Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

Dietary fructose: from uric acid to a metabolic switch in pediatric metabolic dysfunction-associated steatotic liver disease

Fructose consumption in pediatric subjects is rising, as the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). Despite increasing evidence supporting the detrimental effects of fructose in the development of Metabolic Syndrome (MetS) and its related comorbidities, the association between fructose intake and liver disease remains unclear, mainly in youths. The current narrative review aims to illustrate the correlation between fructose metabolism and liver functions besides its impact on obesity and MASLD in pediatrics. Fructose metabolism is involved in the liver through the classical lipogenic pathway via de novo lipogenesis (DNL) or in the alternative pathway via uric acid accumulation. Hyperuricemia is one of the main features of MALSD patients, underlining how uric acid is growing interest as a new marker of disease. Observational and interventional studies conducted in children and adolescents, who consumed large amounts of fructose and glucose in their diet, were included. Most of these studies emphasized the association between high fructose intake and weight gain, dyslipidemia, insulin resistance, and MASLD/MASH, even in normal-weight children. Conversely, reducing fructose intake ameliorates liver fat accumulation, lipid profile, and weight. In conclusion, fructose seems a potent inducer of both insulin resistance and hepatic fat accumulation.

Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study

BACKGROUND

In observational and prospective cohort studies, intake of sugar-sweetened beverages (SSBs) and pure fruit juice (PFJ) has been associated with cardiovascular disease (CVD). Still, the causality of the connection has not yet been determined. Our objective was to uncover the relationship between SSBs/PFJ and CVD.

METHODS

Genetically predicted causal associations between SSBs/PFJ (obtained in a published genome-wide association study) and six common CVDs (atrial fibrillation (AF), angina, heart failure (HF), acute myocardial infarction, hypertension, and coronary atherosclerosis) were assessed using MR analytic modeling. The primary analysis method utilized was the inverse variance weighted (IVW) method, complemented by additional methods such as the weighted median method, MR Egger regression, Cochran's Q test, MR pleiotropy residual, funnel plot, Bonferroni correction, and others for MR analysis. To ensure the robustness of the findings, F-values were calculated as a complementary test to set looser thresholds for exposing genetic instrumental variables (P < 1e-5).

RESULTS

The results of MR analysis suggested genetically causal associations between SSBs and AF (odds ratio (OR): 1.023; 95% confidence interval (CI) 1.007-1.038; P = 0.0039) as well as between PFJ and angina (OR: 0.968; 95% CI, 0.943-0.993; P = 0.0138) there was genetic causality. However, MR analysis showed no causal association between SSBs/PFJ and other CVD risks.

CONCLUSION

This study suggests that there may be a potential causal relationship between SSBs intake and AF and a causal negative association between PFJ intake and angina.

Investigating the Sociodemographic and Health Characteristics of Non-Sugar Sweeteners Consumption in Greek School-Aged Children: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

The childhood consumption of non-sugar-sweetened (NSS) soft drinks is a growing concern due to its potential health implications. This study investigated demographic, anthropometric, and lifestyle factors influencing NSS soft drink consumption among children.

METHODS

A sample of 1304 children and their parents were surveyed.

RESULTS

Analysis revealed that nearly 60% reported consuming NSS soft drinks at least once a week. Also, positive associations were found between NSS soft drink consumption and lower socioeconomic status, increased total beverage consumption, higher maternal BMI, and parental soft drink habits. However, upon employing multivariable models, only the association between total and NSS soft drinks consumption remained statistically significant (OR = 18.925, p < 0.05 for children; OR = 3.801, p < 0.05 for parents), highlighting the pivotal role of parental behavior in shaping children's consumption patterns.

CONCLUSIONS

These findings emphasize the importance of tracking parental habits, revealing a strong correlation between parental behavior and children's soft drink consumption patterns. Understanding these factors is crucial for developing effective public health strategies for children, which should prioritize not only individual behaviors but also parental modeling and household dynamics.

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied.

OBJECTIVES

This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo.

METHODS

This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end.

RESULTS

Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05).

CONCLUSIONS

Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

A Descriptive Study of Spanish and Ecuadorian Commercial Infant Cereals: Are They in Line with Current Recommendations?

Cereals are an important source of nutrients, especially used in complementary feeding. The objective of this study is to review the nutritional composition of cereal-based foods for infants from 4 months and toddlers that are offered in Spain and Ecuador, countries selected because of the opportunity to work in them, and due to their socio-economic differences (industrialized and developing countries, respectively). The number of these products was 105 cereals in Spain and 22 in Ecuador. The products were classified as gluten-free cereals, five cereals, eight cereals, multigrain cereals, and cookies. A 25 g serving was used to determine the percentage in which the samples analyzed can cover the Reference Nutrient Intake (RNI) for micronutrients in infants from 7 months and toddlers according to the European Food Safety Authority (EFSA). Nutritional information per 100 g of dry product was collected according to medium, minimum, and maximum units, and nutrient density was calculated. The age range in which these products are recommended is different in both countries. The nutritional composition presents some differences; Spanish cereals show a lower content of sodium, added sugars, hydrolyzed cereals, and maltodextrin than Ecuadorian cereals. Commercialized cereals could contribute to satisfying the nutritional needs of infants and toddlers; however, they can also be a source of non-recommended components.

Dietary Sugar and Anthropometrics among Young Children in the Guelph Family Health Study: Longitudinal Associations

Purpose: Our understanding of the influence of sugar intake on anthropometrics among young children is limited. Most existing research is cross-sectional and has focused on sugar-sweetened beverages. The study objective was to investigate longitudinal associations between young children's total, free, and added sugar intake from all food sources at baseline with anthropometric measures at baseline and 18 months.Methods: The Guelph Family Health Study (GFHS) is an ongoing randomized controlled trial and a family-based health promotion study. Food records and anthropometric data were collected at baseline (n = 109, 55 males; 3.7 ± 1.1 y, mean ± SD) and 18 months (n = 109, 55 males; 5.1 ± 1.1 y) of the GFHS pilots. Associations between sugar intakes and anthropometrics were estimated using linear regression models with generalized estimating equations adjusted for age, sex, household income, and intervention status.Results: Total sugar intake was inversely associated with body weight at 18 months (P = 0.01). There was no effect of time on any other associations between total, free, and added sugar intakes and anthropometrics.Conclusions: Early life dietary sugar intakes may not relate to anthropometric measures in the short term. Further investigation into potential associations between dietary sugar intakes and anthropometric variables over longer time periods is warranted.

Reply to Benedik et al. Comment on "Jakše et al. Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations. Nutrients 2023, 15, 4715"

Benedik et al [...].

