Variations in Sugar Content of Flavored Milks and Yogurts: A Cross-Sectional Study across 3 Countries

Industrially Produced Plant-Based Food Products: Nutritional Value and Degree of Processing

The plant-based food market is rapidly growing, offering innovative options to meet consumer expectations. However, a comprehensive analysis of the nutritional quality of these foods is lacking. We aimed to characterize industrial plant-based food products' nutritional value and degree of processing. A cross-sectional study was conducted on two market-leading Portuguese food retail chains by assessing the nutritional composition of all the available pre-packaged plant-based food products (n = 407). These products were categorized into meal alternatives, dairy alternatives, and other products containing dairy/meat alternative ingredients including ready meals and desserts. The products' nutritional quality was assessed according to the cut-offs established by the Portuguese Directorate General of Health [DGS] on total fat, saturated fat, sugar, and salt, and considering the degree of processing using NOVA classification. One-tenth of the products were classified as having a high total fat, saturated fat, sugars, or salt content. In some sub-categories, half of foods were classified as high in saturated fat, and over two-thirds were considered high salt products. Less than one-third exhibit a good nutritional profile based on the national cut-offs. A total of 84.3% of plant-based food products were ultra-processed. These findings emphasize the need to improve the nutritional profile of plant-based options.

Application of multiple-intake temporal check all that apply: a case study of strawberry yoghurt formulated with alternative sweeteners

BACKGROUND

It is crucial to reduce the high sugar content of fruit yoghurts in response to the excessive weight gain epidemic. The use of alternative sweeteners in yoghurts is often associated with the negative sensory attributes that can have an impact on yoghurt liking. The main objective of this research was to investigate the effect of alternative sweeteners and strawberry puree addition on the temporal sensory profile of yoghurt using multiple-intake temporal check all that apply (TCATA). A novel approach to the statical analysis of the temporal sensory data was employed by using aligned rank transformation-analysis of variance to investigate the differences between sensory attributes within different products and within different intakes.

RESULTS

Results showed that the attributes sweet and fruity decreased when the concentration of fruit puree was increased at low concentration of sucrose. Interestingly, when the concentration of fruit puree was increased, fruitiness increased and mouthcoating decreased at low concentration of stevia. With successive intakes, the attributes sweet, sour, creamy and fruity significantly decreased in yoghurts sweetened with sucrose, xylitol and stevia. Yoghurts containing low concentrations of sucrose or xylitol and fruit puree were liked the most. However, stevia-sweetened yoghurts varying in sweetener and puree concentration were not significantly different in liking. In order to investigate the consumer acceptance of yoghurts, a novel approach was used - that is, utilizing TCATA temporal data to investigate temporal drivers of liking for each yoghurt type.

CONCLUSION

The use of multiple statistical analysis to analyse temporal data suggested that both sweetener and puree concentration need to be considered when developing products using alternative sweeteners. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Assessing the Policy Implications of Different Definitions for Added Sugars: An Analysis Across the Australian Packaged Food and Beverage Supply

Background

In recent years, various definitions of "added sugars" have emerged across jurisdictions. Although it is clear how these definitions differ, there is limited understanding of the policy implications associated with these variations.

Objective

To test the potential policy implications of different definitions of "added sugars" on the Australian packaged food supply, we developed a method to estimate the content of "added sugars" in packaged foods and applied this to 3 different definitions of "added sugars": (i) United States Food and Drug Administration (US FDA) added sugar definition, (ii) the World Health Organization (WHO) free sugar definition, and (iii) a comprehensive definition that was developed from a review of the evidence on "added sugars."

Methods

Using a representative sample of 25,323 Australian packaged foods, the "added sugar" content and proportion of products that contain "added sugar" under the 3 definitions were estimated. In addition, a comparative analysis exploring the impact of the US FDA definition (least comprehensive) vs. the comprehensive definition was conducted to understand potential implications of adopting different regulatory definitions in Australia.

Results

The US FDA definition identified the lowest number and proportion of products with any "added sugars" at 14,380 products (representing 56.8% of all products), followed by the WHO free sugar definition at 15,168 products (59.9%) and the comprehensive definition at 16,260 products (64.2%). The mean estimates for "added sugars" were 8.5 g/100 g, 8.7 g/100 g, and 9.6 g/100 g for the US FDA, WHO, and comprehensive definitions, respectively. Compared with the US FDA definition, the comprehensive definition captured an additional 7.4% of products, largely driven by nonalcoholic beverages, special foods and fruit, vegetables, nuts, and legumes.

