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Ko A, O’Brien D, Rivera P, Mancl L, Hopkins S, Randall C, Nguyen DP, Chi DL. Identifying sources of variation in added sugar intake for Alaska Native children using a hair biomarker. Int J Circumpolar Health 2024; 83:2336286. [PMID: 38560896 PMCID: PMC10986438 DOI: 10.1080/22423982.2024.2336286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Sugars from sugar-sweetened beverages (SSBs) are an important risk factor for tooth decay. The study goal was to determine if there was variation in added sugar intake across communities and between and within households. In this cross-sectional study, intakes of total sugar, added sugar, and sugar-sweetened beverages (SSBs) were estimated for 282 Alaska Native children ages 0-10 years from 131 households in three Yukon-Kuskokwim (YK) Delta communities using biomarker equations based on hair carbon and nitrogen isotope ratios previously developed for the Yup'ik population. ANOVA was used to assess associations between each predictor (community and household) and outcome (estimated total sugars, added sugars, and SSB intake). Between- and within-household variation was estimated using a linear mixed-effects model with a random intercept for households with three or more children. There was no significant difference in mean estimated total sugar (p = 0.29), added sugar (p = 0.24), or SSB intake (p = 0.40) across communities. Significant variations were observed between and within households, with within-household variation amounting to 59% of the between-household variation. Added sugar intake in Alaska Native children from the three study communities is higher than the recommended maximum, and the variation is greater within households than between households.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Diane O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Patricia Rivera
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Scarlett Hopkins
- Departments of Medicine and Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Cameron Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
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Hassan HI, Othman SM. Sugar-Sweetened Beverage Consumption and Its Association With Dental Caries Among Adolescents in Erbil, Iraq: A Cross-Sectional Study. Cureus 2024; 16:e58471. [PMID: 38765400 PMCID: PMC11100997 DOI: 10.7759/cureus.58471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Background Sugar-sweetened beverages are one of the most common sources of added sugar in the diet and have been associated with an increased risk of dental caries, obesity, major chronic diseases, and possibly cancer. Dental caries is a diet-related, highly prevalent, and preventable oral disease. The objective of this study was to assess the frequency of sugar-sweetened beverage consumption and its association with dental caries in adolescents in Erbil, Iraq. Methods This is a cross-sectional study that invited 11- to 16-year-old intermediate school students (n=380) in Erbil, Iraq. Data collection comprised a validated questionnaire and a clinical examination. In addition, dietary data were collected by using two non-consecutive 24-hour recalls. The mean of the daily consumption of sugar-sweetened beverages over a two-day period was calculated. Dental caries was diagnosed based on World Health Organization (WHO) criteria and was reported as a decayed, missing, and filled permanent tooth (DMFT). A multiple regression model was used to assess the influence of sugar-sweetened beverages on dental caries experience (DMFT). SPSS version 26 (Armonk, NY: IBM Corp) was used to analyze the data at the 5% significance level. Results Of the 380 students interviewed, one participant was excluded because of incomplete data. The participant's mean age and standard deviation (SD) were 13.3±1.2. A total of 54.1% of the students were female. The mean daily intake of sugar-sweetened beverages was 686.71±197.50 mL per day. Male students consumed more beverages than female students (p<0.001). The most frequently consumed sugar-sweetened beverages were sweetened tea and coffee, and the least frequently consumed beverages were milk and dairy products. The mean decayed, missing, and filled permanent tooth (DMFT) was 94.58±2.73. Results of multiple regression analysis showed that caries experience (DMFT) was associated with insufficient toothbrushing (p<0.001), plaque-affected sextants (p=0.001), and male sex (p=0.016). The model also showed a significant association between sugar-sweetened beverage consumption and dental caries experience (DMFT) (regression coefficient=0.008, CI: 0.006-0.009, p<0.001). Conclusions Adolescents in Erbil, Iraq, consumed sugar-sweetened beverages on a frequent basis, and male students consumed more sugary beverages than females. The higher frequency of these beverage consumptions was associated with a higher dental caries experience. Consequently, reducing sugar-sweetened beverage consumption could have a significant positive public health impact.