Association of parental level of education and child factors on length-for-age indicator among socially vulnerable children aged 6-24 months from a Brazilian state using structural equation modelling

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

The Impact of Excessive Fructose Intake on Adipose Tissue and the Development of Childhood Obesity

Worldwide, childhood obesity cases continue to rise, and its prevalence is known to increase the risk of non-communicable diseases typically found in adults, such as cardiovascular disease and type 2 diabetes mellitus. Thus, comprehending its multiple causes to build healthier approaches and revert this scenario is urgent. Obesity development is strongly associated with high fructose intake since the excessive consumption of this highly lipogenic sugar leads to white fat accumulation and causes white adipose tissue (WAT) inflammation, oxidative stress, and dysregulated adipokine release. Unfortunately, the global consumption of fructose has increased dramatically in recent years, which is associated with the fact that fructose is not always evident to consumers, as it is commonly added as a sweetener in food and sugar-sweetened beverages (SSB). Therefore, here, we discuss the impact of excessive fructose intake on adipose tissue biology, its contribution to childhood obesity, and current strategies for reducing high fructose and/or free sugar intake. To achieve such reductions, we conclude that it is important that the population has access to reliable information about food ingredients via food labels. Consumers also need scientific education to understand potential health risks to themselves and their children.

Exploring the Possible Impact of Oral Nutritional Supplements on Children's Oral Health: An In Vitro Investigation

Eight pediatric oral nutritional supplements (ONSs) and 0.5% fat bovine milk were examined in vitro regarding their effect on the adhesion of three caries-related bacteria, Streptococcus mutans (strain CCUG 11877T), Lactobacillus gasseri (strain CCUG 31451), and Scardovia wiggsiae (strain CCUG 58090), to saliva-coated hydroxyapatite, as well as their pH and capacity to withstand pH changes. Bacteria were cultivated and radiolabeled. The adhesion assays used synthetic hydroxyapatite coated with whole or parotid saliva. Measurements of pH and titration of the products with HCl and NaOH were conducted in triplicate. Three ONSs promoted the S. mutans adhesion to saliva-coated hydroxyapatite (increase from 35% to >200%), supporting caries risk enhancement. S. wigssiae and L. gasseri adhered only to one and no ONS, respectively. Most supplements had limited buffering capacity to counteract acidification changes, suggesting their low capacity to neutralize acids, and one ONS showed a significant capacity to counteract basic changes, suggesting a high erosive potential. S. mutans adhesion was influenced by the ONS pH and volume NaOH added to reach pH 10. L. gasseri and S. wiggsiae adhesion was influenced by the ONSs' carbohydrate and fat content. Interdisciplinary efforts are needed to increase awareness and prevent the possible negative impact of ONSs on children's oral health.

Sugar intake above international recommendations and oral disease burden: A population-based study

OBJECTIVE

To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents.

METHODS

This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling.

RESULTS

Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators.

CONCLUSION

Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.

Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study

Background

Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months.

Methods

EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables.

Results

More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children.

Conclusions

Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

Unhealthy food consumption and its determinants among children aged 6 to 23 months in sub-Saharan Africa: a multilevel analysis of the demographic and health survey

BACKGROUND

Unhealthy food consumption that begins early in life is associated with a higher risk of nutrient inadequacy and related chronic diseases later in life. Healthy eating and consumption of important nutrients help to maintain a healthy body weight and reduce the risk of developing chronic conditions. Research from sub-Saharan Africa regarding consumption of unhealthy foods remains limited, with no studies quantifying the pooled prevalence among young children. Therefore, this study is intended to assess the pooled prevalence and determinants of unhealthy food consumption among children aged 6 to 23 months.

METHODS

Data from the most recent demographic and health surveys of five countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 16,226 children aged 6 to 23 months was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

The pooled prevalence of unhealthy food consumption among children aged 6 to 23 months was 13.41% (95% CI: 12.89-13.94%). Higher consumption of unhealthy foods was reported among mothers with low education [adjusted odds ratio (AOR) = 0.37; 95% confidence interval (CI) (0.30, 0.46)], unmarried women [AOR = 1.19; 95% CI (1.05, 1.34)], who had no media exposure [AOR = 0.64; 95% CI (0.56, 0.72)], delivered at home [AOR = 0.74; 95% CI (0.62, 0.87)], who hadn't had a PNC checkup [AOR = 0.66; 95% CI (0.60, 0.73)], wealthier households [AOR = 1.20; 95% CI (1.05, 1.37)], older children (aged ≥ 9 months) [AOR = 3.88; 95% CI (3.25, 4.63)], and low community level media exposure [AOR = 1.18; 95% CI (1.04, 1.34)].

CONCLUSION

Nearly one out of seven children aged 6 to 23 months consumed unhealthy foods. Maternal educational level, marital status of the mother, exposure to media, wealth index, place of delivery, PNC checkup, and the current age of the child were factors significantly associated with unhealthy food consumption. Therefore, improving women's education, disseminating nutrition-related information through the media, providing more attention to poor and unmarried women, and strengthening health facility delivery and postnatal care services are recommended.

The association between plain water intake and periodontitis in the population aged over 45: a cross-sectional study based on NHANES 2009-2014

BACKGROUND

Numerous studies have demonstrated the impact of beverage consumption on overall health and oral health. Specifically, high consumption of sugar-sweetened beverages and coffee has been associated with an increased risk of metabolic disorders and periodontitis. Conversely, high intake of plain water has been linked to various health benefits, including weight management and reduced energy intake. However, no previous studies have explored the potential association between plain water intake and the risk of periodontitis.

OBJECTIVES

Our objective was to investigate the relationship between plain water consumption and periodontitis in a middle-aged and elderly population.

METHODS

The present cross-sectional study was conducted among participants aged ≥ 45 in the 2009-2014 National Health and Nutrition Examination Surveys. Multivariable regression analysis, subgroup analysis and smooth fitting tests were conducted to explore the independent relationship between plain water intake and periodontitis.

RESULTS

A total of 5,882 participants were enrolled,62.02% have periodontitis. Periodontitis patients have lower plain water intake. The multivariable regression tests showed that the risk of periodontitis decreased with increased plain water intake quartiles (Q4 OR = 0.78; 95%CI 0.62-0.96) after fully adjustment. Subgroup analysis and interaction tests showed that gender, age, smoking, diabetes, hypertension or BMI does not significantly interact with the association. However, the relation was significant in males (Q4 OR = 0.64; 95%CI 0.47-0.86) but not in females (Q4 OR = 0.97;95% CI 0.71-1.31). In the smoothed curve fits stratified by gender, the curve for male participants displayed as a U-shape, with an optimal plain water intake at 1200 ml/day. For males drinking plain water less than 1200 ml/day, the risk of periodontitis decreased by 24% with each increase of 500 ml plain water intake (OR = 0.76, 95%CI 0.66-0.87, p < 0.001).

