Fat and sugar: an economic analysis

A scoping study on the social determinants of health and sugar consumption in the context of policy approaches for improving population health

OBJECTIVES

To conduct a scoping review of existing research on the social determinants of health, sugar consumption and public health policy responses to address or improve health outcomes.

METHODS

A total of 13 categories were developed to reflect the authors' interest in the overall focus on the social determinants of health, sugar as an independent risk factor, upstream policy action ('whole populations'), downstream policy action ('targeted') and two contemporary policy strategies (namely 'Vulnerable populations' and 'Proportionate Universalism'). The search strategy was then performed on MEDLINE (via Ovid) and Web of Science, and was limited to the English language. No time limits prior to when the database search was conducted in 2022 were set to explore the full extent of the literature in this field.

RESULTS

Five hundred and sixty articles were retrieved, of which 181 met the criteria for review. When all categories were applied, the findings showed that 76% of papers focusing on sugar consumption as a risk factor for non-communicable diseases (NCDs) mentioned the social determinants of health. The majority of studies (60%) recommended downstream interventions, with 40% recommending 'upstream' interventions. A limited proportion (12%) of research work was published in dental journals. Research had been done using predominantly quantitative methods (66% of articles), with 24% of studies adopting a mixed methods approach, and 8% being exclusively qualitative. Research on contemporary strategies for sugar reduction were focused on the 'Global North' and 98% of papers used individual level data focused on targeted approaches, highlighting that there is little direct evidence for contemporary strategies aimed at reducing sugar consumption.

CONCLUSIONS

Whilst the majority of public and dental health research argues that there is a need to address the social determinants of health, the findings from this study highlight that very few empirical studies have been designed to directly inform contemporary strategies for sugar reduction. More research is therefore needed that can directly assess the evidence for contemporary strategies in public health policy.

Dietary knowledge-attitude-practice status in hemodialysis patients: a latent profile analysis

BACKGROUND

Hemodialysis patients require a reasonable dietary intake to manage their disease progression effectively. However, there is limited research on these patients' overall dietary knowledge, attitude, and practice (KAP) status. This study aimed to investigate the dietary KAP status and latent profiles in hemodialysis patients and identify sociodemographic and disease-related factors associated with these profiles and dietary practice.

METHODS

A multicenter cross-sectional study involving 425 hemodialysis patients was conducted. A dietary KAP questionnaire in hemodialysis patients was used to evaluate the dietary KAP of the patients. A structural equation model was employed to analyze the correlations between dietary knowledge, attitude, and practice. Multiple linear regression analysis was used to identify factors associated with dietary practice scores. Latent profile analysis was conducted to determine the latent profiles of dietary KAP, and binary logistic regression was used to explore the sociodemographic and disease-related characteristics associated with each KAP profile in hemodialysis patients.

RESULTS

The normalized average scores for dietary knowledge, attitude, and practice in hemodialysis patients were 0.58, 0.82, and 0.58, respectively. The structural equation model revealed significant positive correlations between dietary knowledge and attitude, and attitude and practice. Attitude played an indirect effect between knowledge and practice. Gender, cerebrovascular disease, and dietary attitude scores were identified as independent influencing factors for dietary practice scores. Two dietary KAP profiles were developed: a profile with general knowledge and attitude but low practice (40.2%) and a profile with general knowledge and attitude and high practice (59.8%). Binary logistic regression analysis indicated gender and monthly income per household significantly predicted membership in each KAP profile.

CONCLUSIONS

The dietary practice of hemodialysis patients requires improvement. It is necessary to develop more individualized dietary interventions for these patients. Further exploration is needed to understand the motivation of patients to change their dietary behavior.

The Impact of the COVID-19 Pandemic on the Food Security of UK Adults Aged 20-65 Years (COVID-19 Food Security and Dietary Assessment Study)

The first UK lockdown greatly impacted the food security status of UK adults. This study set out to establish if food procurement was adapted differently for different income groups and if this impacted dietary intakes disproportionately. Adults (n = 515) aged 20-65 years participated in an online survey with 56 completing a 3-4 day diet diary. Food availability was a significant factor in the experience of food insecurity. Similar proportions of food secure and food insecure adapted food spend during lockdown, spending similar amounts. Food insecure (n = 85, 18.3%) had a 10.5% lower income and the money spent on food required a greater proportion of income. Access to food was the biggest driver of food insecurity but monetary constraint was a factor for the lowest income group. The relative risk of food insecurity increased by 0.07-fold for every 1% increase in the proportion of income spent on food above 10%. Micronutrient intakes were low compared to the reference nutrient intake (RNI) for most females, with riboflavin being 36% lower in food insecure groups (p = 0.03), whilst vitamin B12 was 56% lower (p = 0.057) and iodine 53.6% lower (p = 0.257) these were not significant. Coping strategies adopted by food insecure groups included altering the quantity and variety of fruit and vegetables which may have contributed to the differences in micronutrients.

Utility of 'substance use disorder' as a heuristic for understanding overeating and obesity

Rates of obesity and obesity-associated diseases have increased dramatically in countries with developed economies. Substance use disorders (SUDs) are characterized by the persistent use of the substance despite negative consequences. It has been hypothesized that overconsumption of palatable energy dense food can elicit SUD-like maladaptive behaviors that contribute to persistent caloric intake beyond homeostatic need even in the face of negative consequences. Palatable food and drugs of abuse act on many of the same motivation-related circuits in the brain, and can induce, at least superficially, similar molecular, cellular, and physiological adaptations on these circuits. As such, applying knowledge about the neurobiological mechanisms of SUDs may serve as useful heuristic to better understand the persistent overconsumption of palatable food that contributes to obesity. However, many important differences exist between the actions of drugs of abuse and palatable food in the brain. This warrants caution when attributing weight gain and obesity to the manifestation of a putative SUD-related behavioral disorder. Here, we describe similarities and differences between compulsive drug use in SUDs and overconsumption in obesity and consider the merit of the concept of "food addiction".

