar biomarker could be found. It may be time to stop the futile effort in searching for such a biomarker, and resources may be better spent on further improving and innovating dietary assessment methods to minimize the bias introduced by self-reporting.
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Snacking in Japanese nursery school children aged 3-6 years: its characteristics and contribution to overall dietary intake. Public Health Nutr 2020; 24:1042-1051. [PMID: 32390580 DOI: 10.1017/s1368980019005007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This cross-sectional study evaluated the dietary characteristics of snacks, the contribution of snacks to daily nutrient intake and the association of energy intake (EI) from snacks with the prevalence of nutritional inadequacy in Japanese nursery school children. DESIGN Foods and nutrients consumed in each eating occasion were assessed by 3-d dietary records. The prevalence of inadequate intake of twenty nutrients assessed by the age- and sex-specific reference values in the Japanese Dietary Reference Intakes was compared according to tertile categories of EI from snacks. SETTING A multi-regional dietary survey based on nursery schools in Japan. PARTICIPANTS A total of 187 boys and 191 girls aged 3-6 years. RESULTS EI from snacks accounted for 19·5 % (sd 6·9) of total daily EI. Confectionaries accounted for the largest part of EI from snacks (35·3 %), followed by milk (19·5 %). Relative to their energy contribution, snacks accounted for a small proportion for all nutrients examined, except for free sugar, calcium, SFA and riboflavin. Although a higher EI from snacks was associated with favourable profiles for intakes of calcium, iron, thiamine and riboflavin, excessive intakes of free sugar and Na were more prevalent among children with a higher EI from snacks. CONCLUSIONS Although snacks are effective in meeting the requirement of some nutrients among Japanese nursery school children, snacks are generally not nutrient-dense and have an impact on excessive intake of some nutrients. There is hence room for improvement in food choices at snack time.
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The association between carbohydrate quality and nutrient adequacy in Australian adults. Eur J Clin Nutr 2020; 74:1594-1602. [PMID: 32253376 DOI: 10.1038/s41430-020-0620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To examine the association between various carbohydrate quality indicators and nutrient adequacy in Australian adults. SUBJECTS/METHODS Dietary data from adult participants of the 2011-2012 Australian Health Survey (weighted n = 6150) who had completed two 24 h recalls were analyzed. Glycaemic indices (GI) of foods were estimated based on a published method. Quartiles of dietary GI (dGI) and glycaemic load (dGL), and intakes of high (CHOhighGI) and low-GI carbohydrates (CHOlowGI) were derived. Estimated marginal means and standard errors of nutrient and food group intakes by quartiles were calculated using ANCOVA. Odds ratios of not meeting the nutrient reference values for Australia and New Zealand (NRVs) by quartiles of the carbohydrate quality indicators were calculated by logistic regression. Analyses were adjusted for known confounders. RESULTS Participants with higher CHOhighGI had lower intakes of the majority of nutrients examined, except sodium and %energy from free sugars. They were also more than 100% more likely to not meet the NRVs of vitamin A (2.19, 95% CI 1.89, 2.84), vitamin C (3.93, 95% CI: 1.61, 9.60), vitamin E (2.63, 95% CI: 2.08, 3.31), iron (2.27, 95% CI: 1.48, 3.49), magnesium (2.50, 95% CI: 2.01, 3.12), potassium (2.25, 95% CI: 1.79, 2.83), %EFS (2.74, 95% CI: 2.22, 3.38), and LCn3PUFA (2.35, 95% CI: 1.76, 3.16). Similar results were observed for dGI and dGL, while trends for CHOlowGI were in opposite direction in general. CONCLUSIONS Of the carbohydrate quality indicators examined, CHOhighGI was the strongest predictor of nutrient adequacy. Improvement in nutrient adequacy likely contributed to the health protective effect of a low-GI diet.