CONCLUSIONS

Together, the results showed that plain water intake is negatively associated with periodontitis risk in US middle aged and elderly population. Further studies are needed to investigate the mechanism unites this association. Attention should be given to adequate plain water intake when considering dietary suggestions to the population at high risk of developing periodontitis, especially for men.

Overpromoted and underregulated: National binding legal measures related to commercially produced complementary foods in seven Southeast Asian countries are not fully aligned with available guidance

The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF-specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6-36 months of age.

Development and internal validation of the SMILE-FSS: a Free Sugars Screener for Australian children aged 2 and 5 years

OBJECTIVE

To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years.

DESIGN

Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers' and Infants' Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5-< 10 % and ≥ 10 %EFS) using cross-classification analysis.

SETTING

Australia.

PARTICIPANTS

858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data.

RESULTS

Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation.

CONCLUSIONS

The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's FSI and compare to the WHO free sugars guidelines to identify those 'at risk'.

Benchmarking the nutrient composition and labelling practices of dry or instant cereals for older infants and young children across seven Southeast Asian countries

In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one-third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals.

Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations

The scientific discourse on vegan diets for children and adolescents primarily involves referencing position statement papers from different scientific and professional organizations, including paediatric associations. Over the past two decades, specialized associations have issued official statements and published position papers about adopting well-designed vegan diets during crucial life stages, including pregnancy and lactation, infancy, and childhood. A subset of these associations firmly supports the notion that a well-designed vegan diet can indeed be healthy and support normal growth and development during particularly delicate life stages, emphasizing careful planning, vitamin B12 supplementation, and regular supervised medical and dietetics oversight. In contrast, specific paediatric associations caution against vegan diets for children and adolescents, citing potential harm and the lack of adequate substantiation. These criticisms in position papers frequently point to lower-quality studies and/or outdated studies. Additionally, concerns extend to comparing vegan and omnivorous diets, considering public health issues such as obesity and early stages of cardiovascular disease as well as the risk of prediabetes and type 2 diabetes. Notably, some scepticism stems from studies where children's adherence to a well-designed vegan diet is incomplete. Scientific rigor suggests performing a comparable assessment of omnivorous and vegan diets. This narrative review highlights the need for a comprehensive, up-to-date literature review to inform balanced perspectives on vegan diets for children and adolescents. Researchers and decision-makers should aim to actively improve the design and consistent implementation of both diet types.

The Relationship between Dietary Habits and Periodontal Pathogens in a Sample of Romanian Children and Adolescents: A Cross-Sectional Study

The role of diet in shaping oral microbiota and its potential contribution to the development of periodontal pathogens cannot be understated. This study aimed to explore the correlation between dietary habits and the prevalence of 11 periodontal pathogens among children and adolescents in Oradea, Romania. The identification of these pathogens was performed using the micro-IDent test kit, capable of detecting 11 specific periodontal pathogens. Bacterial sampling was conducted from the crevicular fluid in the morning, prior to brushing, followed by the completion of a brief questionnaire by parents. The questionnaire captured various aspects of the children's eating habits, including meal frequency, consumption of sweets, and hydration levels. The collected samples were dispatched to the laboratory for analysis, which provided insights into the abundance of microorganisms. The study encompassed 60 participants aged between 2 and 18 years, with the majority reported by their parents to have regulated meal timings, frequent sugar intake, and adequate hydration. The findings revealed significant associations between certain dietary factors and the presence of specific periodontal pathogens. Notably, the absence of breastfeeding was linked with the detection of Tannerella forsythia and Campylobacter rectus. Furthermore, frequent consumption of sweets corresponded with the presence of Capnocytophaga spp., which was particularly observed in individuals consuming sweets 2-3 times a day. Insufficient age-appropriate hydration showed an association with the prevalence of T. forsythia, Peptostreptococcus micros, and Capnocytophaga spp. In this sample, it became evident that eating habits and diet influenced the presence of several periodontal pathogens. The lack of breastfeeding was predominantly associated with positive results for T. forsythia and C. rectus, while inadequate hydration correlated more frequently with the presence of T. forsythia and P. micros. Moreover, frequent consumption of sweets was linked to the presence of Capnocytophaga spp.

Smoothies Marketed in Spain: Are They Complying with Labeling Legislation?

There is no legal definition of a smoothie, so the European legislation applicable to its labeling is that of fruit juice. The smoothie market has grown in recent years, as it can include a wide variety of ingredients: fruits, fruit purees, honey, milk and vegetable milks, vegetables, herbs, cereals, cereal flours, seaweed, and crushed ice. In this study, 57 smoothies were reviewed. All of them were purchased in supermarkets and classified into eight types according to the main ingredients. Fifteen legal statements/items were reviewed on the pack labels: eleven mandatory and three optional. Moreover, nutrition labels, nutritional claims, images, marks, and other symbols were also reviewed. Only 22.8% of the samples complied with EU and Spanish labeling legislation. More incorrectness was related to the name of the food and the fruits included as main ingredients; other errors related to the allergy/intolerance statements, and some nutritional claims concerning vitamin C were also detected to a lesser extent. General advice is provided for consumers to interpret smoothie labels correctly. Lawmakers should amend legislation to accept the term "smoothie" as a legal name.

Sweetness preference and its impact on energy intake and body weight - a review of evidence

In the last few years, several approaches have been postulated for tackling the global increase in overweight and obesity rates, including different dietary macronutrient compositions or the timing of meals. Recently, taste modulation has come into focus as a possible approach for influencing dietary behavior. The perception of sweet taste is innate and an evolutionary protection mechanism to prevent primates from eating poisonous plants. It is hypothesized that this innate sweetness preference could be modulated by dietary sweetness, including sweet foods and beverages, which results in a learned sweetness preference that affects energy intake and body weight. However, this hypothesis is not supported by unanimous scientific evidence. This review provides an update of the current literature, regarding the modulation of sweetness preference as a possible new approach in the prevention of overweight and obesity. In general, results from observation as well as interventional studies in all age groups are heterogeneous. The majority showed no effect of dietary sweetness modulation on sweetness preference, energy intake or anthropometric measures. Therefore, the modulation of sweetness preference due to diet, foods or beverages is still a hypothesis and not scientifically proven. However, due to the lack of data, more research is necessary.