The energetics of uniquely human subsistence strategies

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Maternal Knowledge, Attitude and Practices toward Free Sugar and the Associations with Free Sugar Intake in Children

Research addressing factors related to free sugar (FS) consumption among children in Saudi Arabia is lacking. We aimed to evaluate maternal knowledge, attitude, and practices toward FS and the associations with children's intake of FS. This cross-sectional study included 424 Saudi children aged 6-12 years and their mothers. Data related to maternal knowledge, attitude, and practices were collected using an online survey. Data concerning children's habitual intake of FS were collected through phone interviews using a validated food frequency questionnaire. Limited knowledge on FS was observed among mothers of children [median 7.00 [interquartile range 6.00-8.00] out of 11.0. Maternal knowledge was not correlated with maternal attitude or practices toward FS. Maternal knowledge towards FS did not predict children's intake of FS, whereas maternal attitude and practices toward limiting the consumption of FS predicted lower intake of FS among Saudi children, particularly the FS consumed from solid food sources (B: -5.73 [95% confidence interval (CI): -9.79 to -1.66]) and (B: -6.85 [95% CI: -11.9 to -1.80]), respectively. Despite the limited knowledge pertaining to FS among mothers in Saudi Arabia, they were making efforts to limit their children's consumption of FS.

Orosensory Perception of Fat/Sweet Stimuli and Appetite-Regulating Peptides before and after Sleeve Gastrectomy or Gastric Bypass in Adult Women with Obesity

The aim of this study was to explore the impact of bariatric surgery on fat and sweet taste perceptions and to determine the possible correlations with gut appetite-regulating peptides and subjective food sensations. Women suffering from severe obesity (BMI > 35 kg/m²) were studied 2 weeks before and 6 months after a vertical sleeve gastrectomy (VSG, n = 32) or a Roux-en-Y gastric bypass (RYGB, n = 12). Linoleic acid (LA) and sucrose perception thresholds were determined using the three-alternative forced-choice procedure, gut hormones were assayed before and after a test meal and subjective changes in oral food sensations were self-reported using a standardized questionnaire. Despite a global positive effect of both surgeries on the reported gustatory sensations, a change in the taste sensitivity was only found after RYGB for LA. However, the fat and sweet taste perceptions were not homogenous between patients who underwent the same surgery procedure, suggesting the existence of two subgroups: patients with and without taste improvement. These gustatory changes were not correlated to the surgery-mediated modifications of the main gut appetite-regulating hormones. Collectively these data highlight the complexity of relationships between bariatric surgery and taste sensitivity and suggest that VSG and RYGB might impact the fatty taste perception differently.

Early Exposure to High-Sucrose Diet Leads to Deteriorated Ovarian Health

BACKGROUND

The metabolic syndrome (MetS) is correlated with disorders of the reproductive system, such as the polycystic ovary syndrome (PCOS). While consumption of a diet rich in carbohydrates is linked to the development of MetS, it is still unclear if this diet leads to ovarian dysfunction and PCOS.

OBJECTIVES

We investigated the influence of a high-sucrose diet (HSD) on the ovarian milieu of Wistar rats and studied the correlation between high consumption of sugary drinks and the prevalence of PCOS in women.

METHODS

Wistar rats were given a standard laboratory diet (CTR, 10% sucrose, n = 8) or HSD (HSD, 25% sucrose, n = 8) from postnatal day 21 to 120. Animals were evaluated weekly to calculate food intake, feed efficiency and weight gain. Both onset of puberty and estrous cycle were monitored. Metabolic serum biochemistry, organ morphometry and ovarian histology were performed upon euthanasia. In parallel, a fixed-effects multiple linear regression analysis was performed using data from Brazilian states (459 state-year observations) to test the correlation between the consumption of sugar-sweetened beverages (surrogate for HSD intake) and the prevalence of PCOS (surrogate for ovarian dysfunction).

RESULTS

HSD animals showed increased adipose tissue accumulation, hyperglycaemia and insulin resistance when compared to CTR. Interestingly HSD rats also entered puberty earlier than CTR. Moreover, ovaries from HSD animals had an increased number of atretic antral follicles and cystic follicles, which were correlated with the hypertrophy of periovarian adipocytes. Finally, there was a positive correlation between the intake of sugary drinks and prevalence of PCOS in women of reproductive age.

CONCLUSIONS

HSD ingestion leads to ovarian dysfunction in rats and could be correlated with PCOS in women, suggesting these alterations could lead to public health issues. Therefore, we reinforce the deleterious impact of HSD to the ovarian system and suggest that the reduction of added sugars intake could be beneficial to ovarian health.

Differences in the sugar content of fast-food products across three countries

OBJECTIVE

To compare the sugar content of items at four multinational fast-food chains, across three countries.

DESIGN

Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey-Kramer adjustments.

SETTING

USA, Germany and Australia.

PARTICIPANTS

Burger King™ (Hungry Jack's™), Kentucky Fried Chicken™, McDonald's™ and Subway™.

RESULTS

Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories.

CONCLUSIONS

Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.

[A joint study of the multidimensional factors associated with the overall quality of adult diets in Canada]

BACKGROUND

With 26% of Canadians suffering from obesity, significant steps are needed to reduce the social and economic costs entailed by their condition. Given its major contribution to this phenomenon, the quality of diet has been at the heart of numerous previous studies. The objective of the study is to analyze, based on recent data, the association between the quality of the diet of Canadian adults (18 years old and over), and their individual characteristics as well as those of their living environment, including several new elements (prices of fruits and vegetables, food security status).

METHODS

Using data from the 2015 CCHS-Nutrition Survey and information from the 2007 Canadian Food Guide, a diet quality score (also called healthy eating index) was first calculated and then associated with different factors (identified in a literature review) through multiple linear regressions.

RESULTS

In addition to confirming its association with age, gender, overall well-being and other socio-economic factors, this study reveals that quality of adult diets is negatively correlated with the evolution of people's food insecurity status and the increase of vegetable prices in the Canadian provinces since 2002. The positive link between diabetes and the quality of diet could reflect healthier eating behaviors due to the constraints generated by this disease. While city dwellers generally have access to a more diversified food supply, they nevertheless do not have a better diet than the rural population. Finally, non-North American immigrants appear to have a better diet than non-autochthonous Canadians.

CONCLUSION

Paying more attention to food insecurity and to the affordability of vegetables are avenues to explore in view of improving the quality of nourishment in Canada. In any event, longitudinal studies shall be required to confirm the role and to measure the actual influence of these variables on the quality of individual adult diets.