Conclusions

Despite small variations in different "added sugars" definitions, their application has some significant policy implications. Findings highlight the importance of applying a comprehensive regulatory definition that adequately captures all sugars that have been linked to poor health.

Nutrient composition of milk and plant-based milk alternatives: A cross-sectional study of products sold in Australia and Singapore

Dairy and non-dairy (plant-based) alternatives are promoted as an essential component of a healthy diet. The purpose of this study was to evaluate the range of dairy milks and plant-based milk alternatives in supermarkets in Australia and Singapore, and to explore nutritional differences within the category, and between countries. Product information was collected in store from packaging. Products were sorted into dairy milks and plant-based milk alternatives, and further categorised as (i) breakfast drinks (12 % of products); (ii) plain milks (62 %); or (iii) flavoured milks (26 %). The nutrient profiles of products were tested for differences using Kruskal Wallis and Mann-Whitney U tests. Flavoured products contained almost double the median sugar content of plain products (8.3 g v. 4.6 g, p = 0.005). Two-thirds of the product range were dairy milks, which contained nearly four times the median saturated fat content (1.1 g v. 0.3 v, p < 0.0001) and more than double the amount of sugar (5.1 g v. 2.6 g, p < 0.0001) of plant-based milk alternatives, but three times more protein (3.3 g v. 1.0 g, p < 0.0001). Between countries, generally, calcium contents were similar across products, likely due to fortification of plant-based milk alternatives. Compared to Singapore, dairy milk and plant-based milk alternative products sold in Australia were generally higher in energy, protein and fat, but lower in carbohydrate content. Food supply differences between Singapore and Australia may be cultural and have nutritional implications.

Effect of various types of milk on salivary pH among children: a pilot randomized controlled crossover trial

OBJECTIVE

This study aimed to evaluate salivary pH changes after consuming three types of milk in children aged 3-5 years. The null hypothesis was that no statistically significant difference would be noted in the salivary pH between high-protein, full-fat, and sweetened milk groups at different time points.

MATERIALS AND METHODS

This was a double-blind, pilot randomized controlled crossover trial. 30 Children have undergone three experimental sessions with a 1-week washout period. Each child was given 250 mL of one of the following types of milk: high-protein, full-fat, or sweetened milk. The salivary pH was measured at the baseline (t0) after 5 (t1), 10 (t2), 15 (t3), 30 (t4), and 60 (t5) minutes of milk consumption, using a pH saliva indicator strip.

RESULTS

There is a sharp drop in salivary pH after 5 min of sweetened (P < 0.05) and full-fat milk consumption (p < 0.05). However, the initial drop in the salivary pH was found to remain above the critical level. For the high-protein milk group, salivary pH decreased slightly after 5 min but was similar to that at the baseline (p = 0.573). In the high-protein milk group (p < 0.05), the salivary pH was slightly greater than the baseline value at t5.

CONCLUSIONS

The study shows an initial suggestion that milk is a non-cariogenic beverage, even when sugar is added. Furthermore, high-protein milk has a protective effect from dental caries.

Nutrition analysis - with particular focus on carbohydrate content in kefirs and natural yoghurts in the Polish consumer market

The aim of the study was to assess the nutrition of selected fermented dairy products available in Polish supermarkets and how many of them meet the criterion set by the European Parliament and Council Act (UE) no. 1924/2006 form 20 December 2006 on nutrition and health claims made on foods regarding low sugar content in a solid product. In the study 100 fermented products, widely available in Polish supermarkets, were selected, and their nutrition was analysed based on the information placed on the producer's label, and the carbohydrate content was compared against the recommended 5 g per 100 g of the solid product. As a result, it was determined that among natural products, 92% of the kefirs and 36% fulfilled the carbohydrate content criterion, whereas out of the analysed flavoured products, only one.