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Fulgoni VL, Gaine PC, Scott MO, Ricciuto L, DiFrancesco L. Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009-2014. Nutrients 2020; 12:nu12040985. [PMID: 32252302 PMCID: PMC7230951 DOI: 10.3390/nu12040985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
There is inconsistent evidence regarding the impact of added sugars consumption on micronutrient dilution of the diet. We examined the associations between added sugars intake deciles and nutrient adequacy for 17 micronutrients in U.S. adults 19+ (n = 13,949), 19–50 (n = 7424), and 51+ y (n = 6525) using two days of 24 hour dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 and regression analysis. Added sugars intake deciles ranged from <3.8 to >23.3% of calories among adults 19+ y, with a median intake of 11.0% of calories. Significant associations (p ≤ 0.01) between added sugars intake deciles and percentage of the population below the Estimated Average Requirement (EAR) were found for magnesium, vitamin C, vitamin D, and vitamin E; only the association with magnesium remained significant after dropping the two highest and lowest deciles of intake, suggesting a threshold effect. Intakes below approximately 18% of calories from added sugars were generally not associated with micronutrient inadequacy. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these four micronutrients, suggesting that adequate intakes are difficult to achieve regardless of added sugars intake.
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Affiliation(s)
- Victor L. Fulgoni
- Nutrition Impact, LLC, Battle Creek, MI 49014, USA
- Correspondence: ; Tel.: +1-269-962-0448
| | - P. Courtney Gaine
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
| | - Maria O. Scott
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
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Association between free sugars intake and nutrient dilution among Japanese adults: the 2016 National Health and Nutrition Survey, Japan. Eur J Nutr 2020; 59:3827-3839. [PMID: 32162042 DOI: 10.1007/s00394-020-02213-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The association between free sugars and nutrient intake is unclear in Japanese adults with relatively low free sugars intake. This cross-sectional study aimed to elucidate this relationship using data from the 2016 National Health and Nutrition Survey, Japan, and according to the current World Health Organization (WHO) guidelines for the prevention of nutrient dilution [< 5% or < 10% of energy (%E)]. METHODS Dietary intake of Japanese adults (aged ≥ 20 years; n = 16,652) was assessed using a 1-day weighed dietary record. Mean intakes for selected nutrients and food groups were compared among categories of free sugars intake (i.e., < 2.5%E, 2.5 to < 5%E, 5 to < 10%E, and ≥ 10%E) by adjusting for sex, age, weight status, smoking status, habitual drinking, and occupation. RESULTS Free sugars intake was inversely associated with the intake of 16 of 24 micronutrients investigated. Compared to its lower categories of free sugars intake, significant reductions in intake were identified for almost all micronutrients at ≥ 10%E, whereas ten micronutrients were reduced at 5 to < 10%E. The intake of dietary fibre, sodium, potassium, calcium, and iron was lower at < 2.5%E than at 2.5 to < 5%E and/or 5 to < 10%E. Free sugars intake was also positively associated with sugars and jams, confectionaries, fruit and vegetable juices, and soft drinks and inversely with pulses and nuts and vegetables. CONCLUSIONS This study identified nutrient dilution among Japanese adults with higher free sugars intake and confirmed the significance of the WHO guidelines for preventing nutrient dilution in Japanese.