Análise de série temporal do consumo de bebidas açucaradas entre adultos no Brasil: 2007 a 2014

Resumo O objetivo deste artigo é analisar a tendência temporal e os fatores associados ao consumo de refrigerante ou suco artificial entre adultos no Brasil. Estudo desenvolvido a partir de dados secundários do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, realizado com adultos brasileiros entre 2007-2014. Foi verificada a frequência e a intensidade do consumo (quantidade de copos ou latas por semana) de refrigerante ou suco artificial. Dados sociodemográficos e comportamentais foram as variáveis independentes. A tendência temporal do consumo anual foi avaliada por meio de Regressão Linear. Os fatores associados (idade, sexo, região, trabalho, escolaridade, hábito de assistir TV) ao consumo dessas bebidas foram investigados por Regressão de Poisson. Houve redução de 32,7% do consumo de refrigerante ou suco artificial entre 2007 e 2014. Os fatores associados ao maior consumo foram: sexo masculino (p = 0,000); faixa etária de 18-29 anos (p = 0,000); residência nas regiões centro-oeste, sudeste e sul (p = 0,000); menor escolaridade (p = 0,616); estar empregado (p = 0,007) e assistir TV mais de 3 horas por dia (p = 0,000). As análises descrevem uma tendência de queda no consumo de refrigerante ou suco artificial entre os adultos no Brasil de 2007 a 2014.

Food advertisements on television and eating habits in adolescents: a school-based study

OBJECTIVE To analyze the association of television food advertisements with eating habits in Brazilian adolescents. METHODS The sample was composed of 1,011 adolescents, aged from 10-17 years. The influence of television food advertisements on eating habits, as well as food consumption and socioeconomic variables were assessed through questionnaires. A binary logistic regression was performed to assess the magnitude of the associations, adjusted for gender, age, socioeconomic status, and parental schooling. RESULTS Of the sample, 83.3% (n = 843) reported food consumption while watching TV. Adolescents who do not consume food while watching TV had a higher weekly consumption of fruits (3.98, SD = 2.0 versus 3.39, SD = 2.1) and vegetables (4.1, SD = 2.2 versus 3.4, SD = 2.3). Adolescents that consume food while watching TV had higher weekly consumption of fried foods (3.1, SD = 2.0 versus 2.3, SD = 1.7), sweets (4.1, SD = 2.1 versus 3.3, SD = 2.1), soft drinks (3.2, SD = 2.1 versus 2.2, SD = 1.9), and snacks (2.3, SD = 2.0 versus 1.6, SD = 1.7). For 73,8% of the sample, food advertisements induce product consumerism, most commonly sweets and fast foods. Buying or asking to buy food after seeing it on the television was associated with fried foods (OR = 1.36, 95%CI = 1.03- 1.79), sweets (OR = 1.69, 95%CI = 1.30-2.18), and snacks (OR = 1.57, 95%CI = 1.12-2.22). CONCLUSION Food advertisements were associated with greater consumption of fried foods, sweets, and snacks in adolescents, even after adjusting for confounding factors.

Food Insecurity Is Associated with Prediabetes Risk Among U.S. Adolescents, NHANES 2003-2014

Objective: Food insecurity has been linked to adverse health consequences. We sought to determine if food insecurity was related to obesity and prediabetes risk in U.S. adolescents. We also investigated if Supplemental Nutrition Assistance Program (SNAP) utilization mitigated any observed risks. Materials and Methods: We used linear and logistic regression analysis of cross-sectional data from a nationally representative sample of U.S. adolescents aged 12-19 years participating in the National Health And Nutrition Examination Survey 2003-2014 who had an income:poverty ratio of <5.0 and had complete data regarding metabolic laboratory assessments, food security, and socioeconomic status (n = 2662). Results: Food insecurity was present in 18.40% (95% confidence interval (CI): 16.47-20.37) among U.S. adolescents meeting inclusion criteria. Food insecurity was associated with increased odds of elevated blood pressure (adjusted odds ratio [aOR] = 1.57, 95% CI: 1.11-2.22) and prediabetes (aOR = 1.94, 95% CI: 1.16-3.25). SNAP usage was associated with higher body mass index z-score (e.g., mean: 0.80 vs. 0.59, P = 0.02), increased insulin resistance, and increased prediabetes odds among food-secure adolescents relative to nonusage. Conclusions: Food insecurity is relatively prevalent among U.S. adolescents with an income:poverty ratio of <5.0. Food insecurity is related to laboratory abnormalities and corresponding adverse health outcomes among U.S. adolescents in this relatively large sample. SNAP usage was associated with adverse health observations among food-secure adolescents. Ongoing efforts are still needed toward food assistance as important public health efforts aimed at mitigating the adverse outcomes related to food insecurity.

A New Method for Studying Licking Behavior Determinants in Rodents: Application to Diet-Induced Obese Mice

OBJECTIVE

An original device for exploring taste-guided reward behavior in rodents using a newly designed computer-controlled liquid delivery system equipped with "lickometers" is described.

METHODS

This octagonal shaped "gustometer" is composed of eight shutters that give random access during a few seconds to eight bottles delivering different liquid stimuli. This original design, which forces the animal to move for access to the drinking source, allows a simultaneous analysis of the licking behavior and motivation to drink. Determination of the sucrose licking behavior in diet-induced obese mice was used to validate this method because nutritional obesity disturbs the sweet taste perception in rodents.

RESULTS

A rise in sucrose response threshold and a decrease in the motivation to drink sweet solutions were found in mice fed the obesogenic diet. These data were highly reproducible among independent studies and corroborated the existence of functional links between diet-induced obesity and gustation in rodents.

CONCLUSIONS

The FRM-8 gustometer appears to be especially suitable for exploring determinants of behavioral outputs in response to oro-sensory stimuli in the mouse. It also provides substantial information on the taste-reward relationship, useful for better understanding the origin of gustatory efficiency or, conversely, dysfunction, as reported in nutritional obesity.

The Impact of the Australasian 'Health Star Rating', Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study

Front-of-pack (FoP) nutrition labels are a widely deployed tool in public good marketing. This article reports on a field experimental test of the impact of one of these systems, the Australasian Health Star Rating system (HSR), on consumer choice in the breakfast cereals category in New Zealand. This study forms part of a time-series replication stream of research on this topic. The research applied a 2 × 2 factorial design with multiple replications to retail food consumers exiting from supermarkets in New Zealand. The first part of the time series, undertaken shortly after the HSR’s initiation in 2014, indicated that the HSR was ineffective. Between 2014 and 2016, commercial brands in the category within New Zealand massively promoted the HSR as a basis for consumer choice. The research presented in this article forms part of the second part of the series, undertaken in 2016, using an identical experimental methodology to the 2014 study. The results indicate that the HSR may be beginning to influence consumer choice as it was predicted to, but the impact of the system is still small, and statistically sub-significant, relative to other consumer decision inputs presented on the package.