Development and Testing of the Novel Sugar Meter for Informing Sugar Intake Guidelines to Parents of Three- to Six-Year-Old Children: A Cross-Sectional Study

INTRODUCTION

In recent years, the consumption of refined sugar has increased manifold. Added sugar is implicated in dental caries, cardiovascular risk and obesity amongst other conditions. The 1025 World Health Organization (WHO) Sugar Guidelines recommends sugar intake below 10% of energy, but there is limited awareness about the same in the general population. The aim of this study was to test the Novel Sugar Meter for informing the WHO Sugar Guidelines to the parents of three- to six-year-old children.

METHODS

Twenty consenting parents and their three- to six-year-old children from an English-medium school in Navi Mumbai, India, were selected. The parents were asked to record their child's baseline dietary data for three consecutive days including one weekend day. The Novel Sugar Meter, an indigenously developed ready reckoner for identifying the quantity of sugars consumed, was used. The parents were counselled using the Novel Sugar Meter (intervention) and standard instructions on the WHO guidelines (control). The dietary data were recorded again to assess and compare dietary behaviour modifications.

RESULTS

Comparison of pre-intervention versus post-intervention sugar consumptions showed a statistically significant reduction in the Novel Sugar Meter group (t(10) = 3.70891; p = .001388) but not in the control group (t(10) = 0.94081, p = 0.35926). Both groups showed a reduction in the frequency of daily sugar exposure, with significantly more reduction in the Novel Sugar Meter group (p = .000049).

CONCLUSION

Novel Sugar Meter-based counselling has the potential for application for reducing the quantity and frequency of sugar consumption in children.

Assessing sugar intake rapidly - a short form of the Marburg Sugar Index (MSI)

BACKGROUND

Sugar intake is a major nutritional factor in the development of dental caries. To further clarify its contribution to oral health-related diseases, population-based investigations are recommended. To facilitate economic and reliable assessment of sugar intake, a short form of the approved Marburg Sugar Index (MSI) was developed.

METHODS

According to the principles of item reduction based on original data, a six-item-short form was constructed. A total of 468 participants (aged 15-81) answered the short form together with the long form in a counterbalanced cross-over design, and with two questionnaires concerning self-efficacy and decisional balance in oral health to verify construct validity.

RESULTS

Comparable item characteristics to the original MSI and a high correlation with the long form prove the usefulness of the short form, which was processed by the participants in less than one minute. Low correlations to the other two constructs show discriminant validity.

CONCLUSION

The new short form of the MSI (MSI-S) can replace the long form, especially in population-based studies with no restrictions on assessment quality but with sufficient time saved to add other variables necessary to explore oral health-related issues.

Ratings of the Effectiveness of 13 Therapeutic Diets for Autism Spectrum Disorder: Results of a National Survey

This study presents the results of the effectiveness of 13 therapeutic diets for autism spectrum disorder from 818 participants of a national survey, including benefits, adverse effects, and symptom improvements. The average Overall Benefit of diets was 2.36 (0 = no benefit, 4 = great benefit), which was substantially higher than for nutraceuticals (1.59/4.0) and psychiatric/seizure medications (1.39/4.0), p < 0.001. The average Overall Adverse Effects of diets was significantly lower than psychiatric/seizure medications (0.10 vs. 0.93, p < 0.001) and similar to nutraceuticals (0.16). Autism severity decreased slightly over time in participants who used diet vs. increasing slightly in those that did not (p < 0.001). Healthy and Feingold diets were the two top-rated diets by Overall Benefit; the ketogenic diet was the highest for nine symptoms (though had fewer respondents); and the gluten-free/casein-free diet was among the top for overall symptom improvements. Different diets were reported to affect different symptoms, suggesting that an individual's symptoms could be used to guide which diet(s) may be the most effective. The results suggest that therapeutic diets can be safe and effective interventions for improving some ASD-related symptoms with few adverse effects. We recommend therapeutic diets that include healthy foods and exclude problematic foods. Therapeutic diets are inexpensive treatments that we recommend for consideration by most people with ASD.

Global development and future trends of artificial sweetener research based on bibliometrics

Artificial sweeteners have sparked a heated debate worldwide due to their ambiguous impacts on public and environmental health and food safety and quality. Many studies on artificial sweeteners have been conducted; however, none scientometric studies exist in the field. This study aimed to elaborate on the knowledge creation and development of the field of artificial sweeteners and predict the frontiers of knowledge based on bibliometrics. In particular, this study combined VOSviewer, CiteSpace, and Bibliometrix to visualize the mapping of knowledge production, covered 2389 relevant scientific publications (1945-2022), and systematically analyzed articles and reviews (n = 2101). Scientific publications on artificial sweeteners have been growing at an annual rate of 6.28% and globally attracting 7979 contributors. Susan J. Brown with total publications (TP) of 17, average citation per article (AC) of 36.59, and Hirsch (h)-index of 12 and Robert F. Margolskee (TP = 12; AC = 2046; h-index = 11) were the most influential scholars. This field was clustered into four groups: eco-environment and toxicology, physicochemical mechanisms, public health and risks, and nutrition metabolism. The publications about environmental issues, in particular, "surface water," were most intensive during the last five years (2018-2022). Artificial sweeteners are gaining importance in the monitoring and assessment of environmental and public health. Results of the dual-map overlay showed that the future research frontiers tilt toward molecular biology, immunology, veterinary and animal sciences, and medicine. Findings of this study are conducive to identifying knowledge gaps and future research directions for scholars.

Comparing effects of beetroot juice and Mediterranean diet on liver enzymes and sonographic appearance in patients with non-alcoholic fatty liver disease: a randomized control trials

Background

In both developed and developing countries, non-alcoholic fatty liver disease (NAFLD) has lately risen to the top of the list of chronic liver illnesses. Although there is no permanent cure, early management, diagnosis, and treatment might lessen its effects. The purpose of conducting the current study is to compare the effects of beetroot juice and the Mediterranean diet on the lipid profile, level of liver enzymes, and liver sonography in patients with NAFLD.

Methods

In this randomized controlled trial, 180 people with a mean age of (45.19 ± 14.94) years participated. Participants ranged in age from 19 to 73. The mean weight before intervention was (82.46 ± 5.97) kg, while the mean weight after intervention was roughly (77.88 ± 6.26) kg. The trial lasted for 12 weeks. The participants were split into four groups: control, a Mediterranean diet with beet juice (BJ + MeD), Mediterranean diet alone (MeD), and beetroot juice (BJ). The Mediterranean diet included fruits, vegetables, fish, poultry, and other lean meats (without skin), sources of omega-3 fatty acids, nuts, and legumes. Beetroot juice had 250 mg of beetroot. Data analysis was done using SPSS software (version 26.0). p < 0.05 is the statistical significance level.