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Bergeron A, Labonté MÈ, Brassard D, Bédard A, Laramée C, Robitaille J, Desroches S, Provencher V, Couillard C, Vohl MC, Lamarche B, Lemieux S. Intakes of Total, Free, and Naturally Occurring Sugars in the French-Speaking Adult Population of the Province of Québec, Canada: The PREDISE Study. Nutrients 2019; 11:E2317. [PMID: 31574982 PMCID: PMC6835783 DOI: 10.3390/nu11102317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to characterize the intakes of different types of sugars in an age- and sex-representative sample of French-speaking adults from five regions of the Province of Québec, Canada, enrolled in the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1147, 18-65 years old; 50.2% women). Because only total sugar content of foods and beverages is available in the Canadian Nutrient File (CNF) 2015, the initial step of this study was thus to build a database of free and naturally occurring sugars content of each food item and recipe included in the R24W, which is an automated, self-administered, web-based, 24-h dietary recall validated to estimate nutrient intakes in French-speaking adults of the Province of Québec. Total sugars were manually differentiated into free and naturally occurring sugars using a systematic algorithm based on previously published systematic algorithms. The World Health Organization (WHO)'s free sugar definition was used to differentiate total sugars into free and naturally occurring sugars. Dietary intake estimates were assessed using three 24-h dietary recalls completed with the R24W. Mean total, free, and naturally occurring sugar intakes were 116.4 g (19.3% of daily energy intake (%E)), 72.5 g (11.7%E), and 44.0 g (7.5%E), respectively. Over half (57.3%) of the overall sample did not meet the WHO's recommendation to consume less than 10%E from free sugars. Women had a higher %E from naturally occurring sugars than men and being younger was associated with a greater %E from free sugars. Sugar intakes among French-speaking adults from the Province of Québec were mainly in the form of free sugars, with the majority of the population exceeding the WHO recommendation regarding free sugar intake. This suggests that public health efforts towards reducing free sugar intake in this population are relevant and necessary, considering that overconsumption of free sugars negatively influences health outcomes.
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Affiliation(s)
- Amélie Bergeron
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Marie-Ève Labonté
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Didier Brassard
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Alexandra Bédard
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Catherine Laramée
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Julie Robitaille
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Sophie Desroches
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Charles Couillard
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Marie-Claude Vohl
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
| | - Simone Lemieux
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada.
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada.
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Association of free sugar intake with blood pressure and obesity measures in Australian adults. Eur J Nutr 2019; 59:651-659. [PMID: 30826906 DOI: 10.1007/s00394-019-01932-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/16/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE This study examined the association of free sugar (FS) intake with obesity measures and blood pressure (BP) among a nationally representative sample of Australian adults. METHODS Data from adults (weighted n = 5136) who completed 2 × 24-h recalls and had complete data for BP, waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) were analyzed. Associations between percentage energy of FS from all food sources (%EFStotal), beverages only (%EFSbeverages), and non-beverages sources only (%EFSnon-beverages) and obesity measures and BP were examined using linear and non-linear regressions. Logistic regression was used to calculate the odds ratios (OR) of being classified as overweight and/or obese, having increased cardiometabolic risks, and elevated BP per 5% point increase in %EFStotal, %EFSbeverages, and %EFSnon-beverages. All regression analyses were adjusted for known socio-economic and lifestyle confounders. RESULTS %EFSbeverage was positively associated with BMI, WC, and WHtR (all p < 0.05), while %EFSnon-beverage was inversely associated with these outcomes. Increases in odds of having an undesirable WC/WHtR were found with increasing %EFSbeverages (OR per 5% point increase in %EFSbeverages: 1.19 for WC; 1.23 for WHtR, both p < 0.001). %EFStotal and %EFSnon-beverages were weakly and negatively associated with diastolic BP. A 5% point increase in %EFStotal and %EFSnon-beverage was associated with a 10-25% reduction in odds of having elevated BP. CONCLUSIONS Our results suggested that only a higher FS intake from beverages may be associated with obesity, and higher FS intake was associated with reduced odds of having elevated BP.
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Ramne S, Alves Dias J, González-Padilla E, Olsson K, Lindahl B, Engström G, Ericson U, Johansson I, Sonestedt E. Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 Swedish population-based prospective cohorts. Am J Clin Nutr 2019; 109:411-423. [PMID: 30590448 DOI: 10.1093/ajcn/nqy268] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se. Objective The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk. Methods Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475), which assessed diet with an FFQ. Sugar intakes defined as both added and free sugar and different sugar sources were examined. The associations with mortality were examined using a multivariable Cox proportional hazards regression. Results Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy (E%) intake in both cohorts. Intakes >20E% were associated with a 30% increased mortality risk, but increased risks were also found at intakes <5E% [23% in the MDCS and 9% (nonsignificant) in the NSHDS]. Similar U-shaped associations were found for both cardiovascular and cancer mortality in the MDCS. By separately analyzing the different sugar sources, the intake of SSBs was positively associated with mortality, whereas the intake of treats was inversely associated. Conclusions Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source.