A label survey to identify ingredients potentially containing GM organisms to estimate intake exposure in Brazil

OBJECTIVE

To identify ingredients from products and by-products derived from GM crops in packaged food products and to analyse the presence of these ingredients in the foods most commonly consumed by the Brazilian population.

DESIGN

Cross-sectional study.

SETTING

A search of the scientific literature to identify the use of products and by-products derived from GM crops in foods in Brazil and a study of food labels in a supermarket belonging to one of the ten largest supermarket chains in Brazil.

SUBJECTS

To identify the ingredients present in packaged food products and their nomenclatures, the labels of all packaged food products available for sale in a supermarket were analysed. Subsequently, the presence of potential GM ingredients in the foods most commonly consumed by the Brazilian population was analysed.

RESULTS

A total of twenty-eight GM crops' by-products with applications in the food industry (from soyabeans, corn, cotton and a yeast) were identified. Such by-products are presented as food ingredients or additives on food labels with 101 distinct nomenclatures. Most of the variety (63·8 %) and the quantity (64·5 %) of the foods most commonly consumed by Brazilians may contain a least one GM ingredient.

CONCLUSIONS

The presence of at least one potential GM ingredient was observed in more than half of the variety of foods most commonly consumed by the Brazilian population. Such ingredients were identified with distinct nomenclatures and incomplete descriptions, which may make it difficult to identify potential GM foods and confuse consumers when making food choices.

Evaluating the risk factors that link obesity and dental caries in 11-17-year-old school going children in the United Arab Emirates

OBJECTIVE

The objective is to study the effect of obesity on dental caries among schoolchildren in Sharjah, United Arab Emirates.

MATERIALS AND METHODS

The sample comprised 803, 11-17-year-old schoolchildren. The study was in the form of a randomized cross-sectional manner. Method used was two questioners. The first assessed socioeconomic and general health and the second detailed their demographic, oral hygiene, and dietary habits. Dental examination included dental caries assessment using the World Health Organization 1997 criteria and gingival health valuation. Clinical examination consisted of height, weight, and body mass index (BMI). Data analysis was done by descriptive, univariate, and multiple regressions.

RESULTS

In this sample, 75% had dental caries and the mean decayed, missing, and filled teeth (DMFT) was 3.19 (standard deviation: 2.9). Obesity was seen in 15% of the adolescents and the mean BMI was 21. The link between DMFT and BMI, when evaluated using univariate analysis, showed a significant correlation (r = 0.097, P = 0.006), indicating that the rise in BMI by 10 points resulted in an increase in DMFT by 0.57. However, in the multivariate analysis, a significant relationship was observed only between father's education (P < 0.001), adolescent's age (P < 0.001), gender (P = 0.008), ethnicity (P = 0.001), and soft drink consumption with DMFT while BMI showed a significant association with age (P < 0.001), school fees (P = 0.005), obesity in family (P < 0.001), and soft drink consumption (P < 0.001).

CONCLUSIONS

Obesity and dental caries were not significantly associated. The most important predictor for obesity and dental caries was soft drink consumption.

Association between kindergarten and first-grade food insecurity and weight status in U.S. children

OBJECTIVE

The aim of this study was to determine if food insecurity is an independent risk factor for obesity in U.S. children.

METHODS

We analyzed data from a nationally representative sample of children participating in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011. Statistical analyses were performed to evaluate longitudinal associations between food security and body mass index (BMI) z-score. All regression models included race/ethnicity, household income, and parental education. Survey and anthropometric data was collected from teachers and parents of 8167 U.S. children entering kindergarten in fall 2010 with regular follow-up through third grade. Complete data regarding food security, socioeconomic assessment, and BMI z-score data were included for statistical analyses. All analyses were weighted to be nationally representative.

RESULTS

Children with household food insecurity had increased obesity prevalence from kindergarten through grade 3; for example, at kindergarten, with food insecurity 16.4% (95% confidence interval [CI], 13.7-19) versus food secure 12.4% (95% CI, 11.3-13.6). Adjusted means analysis showed first-grade food insecurity was significantly correlated with increased BMI z-score in first through third grades; for example, at first grade, with food insecurity 0.6 (95% CI, 0.5-0.7) versus food secure 0.4 (95% CI, 0.4-0.5). Logistic regression showed first-grade food insecurity was correlated with increased risk for obesity in that grade (odds ratio 1.4; 95% CI, 1.1-2).

CONCLUSION

Obesity is more prevalent among food-insecure children. First-grade food insecurity is an independent risk factor for longitudinal increases in BMI z-score. There are differences in the association between food insecurity and weight status between kindergarten and first grade.

How poverty affects diet to shape the microbiota and chronic disease

Here, we discuss the link between nutrition, non-communicable chronic diseases and socio-economic standing, with a special focus on the microbiota. We provide a theoretical framework and several lines of evidence from both animal and human studies that support the idea that income inequality is an underlying factor for the maladaptive changes seen in the microbiota in certain populations. We propose that this contributes to the health disparities that are seen between lower-income and higher-income populations in high-income countries.

Geographic determinants of individual obesity risk in Spain: A multilevel approach

This paper seeks to understand the determinants of individual body weight status and obesity risk in Spain by concurrently examining individual and regional characteristics. The data are drawn from the National Health Survey of Spain for the year 2011-2012 (INE-National Statistical Institute of Spain) and contain information for a representative sample of 12,671 adults across 50 provinces in Spain. A multilevel analysis is carried out to examine the determinants of individual weight status and obesity, controlling not only for the individual effects and those of the immediate environment but also for the broader setting to which individuals and their immediate environment belong. Our findings suggest that attributes from all three levels of analysis have an effect on individual weight status and obesity. Lack of green spaces and criminality taken as proxies of the social environment positively affect individual and women's BMI and obesity, respectively.

Next Steps for Science and Policy on Promoting Vegetable Consumption among US Infants and Young Children

Vegetables are an important part of a healthy diet for infants and young children, but they are poorly accepted and underconsumed. This paper highlights major themes and research needs for understanding how to raise children to consume and enjoy vegetables as part of a healthful diet. A range of factors impedes US infants and young children from eating as many vegetables as experts consider optimal for child nutrition, health, and development. Barriers include biological and behavioral issues relating to infant and child development, household- and family-related barriers, obstacles in the larger community, economic limitations, and some government policies and programs. These barriers must be removed to encourage children to eat more vegetables. Research gaps also must be filled. We summarize the basic and applied research that is needed to craft more effective messages, devise strategies for parents and other child caretakers to take within households, develop action in the larger community, and modify some government policies and programs.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

CONTEXT

It is well established in the literature that healthier diets cost more than unhealthy diets.