Results

Following the intervention, Serum Bilirubin, alkaline phosphatase (ALP), alanine transaminase (ALT), serum cholesterol (CHOL), triglyceride (TG), and low-density lipoprotein (LDL) levels were significantly decreased in the BJ + MeD, BJ, and MeD groups (p = 0.001). Also, high-density lipoprotein (HDL) significantly increased in the BJ + MeD, BJ, and MeD groups (p = 0.001), while decreasing in the Control group (p = 0.001).

Conclusion

The research findings indicate a significant reduction in hepatic steatosis among the groups receiving beetroot juice (BJ) and beetroot juice combined with the Mediterranean diet (BJ + MeD). This suggests that beetroot juice holds potential as an effective treatment for non-alcoholic fatty liver disease (NAFLD) in adults. Furthermore, the combination of beetroot juice with the Mediterranean diet showed enhanced efficacy in addressing NAFLD.Clinical trial registration: ClinicalTrials.gov, identifier NCT05909631.

Nutritional aspects of commercial infant and toddler food products sold in Turkey

Background: In recent years, there has been an increase in the variety and consumption of commercial infant and toddler food products. Aim: The aim of this study is to evaluate the nutritional profiles of commercial infant and toddler food products sold in Turkey. Methods: A cross-sectional survey of the nutritional composition of products available at in-store and online supermarkets in Turkey was derived from the nutritional information panel on the product label or information provided on manufacturer websites in March 2023. The targeted age group, package type, serving size, ingredients list, and nutrition information (energy [kcal], protein [g], total fat [g], carbohydrate [g], dietary fiber [g], total sugar [g], and sodium [mg] per 100 g) were recorded. Results: Of the 189 products identified, more than 90% (n = 47) of the first foods were fruit-based, while 2% (n = 4) contained only vegetables. Almost half of the products (n = 89, 49%) contained added sugar or sweeteners, 41 (22%) had added sugar, and 1 in 3 products (n = 68, 36%) had sugar from fruit-based sources. One in 10 products (n = 18, 9.5%) contained added salt while 40% of the products (n = 76) were above the WHO Europe sodium standards. Almost half of the products (n = 6, 46%) targeting the 12 months older age group were pureed foods using squeeze pouch packaging. Conclusions: The majority of commercial infant and toddler food products did not adhere to nutrition guidelines. There is a need for stronger composition standards for commercial infant and toddler food products by reducing sugar and sodium content, reducing the use of fruits and sweet vegetables, and increasing the variety of products containing different types of vegetables.

Anthropometric Indicators and Dietary Intake in Toddlers Aged from 12 to 24 Months Who Attended Private Clinics in the Metropolitan Area of Guadalajara

The objective was to evaluate the anthropometric indicators and dietary intake of toddlers attending private clinics in Guadalajara. In a cross-sectional study, 101 toddlers aged 12 to 24 months were included. They were born full term, had an adequate weight for gestational age, and attended private clinics in Guadalajara. Two 24 h dietary recalls were administered. Anthropometric measurements were taken, and anthropometric indices were estimated. Student's t test or the Mann-Whitney U test, chi-square test, and odds ratio were used for quantitative or qualitative variables. Males had lower Z scores for the weight/age index than females. During the week, energy intake was excessive in males [OR = 5.5 (95% CI 1.4, 20.8)], and cholesterol intake was insufficient in females [OR = 3.03 (95% CI 1.2, 7.1)]. On weekends, energy [OR = 2.5 (95% CI 1.1, 5.7)] and fiber intake [OR = 3.1 (95% CI 1.2, 7.8)] were insufficient in females. Most of the toddlers who attend the private clinics in the upper-middle socioeconomic stratum of the Guadalajara Metropolitan Area had excessive protein intake, excessive consumption of added sugars was frequent, and there was insufficient intake of vitamin D and calcium. Sex was shown to be a factor influencing nutrient intake in these toddlers aged 12-24 months. Males had a Z-score of weight/age lower than females, suggesting nutritional risk.

Systemic and Oral Health Parameters in Eutrophic and Overweight/Obese Adolescents: A Cross-Sectional Study

To date, studies focusing on oral health in obese adolescents have provided controversial data. The aim of this cross-sectional study was to investigate systemic and oral health parameters in eutrophic and overweight/obese adolescents. In total, 100 adolescents, mean aged 13.33 ± 2.04 years, were divided into two groups: 59 overweight/obese adolescents in the study group (SG) and 41 eutrophic-weight adolescents in the control group (CG). Chi-squared and Fisher exact tests were performed to compare dichotomous and categorical variables between the two groups. The subjects in the SG (mean aged 13.21 ± 2.21) reported a body mass index (BMI) of 29.05 ± 4.09 kg/m², corresponding to over 95° percentile for both genders, and the subjects in the CG (mean aged 13.49 ± 1.77) reported a BMI of 18.26 ± 4.81 kg/m², corresponding to 25° percentile for both genders. In the SG, the serum level of 25-hydroxy-vitamin D was significantly lower (p-value < 0.001), whereas fasting blood glucose (p = 0.006), waist circumference, and hip circumference were significantly higher (p-value < 0.001). Plaque Index (PI), Plaque Control Record (PCR), Oral Hygiene Index (OHI), Gingival Index (GI), and Gingival bleeding index (GBI) depicted a significantly worse level of oral health in the SG. Moreover, the number of subjects with caries was significantly higher in the SG. Nutritional and physical activity status according to the Mediterranean Diet Quality Index for children and teenagers (KIDMED test) and the International Physical Activity Questionnaire (IPAQ-Adolescent) were reported to be significanlty better in the CG. In light of our results, obesity and poor oral health coexist in a cohort of adolescents. A screening of oral health status should be considered in obese subjects to focus resources on therapeutic interventions aiming at improving oral health.

Healthy Behavior and Sports Drinks: A Systematic Review

This review article aims to systematically identify the relationship between sports drinks and healthy behavior. This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria, and eligibility criteria were established using the PICOS tool (population, interventions, comparators, outcomes, and study) from about 1000 records of sports drinks articles identified in the various Web of Science Core Collection databases. The literature review stages determined a reduced set of 15 articles relating these drinkable supplements to healthy behavior. This study concludes that water consumption should be emphasized for non-athletes, sports drinks should be labeled to indicate water consumption and carry a warning label, and more randomized clinical trials should be considered to ensure conclusive results for health decision making.