Socio-economic difference in purchases of ultra-processed foods in Australia: an analysis of a nationally representative household grocery purchasing panel

BACKGROUND

Consumption of ultra-processed foods is associated with increased risk of obesity and non-communicable diseases. Little is known about current patterns of ultra-processed foods intake in Australia. The aim of this study was to examine the amount and type of ultra-processed foods purchased by Australian households in 2019 and determine whether purchases differed by socio-economic status (SES). We also assessed whether purchases of ultra-processed foods changed between 2015 and 2019.  METHODS: We used grocery purchase data from a nationally representative consumer panel in Australia to assess packaged and unpackaged grocery purchases that were brought home between 2015 to 2019. Ultra-processed foods were identified according to the NOVA system, which classifies foods according to the nature, extent and purpose of industrial food processing. Purchases of ultra-processed foods were calculated per capita, using two outcomes: grams/day and percent of total energy. The top food categories contributing to purchases of ultra-processed foods in 2019 were identified, and differences in ultra-processed food purchases by SES (Index of Relative Social Advantage and Disadvantage) were assessed using survey-weighted linear regression. Changes in purchases of ultra-processed foods between 2015 to 2019 were examined overall and by SES using mixed linear models.

RESULTS

In 2019, the mean ± SD total grocery purchases made by Australian households was 881.1 ± 511.9 g/d per capita. Of this, 424.2 ± 319.0 g/d per capita was attributable to purchases of ultra-processed foods, which represented 56.4% of total energy purchased. The largest food categories contributing to total energy purchased included mass-produced, packaged breads (8.2% of total energy purchased), chocolate and sweets (5.7%), biscuits and crackers (5.7%) and ice-cream and edible ices (4.3%). In 2019, purchases of ultra-processed foods were significantly higher for the lowest SES households compared to all other SES quintiles (P < 0.001). There were no major changes in purchases of ultra-processed foods overall or by SES over the five-year period.

CONCLUSIONS

Between 2015 and 2019, ultra-processed foods have consistently made up the majority of groceries purchased by Australians, particularly for the lowest SES households. Policies that reduce ultra-processed food consumption may reduce diet-related health inequalities.

Association Between Dairy Intake and Executive Function in Chinese Children Aged 6–12 Years

Association between dairy intake and executive function remains controversial, especially among children, a population with fast-developing executive functions. This study aimed to explore this topic. Additionally, we further distinguished the role of dairy intake types (full- or low-fat milk or yogurt) in this relationship. This survey included 5,138 children aged 6–12 years. Dairy intakes were assessed by validated questionnaires. Executive function was measured by the behavior rating inventory of executive function (BRIEF; Parent Version), and lower T-scores of BRIEF indices indicated superior executive function performance. Results showed that children with higher dairy intake had statistically better performance in Shift (46.58 ± 7.48 vs. 45.85 ± 7.10), Initiate (48.02 ± 8.58 vs. 47.14 ± 8.33), and Working Memory (50.69 ± 8.82 vs. 49.89 ± 8.73). In the analysis of multivariate linear regression, we found that for every one unit increase in full-fat dairy intake, T-scores for Shift (β = −0.350 (95% confidence interval [CI]: (−0.660, −0.039) and Initiate (β = −0.486 (95% CI: (−0.845, −0.127) were decreased and for every one unit increase in low-fat dairy intake, T-score for Organizations of Materials (β = −0.940 (95% CI: (−1.690, −0.189) was decreased. After distinguishing dairy into milk and yogurt, we observed that only milk intake, not yogurt, was significantly associated with better executive function performance in Shift (β = −0.390 (95% CI (−0.745, −0.035) and Initiate (β = −0.509 (95% CI (−0.917, −0.101) after adjusting for potential confounding factors. This study shows that a higher intake of dairy, irrespective of fat content, is related to better executive function performance among children aged 6–12. In addition, a significantly positive relationship between dairy intake and executive function’s indices of Shift and Initiate only was observed in milk, not in yogurt.