OBJECTIVE

The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality.

DATA SOURCES

A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed.

STUDY SELECTION

Publications linking food prices, dietary quality, and socioeconomic status were selected.

DATA EXTRACTION

Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices.

DATA SYNTHESIS

Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets.

CONCLUSIONS

Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.

Beyond the sticker price: including and excluding time in comparing food prices

BACKGROUND

An ongoing debate in the literature is how to measure the price of food. Most analyses have not considered the value of time in measuring the price of food. Whether or not the value of time is included in measuring the price of a food may have important implications for classifying foods based on their relative cost.

OBJECTIVE

The purpose of this article is to compare prices that exclude time (time-exclusive price) with prices that include time (time-inclusive price) for 2 types of home foods: home foods using basic ingredients (home recipes) vs. home foods using more processed ingredients (processed recipes). The time-inclusive and time-exclusive prices are compared to determine whether the time-exclusive prices in isolation may mislead in drawing inferences regarding the relative prices of foods.

DESIGN

We calculated the time-exclusive price and time-inclusive price of 100 home recipes and 143 processed recipes and then categorized them into 5 standard food groups: grains, proteins, vegetables, fruit, and dairy. We then examined the relation between the time-exclusive prices and the time-inclusive prices and dietary recommendations.

RESULTS

For any food group, the processed food time-inclusive price was always less than the home recipe time-inclusive price, even if the processed food's time-exclusive price was more expensive. Time-inclusive prices for home recipes were especially higher for the more time-intensive food groups, such as grains, vegetables, and fruit, which are generally underconsumed relative to the guidelines.

CONCLUSION

Focusing only on the sticker price of a food and ignoring the time cost may lead to different conclusions about relative prices and policy recommendations than when the time cost is included.

Metabolic and Histopathological Effects of Fructose Intake During Pregestation, Gestation and Lactation in Rats and their Offspring

OBJECTIVE

Studies have demonstrated a significant relationship between maternal fructose intake and metabolic outcome in their offspring. However, there is a paucity of data about the long-term effects of fructose intake on the offspring of fructose-fed dams. Therefore, we planned a study to evaluate the long-term effects of fructose intake on the offspring of dam rats fed a high-fructose diet.

METHODS

Sixteen virgin female Sprague-Dawley rats were divided into two groups. Group 1 received a regular diet and Group 2 a high-fructose diet. Both groups received their experimental diets for 8 weeks before conception. They were mated and continued to feed with their experimental diet during mating and during their pregnancy and lactation periods. After weaning, the offspring from each group were divided into two groups. Group 1A received a regular diet, Group 1B - a fructose diet, Group 2A - a regular diet and Group 2B received a fructose diet. After weaning, the offspring were anesthetized and blood samples were collected for biochemical analysis. Liver, kidney and retroperitoneal adipose tissue were harvested for histopathological examination. Primary antibodies against inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) were determined as early inflammation markers.

RESULTS

After weaning, while daily water consumption was found to be significantly higher in Groups 2B and 1B (p<0.01), daily laboratory chow consumption was significantly lower in Groups 1A and 2A (p<0.01). Body weight was significantly higher in Groups 1B and 2B (p<0.01). Serum glucose, triglyceride, low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels were found to be increased and high-density lipoprotein cholesterol levels decreased in Group 2B (p<0.05). The intensities of iNOS staining in the retroperitoneal adipose tissue, COX-2 staining in the liver and both iNOS and COX-2 staining in the kidney were higher in Group 2B (p<0.05).

CONCLUSION

Based on our findings, we believe that the offspring of dams which received a high fructose intake during their pregestation, gestation and lactation periods are at risk of developing metabolic syndrome in their later life only if they continue to receive a high intake of fructose. We therefore propose that the risk of developing metabolic syndrome can probably be reduced by modifying the diet of the offspring after weaning.

Brain evolution, the determinates of food choice, and the omnivore's dilemma

A coevolutionary paradigm using a biocultural perspective can help to unravel the complex interactions that led to the contemporary pattern of eating. Evolutionary history helps to understand the adaptation of diet and its nutritional implications. Anatomical and behavioral changes linked to changing dietary patterns in the Paleolithic resulted in an adaptive framework that affects modern diet. The evolution of an expanding brain, a shrinking large intestine, and lengthening small intestine necessitated a demand for nutritionally dense foods. The key to these changes is an understanding of the response to the omnivore's dilemma. Omnivores in their search for new items to feed their varied diet (neophilia) have a challenge when they fear (neophobia) novel items that may be poisonous and can cause death. The inborn mechanism initiates palate fatigue (sensory-specific satiety) ensuring a variety of foods will be eaten. Variety will limit the impact of toxins ingested and provide a more balanced diet. The development of cuisine, a momentous event in history, mediated the conflict, and changed the course of human evolution. The cuisine, a biocultural construct, defines which items found in nature are edible, how these products are transformed into food, the flavors used to add a sensory dimension to foods, and rules of eating or etiquette. Etiquette defines how, when, and with whom we eat. Patterns of eating in the modern setting are the end product of the way that Homo sapiens evolved and resolved the omnivore's dilemma. Control of fire and cooking expanded the range of available foods by creating a class of foods that are "predigested." An essential element to the evolution of the human diet was the transition to agriculture as the primary mode of subsistence. The Neolithic revolution dramatically narrowed the dietary niche by decreasing the variety of available foods, with the shift to intensive agriculture creating a dramatic decline in human nutrition. The recent industrialization of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity. In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories. Furthermore, the abundant variety of ultraprocessed foods overrides the sensory-specific satiety mechanism leading to overconsumption.

The status of men's health in Asia

OBJECTIVES

This study aims to compare health status and its risk factors between men and women who are from countries of different income status in Asia.

METHOD

We have included 47 Asian countries and 2 regions in this study. Life expectancy, mortality rate from communicable disease, non-communicable disease and injuries, the prevalence of non-communicable diseases risk factors and their trends were extracted from the WHO and respective governmental database. Subgroup analysis was performed based on country income groups.

RESULTS

Overall, men have shorter life expectancy and higher mortality rates compared to women. Men from higher-income countries lived longer compared to men from lower-income countries. There is a wide variation of male life expectancy in upper and lower middle income countries. The mean systolic blood pressure, fasting blood glucose and body mass index in Asia have also increased over the years.

CONCLUSION

This study confirms that Asian men have poorer health compared to women besides the growing concerns on NCD risk factors. The findings from this study calls for a concerted effort to find solutions in addressing men's health problems in Asia.