Diet and metabolic syndrome: a narrative review

Metabolic syndrome (MetS) is a highly prevalent condition defined by the presence of at least three out of five risk factors including central obesity, increased fasting glucose, high blood pressure, and dyslipidaemia. Metabolic syndrome is associated with a 2-fold increase in cardiovascular outcomes and a 1.5-fold increase in all-cause mortality. Excess energy intake and Western dietary pattern may influence the development of metabolic syndrome. By contrast, both Mediterranean diet (Med-diet) and Dietary Approaches to Stop Hypertension (DASH) diet, with or without calorie restriction, have positive effects. For the prevention and management of MetS, it is recommended to increase the daily intake of fiber-rich and low-glycaemic-index foods and the consumption of fish and dairy products, especially yogurt and nuts. Moreover, it is advisable to consume a large variety of unprocessed cereals, legumes, and fruit. Finally, it is suggested to replace saturated fatty acids with monounsaturated and polyunsaturated fatty acids and to limit the consumption of free sugars to less than 10% of the total energy intake. The aim of this narrative review is to analyze current evidence on the different dietary patterns and nutrients that may affect prevention and treatment of MetS and to discuss the underlying pathophysiological mechanisms.

Current perspectives on global sugar consumption: definitions, recommendations, population intakes, challenges and future direction

Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12-14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.

The Nutritional Quality of Food Provision at UK Government-Funded Holiday Clubs: A Cross-Sectional Analysis of Energy and Nutrient Content

A large proportion of children are at risk of food insecurity during school holidays in the UK. The government-funded Holiday Activities and Food (HAF) programme provides free holiday clubs offering at least one healthy meal/day to eligible children and adolescents. This study aims at evaluating the nutritional quality of food provision at HAF holiday clubs, particularly hot/cold and vegetarian/non-vegetarian meals. Menu variants (n = 2759) from 49 HAF holiday clubs were assessed for adherence to School Food Standards (SFS) and their notional compositional quality, which was scored utilising a novel nutrient-based meal quality index. The median adherence to SFS across all available menus was 70% (IQR 59-79%). Overall, hot variants scored statistically higher menu quality scores than cold variants for both 5-11y (92.3 (80.7-102.7) vs. 80.4 (69.3-90.6)) and 11-18y (73.5 (62.5-85.8) vs. 58.9 (50.0-70.7)) criteria. Cold and hot menu variants tended to score differentially for quality sub-components. These findings highlight areas for potential future improvement in HAF holiday club provision with a tendency for food provision to appear less ideal for attendees for those aged 11-18. Ensuring that children from low-income households have access to a healthy diet is crucial to reduce UK health inequalities.

Effect of Non-Nutritive Sweeteners on the Gut Microbiota

The human gut microbiota, a complex community of microorganisms living in the digestive tract, consists of more than 1500 species distributed in more than 50 different phyla, with 99% of bacteria coming from about 30-40 species. The colon alone, which contains the largest population of the diverse human microbiota, can harbor up to 100 trillion bacteria. The gut microbiota is essential in maintaining normal gut physiology and health. Therefore, its disruption in humans is often associated with various pathological conditions. Different factors can influence the composition and function of the gut microbiota, including host genetics, age, antibiotic treatments, environment, and diet. The diet has a marked effect, impacting the gut microbiota composition, beneficially or detrimentally, by altering some bacterial species and adjusting the metabolites produced in the gut environment. With the widespread use of non-nutritive sweeteners (NNS) in the diet, recent investigations have focused on their effect on the gut microbiota as a mediator of the potential impact generated by gastrointestinal-related disturbances, such as insulin resistance, obesity, and inflammation. We summarized the results from pre-clinical and clinical studies published over the last ten years that examined the single effects of the most consumed NNS: aspartame, acesulfame-K, sucralose, and saccharin. Pre-clinical studies have given conflicting results for various reasons, including the administration method and the differences in metabolism of the same NNS among the different animal species. A dysbiotic effect of NNS was observed in some human trials, but many other randomized controlled trials reported a lack of significant impacts on gut microbiota composition. These studies differed in the number of subjects involved, their dietary habits, and their lifestyle; all factors related to the baseline composition of gut microbiota and their response to NNS. The scientific community still has no unanimous consensus on the appropriate outcomes and biomarkers that can accurately define the effects of NNS on the gut microbiota.

Intake of added sugar, fruits, vegetables, and legumes of Portuguese preschool children: Baseline data from SmartFeeding4Kids randomized controlled trial participants

Introduction

The SmartFeeding4Kids (SF4K) program is an online self-guided intervention for parents with the propose of changing parental feeding practices and children’s dietary intake, focusing on the intake of added sugars, fruit, vegetables, and legumes. This paper aims to describe children’s dietary pattern at baseline through a 24-h food recall, the SmartKidsDiet24.

Methods

Overall, 89 participants recorded at least one meal of the 3-day food recall. Mean age was 36.22 ± 6.05 years and 53.09 ± 15.42 months old for parents and children, respectively. Of these, 22 participants were considered to have 2 days of near complete 24-h food recalls. Children’s dietary intake are reported for these 22 participants based on parents reports and, thus, represent estimations only, as it remains unknown whether children consumed other non-reported foods.

Results

Fruit was the group with the highest daily intake among children (mean 1.77 ± 1.10 portions/day), followed by added sugar foods (mean 1.48 ± 0.89 portions/day), vegetables [median 1.27 (1.64) portions/day] and legumes [median 0.12 (0.39) portions/day]. Fruit intake was positively correlated with vegetable intake (p = 0.008). Regarding Dietary Reference Values accomplishment, 13.6% of children exceeded the daily safe and adequate intake of sodium, 77.3% did not meet potassium and fiber recommendations, and 31.8% did not meet vitamin C recommendations.

Discussion

All children did not meet calcium, vitamin B12 and vitamin D intake recommendations. Our findings further justify the need for dietary interventions in this field, to improve young children’s diets.

Clinical trial registration

ClinicalTrials.gov, identifier NCT04591496.

Combined intake of sugar-sweetened beverages and sugar-containing ultra-processed foods is associated with an increase in body mass index during early childhood

BACKGROUND

Sugar-containing ultra-processed (SUP) foods and beverages consumption has increased globally in recent years and contributes to the rising global trends of obesity and diet-related chronic non-communicable diseases. However, there are limited longitudinal studies of SUP foods and beverages intake and weight gain in children.

OBJECTIVES

To examine associations between intake of sugar-sweetened beverages (SSB) and SUP foods and changes in body mass index during early childhood.