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Affiliation(s)
| | | | | | | | - Bernt Lindahl
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine
| | | | - Ulrika Ericson
- Diabetes and Cardiovascular Disease-Genetic Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ingegerd Johansson
- Departments of Odontology and Nutritional Research, Umeå University, Umeå, Sweden
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Fujiwara A, Murakami K, Asakura K, Uechi K, Sugimoto M, Wang HC, Masayasu S, Sasaki S. Estimation of Starch and Sugar Intake in a Japanese Population Based on a Newly Developed Food Composition Database. Nutrients 2018; 10:nu10101474. [PMID: 30309012 PMCID: PMC6213530 DOI: 10.3390/nu10101474] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/20/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022] Open
Abstract
Due to a lack of a food composition database on starch and sugars, we developed a comprehensive database on starch and seven types of sugars in commonly consumed foods (n = 2222) in Japan. Dietary record data of 368 toddlers (aged 18–35 months), 376 preschool children (aged 3–6 years), 915 schoolchildren (aged 8–14 years) and 392 adults (aged 20–69 years) were used. The mean starch intake ranged from 55.6 g/day (female toddlers) to 206.0 g/day (male schoolchildren). Irrespective of age and sex, >50% of starch was provided by rice and grains. The mean total sugar intake ranged from 46.1 g/day (female toddlers) to 68.7 g/day (male schoolchildren). In all age and sex groups, the major contributors of total sugar included sucrose (mean: 18.2–34.0 g/day), glucose (7.8–13.1 g/day), lactose (5.3–13.1 g/day) and fructose (7.6–11.1 g/day). The top food sources were dairy products (toddlers) and confectionaries (other age groups) for total sugar, confectionaries for sucrose, fruits (toddlers) and vegetables (other age groups) for glucose, dairy products for lactose and fruits (toddlers and preschool children) and vegetables (schoolchildren and adults) for fructose. In conclusion, this study clarified the starch and sugar intake in Japan and provides a foundation for future research.
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Affiliation(s)
- Aya Fujiwara
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan.
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan.
| | - Keiko Asakura
- School of Medicine, Toho University, Tokyo 143-8540, Japan.
| | - Ken Uechi
- Faculty of Health Science, Toho University, Chiba 274-8510, Japan.
| | - Minami Sugimoto
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan.
| | - Han-Chieh Wang
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan.
| | | | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan.
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Lean MEJ, Garcia AL, Gill T. Sugar taxation: a good start but not the place to finish. Am J Clin Nutr 2018; 108:435-436. [PMID: 30535111 DOI: 10.1093/ajcn/nqy211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Ada L Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Tim Gill
- Boden Institute and Charles Perkins Centre, University of Sydney, NSW, Australia
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Wong THT, Mok A, Ahmad R, Rangan A, Louie JCY. Intake of free sugar and micronutrient dilution in Australian children and adolescents. Eur J Nutr 2018; 58:2485-2495. [PMID: 30066176 DOI: 10.1007/s00394-018-1801-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/28/2018] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Tommy Hon Ting Wong
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong
| | - Angelique Mok
- School of Life and Environmental Sciences and Charles Perkins Centre, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rabia Ahmad
- School of Life and Environmental Sciences and Charles Perkins Centre, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Anna Rangan
- School of Life and Environmental Sciences and Charles Perkins Centre, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong.
- School of Life and Environmental Sciences and Charles Perkins Centre, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia.
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