No food for thought: moderating effects of delay discounting and future time perspective on the relation between income and food insecurity

BACKGROUND

Low income is related to food insecurity, and research has suggested that a scarcity of resources associated with low income can shift attention to the present, thereby discounting the future.

OBJECTIVE

We tested whether attending to the present and discounting the future may moderate the influence of income on food insecurity.

DESIGN

Delay discounting and measures of future time perspective (Zimbardo Time Perspective Inventory, Consideration of Future Consequences Scale, time period of financial planning, and subjective probability of living to age 75 y) were studied as moderators of the relation between income and food insecurity in a diverse sample of 975 adults, 31.8% of whom experienced some degree of food insecurity.

RESULTS

Income, financial planning, subjective probability of living to age 75 y, and delay discounting predicted food insecurity as well as individuals who were high in food insecurity. Three-way interactions showed that delay discounting interacted with financial planning and income to predict food insecurity (P = 0.003). At lower levels of income, food insecurity was lowest for subjects who had good financial planning skills and did not discount the future, whereas having good financial skills and discounting the future had minimal influence on food insecurity. The same 3-way interaction was observed when high food insecurity was predicted (P = 0.008).

CONCLUSION

Because of the role of scarce resources on narrowing attention and reducing prospective thinking, research should address whether modifying future orientation may reduce food insecurity even in the face of diminishing financial resources.

The inverse relationship between food price and energy density: is it spurious?

Objective

An important debate in the literature is whether or not higher energy-dense foods are cheaper than less energy-dense foods. The present communication develops and applies an easy statistical test to determine if the relationship between food price and energy density is an artifact of how the data units are constructed (i.e. is it ‘spurious’ or ‘real’?).

Design

After matching data on 4430 different foods from the National Health and Nutrition Examination Survey with corresponding prices from the Center for Nutrition Policy and Promotion’s Food Prices Database, we use a simple regression model to test if the relationship between food price and energy density is ‘real’ or ‘spurious’.

Setting

USA.

Subjects

Total sample size is 4430 observations of consumed foods from 4578 participants from the non-institutionalized US adult population (aged 19 years and over).

Results

Over all 4430 foods, the null hypothesis of a spurious inverse relationship between food price per energy density and energy density is not rejected. When the analysis is broken down by twenty-five food groups, there are only two cases where the inverse relationship is not spurious. In fact, the majority of non-spurious relationships between food price and energy density are positive, not negative.

Conclusions

One of the main arguments put forth regarding the poor diet quality of low-income households is that high energy-dense food is cheaper than lower energy-dense food. We find almost no statistical support for higher energy-dense food being cheaper than low energy-dense food. While economics certainly plays a role in explaining low nutritional quality, more sophisticated economic arguments are required and discussed.

Early life exposure to fructose and offspring phenotype: implications for long term metabolic homeostasis

The consumption of artificially sweetened processed foods, particularly high in fructose or high fructose corn syrup, has increased significantly in the past few decades. As such, interest into the long term outcomes of consuming high levels of fructose has increased significantly, particularly when the exposure is early in life. Epidemiological and experimental evidence has linked fructose consumption to the metabolic syndrome and associated comorbidities-implicating fructose as a potential factor in the obesity epidemic. Yet, despite the widespread consumption of fructose-containing foods and beverages and the rising incidence of maternal obesity, little attention has been paid to the possible adverse effects of maternal fructose consumption on the developing fetus and long term effects on offspring. In this paper we review studies investigating the effects of fructose intake on metabolic outcomes in both mother and offspring using human and experimental studies.

An increasing socioeconomic gap in childhood overweight and obesity in China

We used a new conceptual framework that integrates tenets from health economics, social epidemiology, and health behavior to analyze the impact of socioeconomic forces on the temporal changes in the socioeconomic status (SES) gap in childhood overweight and obesity in China. In data from the China Health and Nutrition Survey for 1991 to 2006, we found increased prevalence of childhood overweight and obesity across all SES groups, but a greater increase among higher-SES children, especially after 1997, when income inequality dramatically increased. Our findings suggest that for China, the increasing SES gap in purchasing power for obesogenic goods, associated with rising income inequality, played a prominent role in the country's increasing SES gap in childhood obesity and overweight.

Leaving a flat taste in your mouth: task load reduces taste perception

In recent years, people have tended to pay less attention to their meals, often consuming them while engaging in other activities. At the same time, foods have become increasingly sweet and salty. We therefore investigated how performing concurrent activities affects taste perception and how this relates to actual consumption. Participants tasted sour, sweet, and salty substances in various concentrations under differing task loads. Our results demonstrated that under high task load (relative to low task load), participants rated the substances as less intense, consumed more of the substances, and preferred stronger tastants. Our findings suggest that increased task load reduces people's taste perception by limiting attentional capacity to assess taste intensity and that people adjust their consumption accordingly.

Convenience stores are the key food environment influence on nutrients available from household food supplies in Texas Border Colonias

Background

Few studies have focused on the relationship between the retail food environment and household food supplies. This study examines spatial access to retail food stores, food shopping habits, and nutrients available in household food supplies among 50 Mexican-origin families residing in Texas border colonias.

Methods

The design was cross-sectional; data were collected in the home March to June 2010 by promotora-researchers. Ground-truthed methods enumerated traditional (supercenters, supermarkets, grocery stores), convenience (convenience stores and food marts), and non-traditional (dollar stores, discount stores) retail food stores. Spatial access was computed using the network distance from each participant’s residence to each food store. Data included survey data and two household food inventories (HFI) of the presence and amount of food items in the home. The Spanish language interviewer-administered survey included demographics, transportation access, food purchasing, food and nutrition assistance program participation, and the 18-item Core Food Security Module. Nutrition Data Systems for Research (NDS-R) was used to calculate HFI nutrients. Adult equivalent adjustment constants (AE), based on age and gender calorie needs, were calculated based on the age- and gender composition of each household and used to adjust HFI nutrients for household composition. Data were analyzed using bivariate analysis and linear regression models to determine the association of independent variables with the availability of each AE-adjusted nutrient.

Results

Regression models showed that households in which the child independently purchased food from a convenience store at least once a week had foods and beverages with increased amounts of total energy, total fat, and saturated fat. A greater distance to the nearest convenience store was associated with reduced amounts of total energy, vitamin D, total sugar, added sugar, total fat, and saturated fat. Participation in the National School Lunch Program (NSLP) was associated with lower household levels of total energy, calcium, vitamin C, sodium, vitamin D, and saturated fat. Spatial access and utilization of supermarkets and dollar stores were not associated with nutrient availability.