METHODS

Multistage sampling was used to select a nationally representative sample of Uruguayan children living in urban areas from the 2012-2013 Continuous Household Survey. The sample for this analysis included all children aged 0-3 years 11 months with dietary data in 2013-2014 (wave 1; n = 2611) and in 2015-2016 (wave 2; n = 2383). Multilevel regression modelling tested the association between children's consumption of SSB and SUP foods and change in BMI z-score (BMIz).

RESULTS

In multivariable-adjusted models, intake of SSB and SUP foods (in combination but not individually) in both waves was positively associated with change in BMIz over 2 years β coefficient: 0.13 (95% confidence interval [CI]: 0.02, 0.23). BMIz decreased among non-consumers (β: -0.12, 95% CI: -0.24, -0.00, p = 0.048). Associations were significant for SUP foods but not SSB foods individually. Children consuming ≥2 SSB and SUP foods (vs. <2) at baseline had increased BMIz (p for trend = 0.02).

CONCLUSION

Early and current intake of SSB and SUP foods and beverages was associated with increases in BMIz in children over 2 years.

Sugar-sweetened beverages and childhood abnormal adiposity in the Czech Republic - narrative literature review

OBJECTIVES

In Czech children, the burden related to the high body-mass index is rising. In the last three decades, Western eating patterns have influenced Czech children's diet, including the high consumption of sugar-sweetened beverages. This narrative review aims to evaluate evidence of the trend of sugar-sweetened beverages consumption in Czech children and its impact on the prevalence of childhood abnormal adiposity.

METHODS

A comprehensive literature review in MEDLINE (PubMed) and a hand search using references in identified articles were performed. The inclusion criteria were population-based studies of randomly selected samples of children from 0 to 18 years old, data involving the Czech population, published from 1990 to 2021. The results were organized into three sections - childhood abnormal adiposity, SSBs consumption, and the association between SSBs consumption and abnormal adiposity.

RESULTS

The studies showed a significant increase in abnormal adiposity in both genders and all age categories. The highest prevalence of abnormal adiposity was observed in boys and younger children. On the contrary, sugar-sweetened beverages showed a significant decline in daily consumption among Czech children of both genders and all age categories. No results were found for consequences of abnormal adiposity concerning sugar-sweetened beverages consumption.

CONCLUSION

Findings from this review could serve public health experts to detect the areas of a gap in research and establish potential interventions in vulnerable groups. Observation of potential obesogenic contributors - including sugar-sweetened beverages - should be an integral part of effective action against the obesity pandemic.

Prevalence of nutritional inadequacy in children aged 12-36 months: EPACI Portugal 2012

Adequate nutritional intake in the first years of life is crucial for future health. The purpose of this study is to assess the adequacy of nutritional intake in Portuguese toddlers. The EPACI Portugal 2012 is a cross-sectional study of a representative sample of toddlers (n = 2230), aged between 12 and 36 months. Data on diets were collected by trained interviewers. The current analysis included 853 children with full data from 3-day food diaries completed by parents/caregivers. Intakes of energy, macro- and micronutrients were estimated through Statistical Program to Assess Dietary Exposure (SPADE). Nutritional adequacy was evaluated using Dietary Reference Values established by the European Food Safety Authority. A large proportion of children exceeded the recommended energy intake. The median daily protein intake was 4.7 g/kg/day, five times more than that recommended. About 9% and 90% of the children consumed a lower proportion of energy than the lower limit of the Reference Intake range for carbohydrates and fat, respectively. Around a third consumed less fibre and magnesium and 100% less vitamin D than the recommended Adequate Intake (AI). Almost a third consumed less vitamin A than the recommended Average Requirement (AR) and 86% of the children showed excessive sodium consumption. Portuguese toddlers consumed a low proportion of energy from fat, had energy and protein intakes above the recommendations and excessive intakes of sodium, and inadequate intakes of vitamin A. Every child consumed less than the recommended AI for vitamin D.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Hydration and Nephrolithiasis in Pediatric Populations: Specificities and Current Recommendations

Renal lithiasis is less frequent in children than in adults; in pediatrics, lithiasis may be caused by genetic abnormalities, infections, and complex uropathies, but the association of urological and metabolic abnormalities is not uncommon. The aim of this study is to provide a synthesis of nephrolithiasis in children and to emphasize the role of hydration in its treatment. As an etiology is reported in 50% of cases, with a genetic origin in 10 to 20%, it is proposed to systematically perform a complete metabolic assessment after the first stone in a child. Recent data in the field reported increased incidence of pediatric urolithiasis notably for calcium oxalate stones. These changes in the epidemiology of stone components may be attributable to metabolic and environmental factors, where hydration seems to play a crucial role. In case of pediatric urolithiasis, whatever its cause, it is of utmost importance to increase water intake around 2 to 3 L/m² per day on average. The objective is to obtain a urine density less than 1010 on a dipstick or below 300 mOsm/L, especially with the first morning urine. Some genetic diseases may even require a more active 24 h over-hydration, e.g., primary hyperoxaluria and cystinuria; in such cases naso-gastric tubes or G-tubes may be proposed. Tap water is adapted for children with urolithiasis, with limited ecological impact and low economical cost. For children with low calcium intake, the use of calcium-rich mineral waters may be discussed in some peculiar cases, even in case of urolithiasis. In contrast, sugar-sweetened beverages are not recommended. In conclusion, even if parents and patients sometimes have the feeling that physicians do not propose "fancy" therapeutic drugs, hydration and nutrition remain cornerstones of the management of pediatric urolithiasis.

Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review

Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described.

METHODS

we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications.

RESULTS

different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents' behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome.

CONCLUSIONS

Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.

Geographic Information Systems (GIS) to Assess Dental Caries, Overweight and Obesity in Schoolchildren in the City of Alfenas, Brazil

Childhood-related obesity and overweight are increasing concerns for the health and well-being of children. Dental caries (decay) is the most prevalent oral disease during childhood, and several studies have suggested that nutritional status and dental caries are associated in children. Therefore, this study aimed to determine the geographic distribution of childhood overweight/obesity and dental caries in a medium-sized Brazilian city. This cross-sectional study was conducted with 269 children of both genders enrolled in four public schools in the city of Alfenas. The children were clinically examined to assess cavitated dental caries and nutritional status (overweight and obesity). In addition, the GIS was used for the geospatial clustering analyses. A heat map was created by the Kemel method to estimate the concentration of the outcomes. The cavitated dental caries and overweight/obesity were also pointed out by dots on the map. However, of the 269 children, 118 were boys (43.87%) and 151 were girls (56.13%). One hundred fifty-seven children (58.4%) were classified as having "non-cavitated caries," while 112 (41.6%) were classified as having "cavitied caries." In the nutritional status assessment, 204 children (75.84%) were classified as "eutrophic," while 65 children (24.16%) were classified as "overweight/obesity," A geographical correlation of dental caries with overweight/obesity may exist in the northeast and southwest areas. In conclusion, a geographical concordance between the dental caries and the occurrence of overweight/obesity among the schoolchildren from Alfenas may exist in some areas. Future studies are necessary.