A food systems approach and qualitative system dynamics model to reveal policy issues within the commercial broiler chicken system in South Africa

Global broiler production and consumption levels continue to rise. South Africa’s broiler system is dominated by commercial production and formal retail trade, with competition from cheap imports. Local broiler policies have narrow, production-driven, short-term aims for industry growth and national food security. However, these have unintended consequences that undermine the system’s future sustainability. Using a food systems approach, this study developed a qualitative system dynamics model of the South African commercial broiler system and used it to engage stakeholders in policy discussions within the boundaries of health, nutrition, and environmental sustainability. A problem statement and key system elements were drawn from a previously published qualitative study and were validated by 15 stakeholders via an online questionnaire. From this, a seed model was developed, expanded into a larger model, and shared in a modular format with stakeholders in virtual meetings, on an individual or institutional basis, for feedback and validation, and for discussion of areas for policy consideration. Refinements were incorporated into the modules, policy considerations were summarised, and crosscutting issues were identified. The model demonstrated the system’s complexity, interlinkages, feedbacks, reinforcing and balancing loops, and behaviour archetypes. The modular presentation format created a suitable platform for stakeholder engagement. Current policies focus on local commercial production, formal markets, and affordability without cognisance of the broader system represented by the model. Inequality pervades throughout the system. Commercial producers, linked to large supermarkets and fast-food chains, dominate the system, presenting barriers to entry. Affordability is unintentionally traded off against non-communicable disease risks through brining of most frozen products, and ultra-processing of fast-food items. Foodborne disease control is critical, given the proportion of vulnerable individuals, and greater coherence of food safety policy is urgently needed. The environmental footprint of broilers, whilst less than that of ruminants, deserves closer scrutiny based on its dependence on intensive cereal production for feed. This study’s food systems approach provides a system-wide perspective and a foundation for policymakers to develop more integrated and transformative policies.

Nutritional Content and Health Profile of Non-Dairy Plant-Based Yogurt Alternatives

Yogurt is considered a healthy, nutritious food in many cultures. With a significant number of people experiencing dairy intolerance, and support for a more sustainable diet, consumer demand for dairy alternatives has surged. The aim of this study was to conduct a cross-sectional survey of plant-based yogurt alternatives to assess their nutritional content and health profile. A total of 249 non-dairy yogurt alternatives were analyzed from the nutrition label listed on the commercial package. The various yogurt alternatives contained extracts of coconut (n = 79), almonds (n = 62), other nuts or seeds (n = 20), oats (n = 20), legumes (n = 16), and mixed blends (n = 52). At least one-third of the yogurt alternatives had 5 g or more of protein/serving. Only 45% of the yogurt alternatives had calcium levels fortified to at least 10% of daily value (DV), while only about one in five had adequate vitamin D and B12 fortification at the 10% DV level. One-half of the yogurt alternatives had high sugar levels, while 93% were low in sodium. Except for the coconut-based products, the yogurts were not high in fat or saturated fat. The yogurt alternatives were not fortified as frequently or to the same levels as the corresponding non-dairy, plant-based beverages.

Estimating the potential impact of the Australian government's reformulation targets on household sugar purchases

BACKGROUND

Countries around the world are putting in place sugar reformulation targets for packaged foods to reduce excess sugar consumption. The Australian government released its voluntary sugar reformulation targets for nine food categories in 2020. We estimated the potential impact of these targets on household sugar purchases and examined differences by income. For comparison, we also modelled the potential impact of the UK sugar reduction targets on per capita sugar purchases as the UK has one of the most comprehensive sugar reduction strategies in the world.

METHODS

Grocery purchase data from a nationally representative consumer panel (n=7,188) in Australia was linked with a large database (FoodSwitch) with product-specific sugar content information for packaged foods (n=25,261); both datasets were collected in 2018. Potential reductions in per capita sugar purchases were calculated overall and by food category. Differences in sugar reduction across income level were assessed by analysis of variance.

RESULTS

In 2018, the total sugar acquired from packaged food and beverage purchases consumed at-home was 56.1 g/day per capita. Australia's voluntary reformulation targets for sugar covered 2,471/25,261 (9.8%) unique products in the FoodSwitch dataset. Under the scenario that all food companies adhered to the voluntary targets, sugar purchases were estimated to be reduced by 0.9 g/day per capita, which represents a 1.5% reduction in sugar purchased from packaged foods. However, if Australia adopted the UK targets, over twice as many products would be covered (n=4,667), and this would result in a more than four times greater reduction in sugar purchases (4.1 g/day per capita). It was also estimated that if all food companies complied with Australia's voluntary sugar targets, reductions to sugar would be slightly greater in low-income households compared with high-income households by 0.3 g/day (95%CI 0.2 - 0.4 g/day, p<0.001).