Conclusions

Although household members frequently purchased food items from supermarkets or dollar stores, it was spatial access to and frequent utilization of convenience food stores that influenced the amount of nutrients present in Texas border colonia households. These findings also suggest that households which participate in NSLP have reduced AE-adjusted nutrients available in the home. The next step will target changes within convenience stores to improve in-store marketing of foods and beverages to children and adults.

Using rewards-based incentives to increase purchase of fruit and vegetables in lower-income households: design and start-up of a randomized trial

OBJECTIVE

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.

DESIGN

A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.

SETTING

A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.

SUBJECTS

Fifty-eight households, with at least one child living in the home.

RESULTS

During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.

CONCLUSIONS

At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

Why are children living in poverty getting fatter?

In recent decades, there has been a dramatic increase in unhealthy weight for both children and adults. The Canadian standard of living has changed in favour of more easily prepared, calorie-dense foods and sedentary practices. Many family characteristics have also changed over the past 50 years. More Canadian families are living in disadvantaged situations, forecasting a host of unhealthy behaviours and attitudes in adults. The poor are not only getting poorer, they are also becoming heavier. Children from disadvantaged families seem to be leading the trend in increasing prevalence of unhealthy weight. Because they live in neighbourhoods that are perceived as unsafe, these children are likely spending more time indoors. This is associated with watching more television, which not only displaces other forms of educational and active entertainment but also places them at risk of learning inaccurate information about proper eating. Social science research helps identify factors contributing most to the rise in excess weight within this population, thus providing essential clues for effective approaches to its eradication.

Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias

BACKGROUND

Food insecurity among Mexican-origin and Hispanic households is a critical nutritional health issue of national importance. At the same time, nutrition-related health conditions, such as obesity and type 2 diabetes, are increasing in Mexican-origin youth. Risk factors for obesity and type 2 diabetes are more common in Mexican-origin children and include increased intakes of energy-dense and nutrient-poor foods. This study assessed the relationship between children's experience of food insecurity and nutrient intake from food and beverages among Mexican-origin children (age 6-11 y) who resided in Texas border colonias.

METHODS

Baseline data from 50 Mexican-origin children were collected in the home by trained promotora-researchers. All survey (demographics and nine-item child food security measure) and 24-hour dietary recall data were collected in Spanish. Dietary data were collected in person on three occasions using a multiple-pass approach; nutrient intakes were calculated with NDS-R software. Separate multiple regression models were individually fitted for total energy, protein, dietary fiber, calcium, vitamin D, potassium, sodium, Vitamin C, and percentage of calories from fat and added sugars.

RESULTS

Thirty-two children (64%) reported low or very low food security. Few children met the recommendations for calcium, dietary fiber, and sodium; and none for potassium or vitamin D. Weekend intake was lower than weekday for calcium, vitamin D, potassium, and vitamin C; and higher for percent of calories from fat. Three-day average dietary intakes of total calories, protein, and percent of calories from added sugars increased with declining food security status. Very low food security was associated with greater intakes of total energy, calcium, and percentage of calories from fat and added sugar.

CONCLUSIONS

This paper not only emphasizes the alarming rates of food insecurity for this Hispanic subgroup, but describes the associations for food insecurity and diet among this sample of Mexican-origin children. Child-reported food insecurity situations could serve as a screen for nutrition problems in children. Further, the National School Lunch and School Breakfast Programs, which play a major beneficial role in children's weekday intakes, may not be enough to keep pace with the nutritional needs of low and very low food secure Mexican-origin children.

Label, nudge or tax? A review of health policies for risky behaviours

This work proposes a critical, non systematic, review of the three main lines of health policy interventions to deal with risky behaviours, such as over-eating, smoking, sedentary lives, and excess alcohol drinking, namely: i) the release of information on health risks and consequences; ii) the use of incentives; and iii) direct policy intervention in markets, through regulation and taxation. First, the health and economic impact of the risky behaviours epidemics are briefly described. Then a critical review follows on the evidence existing on the effectiveness of each type of intervention. The review will also highlight the public health approach staying beyond each type of policy on risky behaviours and critically consider them within the context of more general health and social policy interventions.

Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children

OBJECTIVE

To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.

DESIGN

Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.

SETTING

Edmonton region, Canada.

SUBJECTS

Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.

RESULTS

Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.

CONCLUSIONS

Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

Maternal obesity trends in Egypt 1995-2005

According to the World Health Organization (WHO), 46% of adult females in Egypt are obese. This research was aimed at documenting obesity trends and identifying the populations most at risk for obesity. Using data from the 1995 and 2005 Egyptian Demographic and Health Surveys a linear model was employed to seek associations between household wealth, urban/rural residence, governorate of residence, employment status, parity and age and increases in body mass index (BMI) among married Egyptian women between the ages of 15-49. Between 1995 and 2005, the mean BMI of women of reproductive age in Egypt increased from 26.31 to 28.52. Although there was an overall trend towards greater obesity between 1995 and 2005, older women residing in rural, poor households became obese at a faster rate than younger women residing in richer, urban households. Studies have shown that household wealth is a key determinant of food consumption patterns. Rising obesity rates among the poor in developed countries are linked to the relatively cheap price of high-calorie, nutrient-poor foods. One factor that may be contributing to the rapid increases in obesity among the rural poor in Egypt is the subsidisation of high-energy, low-nutritive value foods that form a larger part of the diet of poor, rural populations.

Innate and learned preferences for sweet taste during childhood

PURPOSE OF REVIEW

In nature, carbohydrates are a source of energy often equated with sweetness, the detection of which is associated with powerful hedonic appeal. Intakes of processed carbohydrates in the form of added sugars and sugar-sweetened beverages have risen consistently among all age groups over the last two decades. In this review, we describe the biological underpinnings that drive the consumption of sweet-tasting foods among pediatric populations.

RECENT FINDINGS

Scientific literature suggests that children's liking for all that is sweet is not solely a product of modern-day technology and advertising but reflects their basic biology. In fact, heightened preference for sweet-tasting foods and beverages during childhood is universal and evident among infants and children around the world. The liking for sweet tastes during development may have ensured the acceptance of sweet-tasting foods, such as mother's milk and fruits. Moreover, recent research suggests that liking for sweets may be further promoted by the pain-reducing properties of sugars.

SUMMARY

An examination of the basic biology of sweet taste during childhood provides insight, as well as new perspectives, for how to modify children's preferences for and intakes of sweet foods to improve their diet quality.