Dietary Intake by Toddlers and Preschool Children: Preliminary Results from a Michigan Cohort

Identifying the consumption patterns of toddlers and preschool children is critical to evaluating their potential for healthy development and future heath trajectories. The purpose of this longitudinal cohort study was to describe breastfeeding, nutritional trends, and dietary diversity in 12-to-36-month-old children in a Michigan cohort. Mothers completed surveys when their children were 12 (n = 44), 24 (n = 46) and 36 months old (n = 32). Mothers reported their child's dietary intake in the past 24 h and intake of specific foods in the past year. About 95% of 12-to-24-month-old children in the study population were ever breastfed, with 70% consuming human milk at 6 months and just over 40% at 12 months. Over 90% of participants gave their child a bottle since birth, with 75% providing human milk and 69% giving formula. Consumption of juice significantly increased with age and ~55% of the 36-month-old children consumed juice. A larger proportion of children consumed soda, chocolate, and candy as they aged. Though dietary diversity numerically increased with child age, this did not reach significance. Gut microbiota composition and structure was not associated with diet diversity. This research lays the foundation for future work to determine which nutritional interventions may be most effective in this population.

Evolution of beverage portion sizes consumed in Brazil between 2008 and 2018

Objective

To describe the evolution of beverage portion sizes consumed in Brazil between 2008 and 2018.

Methods

Data from the dietary surveys of 2008-2009 and 2017-2018 Brazilian Household Budget Surveys, conducted with 34,003 and 46,164 individuals, respectively, were used to analyze the portion size of beverages. Food consumption data were used to group beverages according to nutritional characteristics, type and size of portions into eight groups: high-calorie soft drinks, fruit refreshments, alcoholic beverages, coffee/tea, fruit juices, milk and milk substitutes and ultra-processed milk-based beverages. The two-day food record and recall were considered to analyze the consumed portions. Comparisons between the surveys were done using Chi-Square tests and linear regression models.

Results

Between 2008 and 2018, the average portion consumed showed a significant increase for the group of alcoholic beverages (+29%), flavored juices (+11%), caloric soft drinks (+8%), milk and milk substitutes (+6%) and fruit juices (+5%); and reduction for the coffee/tea group (-11%). Analyzes by age group showed that among individuals between 20 and 40 years of age, the soft drinks and alcoholic beverage groups showed the greatest increase in portion size, +12 and +44%, respectively.

Conclusion

The beverage portion sizes consumed in Brazil between 2008 and 2018 increased for the group of alcoholic beverages, flavored juices, caloric soft drinks, milk and milk substitutes, and fruit juices.

Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review

This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.

Dietary Supplements among Children Ages 0-3 Years in Poland-Are They Necessary?

(1) Background: One of the ways to prevent nutritional deficiencies may be supplementation. Experts have observed the increased use of dietary supplements, not only in adults but also in children. Considering controversies among dietary supplements and possible errors in children's feeding, the goal of our research was to evaluate use and reasons behind supplementation in terms of children's diet analysis. (2) Methods: Our research involved 507 legal guardians of the youngest children (up to 3 years of age) and was conducted via a questionnaire. (3) Results: 79% of all children received dietary supplements. The analysis of children's diets showed a need to implement omega-3 acids and vitamin D supplementation, which was very low in children. On the other hand, vitamin C, vitamin B, vitamin A, and copper levels were extremely high. (4) Conclusions: Popularity of dietary supplements in Polish children aged 0-3 years old is an omnipresent issue. Although the reasoning behind administering nutritional supplements to children seems justified, considering the supply of vitamin D and omega-3 fatty acids, it seems justified to increase parents' knowledge in this regard in terms of the use and means to choose the best supplement possible, as dietary supplementation should always be tailored to individual needs.

Recent advance in technological innovations of sugar-reduced products

Sugar is crucial as an essential nutrient for humans as well as for providing texture, sweetness and so on to food. But with the rise in people's pursuit of health, it is becoming increasingly clear that excessive consumption of sugar can locate a load on the body. It has been that excessive sugar is associated with many diseases, such as dental caries, obesity, diabetes, and coronary heart disease. Therefore, researchers and industries are trying to reduce or substitute sugar in food without affecting the sensory evaluation. Substituting sugar with sweeteners is alternatively becoming the most traditional way to minimize its use. So far, the sweeteners such as stevia and xylitol have been are commercially applied. Several studies have shown that technological innovation can partially compensate for the loss in sweetness as a result of sugar reduction, such as cross-modal interactions that stimulate sweetness with aroma, nanofiltration that filters disaccharides and above, enzyme-catalyzed sugar hydrolysis, and microbial fermentation that turns sugar into sugar alcohol. This review summarizes these studies to enhance the safety and quality of sugar-reduced products, and will provide some theoretical frameworks for the food industry to reduce sugar in foods, meet consumers' needs, and promote human health.

Use of Health-Promoting Food and Supplements in Swiss Children

INTRODUCTION

Our diet is the sum of many different influences and has visibly changed over the past decades. Since children also imitate their parents when it comes to eating habits, the aim of the study was to assess the current dietary habits in Swiss children.

METHOD

Cross-sectional study of children between 0 and 18 years of age in Switzerland.

RESULTS

A total of 1964 children participated, with an average age of 7.4 years. A total of 57.9% of participants stated to buy supplements to promote health, while fruit juices/smoothies were the most popular product (42.5%), followed by protein-enriched products (40%) and vitamins/minerals (29%). A statistically significant correlation between longer screen time, a higher socioeconomic background, and the intake of supplements was found. Over 20% of all families regularly consume plant-based drinks.

DISCUSSION

This Swiss cross-sectional study of over 1900 participants reveals that 58% of all participants buy supplements or special kid's food to promote the child's health. There is a correlation between higher screen time, higher parental income, and the usage of supplements. A total of 23% of participating families consume at least one plant-based drink on a regular basis. As more and more families use supplements, the pediatrician should not only focus on weight, which reflects the intake of macronutrients but should also take a history of whether children omit certain foods or take supplements to ensure the child does not have a deficiency of micronutrients.