CONCLUSIONS

Sugar-reduction policies have the potential to substantially reduce population sugar consumption and may help to reduce health inequalities related to excess sugar consumption. However, the current reformulation targets in Australia are estimated to achieve only a small reduction to sugar intakes, particularly in comparison to the UK's sugar reduction program.

The Contribution of Major Food Categories and Companies to Household Purchases of Added Sugar in Australia

BACKGROUND

The Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods.

OBJECTIVE

To estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels.

DESIGN

Cross-sectional study.

PARTICIPANTS/SETTING

We used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch).

MAIN OUTCOME MEASURES

Added sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita).

STATISTICAL ANALYSES PERFORMED

Food categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance.

RESULTS

Added sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases.

CONCLUSIONS

The Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.

Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden

BACKGROUND

Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly.

OBJECTIVE

Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating.

METHODS

The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package.

RESULTS

Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating.

CONCLUSIONS

Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals.

Estimating the potential impact of Australia's reformulation programme on households' sodium purchases

Background

On average, Australian adults consume 3500 mg sodium per day, almost twice the recommended maximum level of intake. The Australian government through the Healthy Food Partnership initiative has developed a voluntary reformulation programme with sodium targets for 27 food categories. We estimated the potential impact of this programme on household sodium purchases (mg/day per capita) and examined potential differences by income level. We also modelled and compared the effects of applying the existing UK reformulation programme targets in Australia.

Methods

This study used 1 year of grocery purchase data (2018) from a nationally representative consumer panel of Australian households (Nielsen Homescan) that was linked with a packaged food and beverage database (FoodSwitch) that contains product-specific sodium information. Potential reductions in per capita sodium purchases were calculated and differences across income level were assessed by analysis of variance. All analyses were modelled to the Australian population in 2018.

Results

A total of 7188 households were included in the analyses. The Healthy Food Partnership targets covered 4307/26 728 (16.1%) unique products, which represented 22.3% of all packaged foods purchased by Australian households in 2018. Under the scenario that food manufacturers complied completely with the targets, sodium purchases will be reduced by 50 mg/day per capita, equivalent to 3.5% of sodium currently purchased from packaged foods. Reductions will be greater in low-income households compared with high-income households (mean difference -7 mg/day, 95% CI -4 to -11 mg/day, p<0.001). If Australia had adopted the UK sodium targets, this would have covered 9927 unique products, resulting in a reduction in per capita sodium purchases by 110 mg/day.

Conclusion

The Healthy Food Partnership reformulation programme is estimated to result in a very small reduction to sodium purchases. There are opportunities to improve the programme considerably through greater coverage and more stringent targets.

Effect of Yogurt Consumption on Metabolic Syndrome Risk Factors: a Narrative Review

PURPOSE OF REVIEW

Metabolic syndrome (MetS) comprises risk factors such as obesity, hypertriglyceridemia, hypertension, and hyperglycemia. Here we described the outcome of various yogurt consumption, either conventional, low-fat, high-fat, Greek, or enriched with nutrients or probiotics: (1) on the parameters of MetS risk factors and (2) on the mechanisms of action of the MetS risk factors.

RECENT FINDING

The majority (25 studies) of clinical trials and meta-analyses of clinical trials reported a beneficial effect of yogurt consumption in the prevention of MetS risk. Yogurt components, such as calcium, vitamin D, proteins, and probiotics, were associated with the multiple beneficial effects on the prevention of MetS. In general, yogurt consumption may be promoted within healthy dietary patterns to prevent MetS. More studies are needed to determine what type of yogurt has the greatest benefits for specific MetS risk factor prevention.

Projected effects on salt purchases following implementation of a national salt reduction policy in South Africa

OBJECTIVE

To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with.

DESIGN

This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content.

SETTING

South Africa.

PARTICIPANTS

The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018.

RESULTS

Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels.

CONCLUSIONS

A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.

Sodium concentration of pre-packaged foods sold in Hong Kong

OBJECTIVE

To describe the Na concentration of pre-packaged foods available in Hong Kong.