Predictors of adolescent weight status and central obesity in rural South Africa

OBJECTIVE

To investigate predictors of adolescent obesity in rural South Africa.

DESIGN

Cross-sectional study. Height, weight and waist circumference were measured using standard procedures. Overweight and obesity in adolescents aged 10-17 years were assessed using the International Obesity Taskforce cut-offs, while the WHO adult cut-offs were used for participants aged 18-20 years. Waist-to-height ratio of >0.5 defined central obesity in those at Tanner stages 3-5. Linear and logistic regression analysis was used to evaluate risk factors.

SETTING

Agincourt sub-district, rural South Africa.

SUBJECTS

Participants (n 1848) were aged 10-20 years.

RESULTS

Combined overweight and obesity was higher in girls (15 %) than boys (4 %), as was central obesity (15 % and 2 %, respectively). With regard to overweight/obesity, fourfold higher odds were observed for girls and twofold higher odds were observed for participants from households with the highest socio-economic status (SES). The odds for overweight/obesity were 40 % lower if the household head had not completed secondary level education. For central obesity, the odds increased 10 % for each unit increase in age; girls had sevenfold higher odds v. boys; post-pubertal participants had threefold higher odds v. pubertal participants; those with older mothers aged 50+ years had twofold higher odds v. those whose mothers were aged 35-49 years; those in highest SES households had twofold higher odds v. those in lowest SES households.

CONCLUSIONS

In rural South Africa, adolescent females are most at risk of obesity which increases with age and appears to be associated with higher SES. To intervene effectively, it is essential to understand how household factors influence food choice, diet and exercise.

Addictive genes and the relationship to obesity and inflammation

There is increasing evidence that the same brain reward circuits involved in perpetuating drug abuse are involved in the hedonic urges and food cravings observed clinically in overweight and obese subjects. A polymorphism of the D2 dopamine receptor which renders it less sensitive to dopamine stimulation has been proposed to promote self-stimulatory behavior such as consuming alcohol, abusing drugs, or binging on foods. It is important to determine how this polymorphism may interact with other well-known candidate genes for obesity including polymorphisms of the leptin receptor gene and the opiomelanocortin gene. Leptin is a proinflammatory cytokine as well as a long-term signal maintaining body fat. Upper-body obesity stimulates systemic inflammation through the action of multiple cytokines including leptin throughout many organs including the brain. The association of numerous diseases including diabetes mellitus, heart disease, as well as depression with chronic low-grade inflammation due to abdominal obesity has raised the possibility that obesity-associated inflammation affecting the brain may promote addictive behaviors leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol, and gambling. This new area of interdisciplinary research holds the promise of developing new approaches to treating drug abuse and obesity.

Evaluation of the Monell forced-choice, paired-comparison tracking procedure for determining sweet taste preferences across the lifespan

Lack of methodology to assess taste in children limits its measurement in research studies that include pediatric populations. We used the Monell 2-series, forced-choice tracking method to measure sucrose preferences of a racially/ethnically diverse sample (n = 949) of children, adolescents, and adults. Reliability was assessed by comparing the results of the first series with the second series. Validity was assessed by relating participants' sucrose preferences to their preferences for foods varying in sweetness. The task required, on average, 7 presentations of aqueous sucrose solution pairs. Children and adolescents preferred more concentrated sweetness than adults (P < 0.001). Black children/adolescents preferred a more concentrated sucrose solution than did White children/adolescents even when gender, parental education level, and family income were used as covariates. Data from a single series were sufficient to detect age-related differences but insufficient to detect racial/ethnic differences in sweet preferences. Level of sweetness preferred significantly correlated with the sugar content of favorite cereals (P < 0.001) and beverages (P < 0.02). This method is brief and has evidence of reliability and external validity. Although a single series will yield useful information about age-related differences in taste preferences, the 2-series version should be considered when differences in race/ethnicity are of interest.

The impact of salt, fat and sugar levels on toddler food intake

Understanding the early determinants of food intake, in particular the role of food sensory quality, is a necessary step to improve the prevention of unhealthy food habits. However, the extent to which food intake varies according to salt, fat and sugar content is imperfectly known. The present study aimed at evaluating whether toddler food intake varied during lunches or snacks in which salt, fat or sugar contents had been modified in common foods. Seventy-four children (30 (se 0·5) months old) participated in the study in their usual day-care centres. Every other week, they were served lunches composed, among other items, of green beans and pasta with varying salt (0, 0·6 and 1·2 % added salt) or fat (0, 2·5 and 5 % added butter) levels and afternoon snacks composed of fruit purée varying in sugar level (0, 5 and 10 % added sugar). During each meal, children could eat as much as they wanted from the target foods. Each food was weighed before and after the meal. Salt level had a positive impact on the intake of the target foods. On the contrary, no impact of added fat or added sugar levels was observed. This implies that fat and sugar addition could be avoided in foods for children without having an impact on palatability, allowing the energy density of children's diet to be limited. Salt addition should be limited, but its suppression in vegetables, whose intake is to be promoted, should be considered cautiously.

Opposing effects of dietary sugar and saturated fat on cardiovascular risk factors and glucose metabolism in mitochondrially impaired mice

PURPOSE

Both dietary fat and dietary sucrose are major components of Western diets that may differentially affect the risk for body mass gain, diabetes mellitus, and cardiovascular disease.

METHODS

We have phenotypically analyzed mice with ubiquitously impaired expression of mitochondrial frataxin protein that were challenged with diets differing in macronutrient content, namely high-sucrose/low-fat and high-saturated fat/low-sugar diets.

RESULTS

We find here that a high-sucrose/low-fat diet has especially detrimental effects in mice with impaired mitochondrial metabolism promoting several independent cardiovascular risk factors, including impaired glucose metabolism, fasting hyperinsulinemia, reduced glucose-stimulated insulin secretion, increased serum triglycerides, and elevated cholesterol levels due to increased expression of HMG-CoA reductase. In contrast, a high-saturated fat/low-sugar diet protects mice with impaired mitochondrial metabolism from diet-induced obesity by increasing total energy expenditure and increasing expression of ACAA2, a rate-limiting enzyme of mitochondrial beta-oxidation, whereas no concomitant improvement of glucose metabolism was observed.

CONCLUSIONS

Taken together, our results suggest that mitochondrial dysfunction may cause sucrose to become a multifunctional cardiovascular risk factor, whereas low-sugar diets high in saturated fat may prevent weight gain without improving glucose metabolism.