DESIGN

The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na (<120 mg/100 g or mg/100 ml and >600 mg/100 g or mg/100 ml, respectively) were determined.

SETTING

Hong Kong.

PARTICIPANTS

Not applicable.

RESULTS

We analysed 11 518 pre-packaged products. 'Fruit and vegetables (including table salt)' had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by 'sauces, dressings, spreads and dips' ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446-3520), followed by meat and meat products (median 800, IQR 632-1068) and snack foods (median 650, IQR 453-926). Fish and fish products (median 531, 364-791) and meat and meat products (median 444, IQR 351-593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively.

CONCLUSIONS

Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.

Total carotene content and quality characteristics of pumpkin flavoured buffalo milk

As per the World Health Organization (WHO) and Global Hunger Index, the incidence of malnutrition and Vitamin-A deficiency in preschool-age children is higher in South-East Asian countries. Therefore, this study was envisaged to formulate value-added flavoured buffalo milk and to carry out the sensory evaluation, nutritional analysis, storage characteristics and total carotene content of the developed product. Flavoured buffalo milk was prepared by incorporation of Cucurbita pepo (Pumpkin) pulp and ground sugar at a concentration of 15% and 10%, respectively. The formulation was found preeminent by panellists and then subjected to nutritional analysis and storage studies at room temperature following "in bottle heat treatment". Nutritional analysis revealed that the protein, fat, total carbohydrates, total ash and moisture content of pumpkin flavoured buffalo milk were 3.07%, 5.21%, 12.63%, 0.61% and 78.48%, respectively. The storage study of flavoured buffalo milk showed a significantly (p < 0.05) declined score in colour and appearance as well as flavour only after day 90. The overall acceptability score also declined significantly (p < 0.05) after day 60 of storage. Though the sensory score declined gradually during the storage period, the product was liked by the panellist even till day 180. The carotene content of pumpkin flavoured buffalo milk was 1.2 mg/100 g at day 0 and it decreased significantly as storage prolongs. The nutritional components were not affected significantly during the 180 days storage period. Standard plate counts, coliform counts as well as yeast and mould counts were not detected during storage of pumpkin flavoured buffalo milk.

Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis

IMPORTANCE

Sugar-sweetened beverages (SSBs) are associated with increased risk of metabolic syndrome (MetS). However, the role of other important food sources of fructose-containing sugars in the development of MetS remains unclear.

OBJECTIVE

To examine the association of major food sources of fructose-containing sugars with incident MetS.

DATA SOURCES

MEDLINE, Embase, and Cochrane Library were searched from database inception to March 24, 2020, in addition to manual searches of reference lists from included studies using the following search terms: sugar-sweetened beverages, fruit drink, yogurt, metabolic syndrome, and prospective study.

STUDY SELECTION

Inclusion criteria included prospective cohort studies of 1 year or longer that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study.

DATA EXTRACTION AND SYNTHESIS

Study quality was assessed using the Newcastle-Ottawa Scale. Extreme quantile risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Dose-response analyses were performed using a 1-stage linear mixed-effects model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results were reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines.

MAIN OUTCOMES AND MEASURES

Pooled risk ratio (RR) of incident MetS (pairwise and dose response).

RESULTS

Thirteen prospective cohort studies (49 591 participants [median age, 51 years; range, 6-90 years]; 14 205 with MetS) that assessed 8 fructose-containing foods and MetS were included. An adverse linear dose-response association for SSBs (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86) was found. Fruit juices (mixed and 100%) had a U-shaped dose-response association with protection at moderate doses (mixed fruit juice: RR for 125 mL/d, 0.58; 95% CI, 0.42-0.79; 100% fruit juice: RR for 125 mL/d, 0.77; 95% CI, 0.61-0.97). Honey, ice cream, and confectionary had no association with MetS incidence. The certainty of the evidence was moderate for SSBs, yogurt, fruit, mixed fruit juice, and 100% fruit juice and very low for all other food sources.

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis suggest that the adverse association of SSBs with MetS does not extend to other food sources of fructose-containing sugars, with a protective association for yogurt and fruit throughout the dose range and for 100% fruit juice and mixed fruit juices at moderate doses. Therefore, current policies and guidelines on the need to limit sources of free sugars may need to be reexamined.