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Affiliation(s)
- Heran I Hassan
- Orthodontics, Pediatric and Preventive Dentistry, College of Dentistry, Hawler Medical University, Erbil, IRQ
| | - Samir M Othman
- Community Medicine, College of Medicine, Hawler Medical University, Erbil, IRQ
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Kabous J, Esclassan R, Noirrit-Esclassan E, Alva O, Krishna Murti P, Paquet L, Grondin J, Letellier T, Pierron D. History of dental caries in Inuit populations: genetic implications and 'distance effect'. Int J Circumpolar Health 2023; 82:2252568. [PMID: 37643455 PMCID: PMC10467516 DOI: 10.1080/22423982.2023.2252568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
Dental caries is considered the third most important scourge in the world. In North America, Inuit populations are the population the most severely affected by dental caries. It is often assumed that this situation can be explained by a combination of factors classical for Indigenous populations: remoteness (geographical distance), low economic status and low health literacy (cultural distance). Using a bibliographic approach, we tested this hypothesis of the "distance effect" by exploring the caries prevalence in other Indigenous populations living in high-income countries. Next, we tested whether the high prevalence of caries is due to population-specific characteristics by tracking caries prevalence over the past few centuries. In result, we showed that while other Indigenous populations are more impacted by caries than the general populations, the Inuit populations present the highest prevalence. Paradoxically, we showed also that past Inuit populations were almost immune to caries before 1950. These two elements suggest that the prevalence of caries observed presently is a recent maladaptation and that beyond the effect of cultural and geographical distance, specific biocultural factors have to be investigated.
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Affiliation(s)
- Julie Kabous
- Équipe de Médecine Evolutive, EVOLSAN faculté de chirurgie dentaire, Université Toulouse III, Toulouse, France
| | - Rémi Esclassan
- CAGT UMR 5288 CNRS, Université Paul Sabatier, UFR Santé – 3 Chemin des Maraîchers, Toulouse, France
- Department of Prosthodontics, CHU de Toulouse, Hôtel-Dieu Saint Jacques, Toulouse, France
| | - Emmanuelle Noirrit-Esclassan
- Department of Prosthodontics, CHU de Toulouse, Hôtel-Dieu Saint Jacques, Toulouse, France
- ADES Laboratory UMR 7268 CNRS, Aix-Marseille Université, Faculté des Sciences Médicales et paramédicales Secteur Nord, Marseille Cedex, France
| | - Omar Alva
- Équipe de Médecine Evolutive, EVOLSAN faculté de chirurgie dentaire, Université Toulouse III, Toulouse, France
| | - Pawan Krishna Murti
- Équipe de Médecine Evolutive, EVOLSAN faculté de chirurgie dentaire, Université Toulouse III, Toulouse, France
| | - Liliane Paquet
- Department of Anthropology, Private practice in Kuujjuaq, Kuujjuaq, Canada
| | - Julie Grondin
- Department of Pedodontics, Private practice in L’Assomption, L'assomption, QC, Canada
| | - Thierry Letellier
- Équipe de Médecine Evolutive, EVOLSAN faculté de chirurgie dentaire, Université Toulouse III, Toulouse, France
| | - Denis Pierron
- Équipe de Médecine Evolutive, EVOLSAN faculté de chirurgie dentaire, Université Toulouse III, Toulouse, France
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Boachie MK, Molete M, Hofman K, Thsehla E. Cost-effectiveness of dental caries prevention strategies in South African schools. BMC Oral Health 2023; 23:814. [PMID: 37898738 PMCID: PMC10613394 DOI: 10.1186/s12903-023-03474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.
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Affiliation(s)
- Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 4041, Durban, South Africa.
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa.
| | - Mpho Molete
- Department of Oral Biological Sciences, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
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Ohle KA, Koller KR, Walch AK, Lee FR, Palmer L, Nu J, Thomas TK. Alaska Native Parents' Decision-Making About Food, Beverages, and Screen Time for Young Children: Formative Insights From the "Got Neqpiaq?" Project. FAMILY & COMMUNITY HEALTH 2023; 46:250-258. [PMID: 37703513 PMCID: PMC10502956 DOI: 10.1097/fch.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
With rising childhood obesity rates, ensuring children adopt healthy habits early is imperative. Given the unique context for Alaska Native families living in rural remote communities, who are concurrently experiencing changes in traditional practices, we investigated what impacts parents' decisions as they relate to daily living before revising a preschool curriculum focused on healthy habits. The objective of this study was to explore factors influencing parents' decisions about their children's foods, beverages, and activities. In focus group discussions with AN parents of young children across 12 communities, we asked about meals, traditional foods, beverages, physical activity, and screen time. All sessions were recorded, transcribed, and analyzed using open and selective coding to allow the most important themes to emerge. As parents discussed how they make decisions, several trends emerged related to adults' and children's food and beverage preferences; the impact of adult modeling on children; and how convenience, seasonality, access, and a reluctance to engage in conflict all impact decision-making. Parents and other community members shared important perspectives on exposing children to traditional subsistence foods and activities and passing important traditional knowledge to them at an early age. These perspectives will form the basis for preschool curricula in these communities.
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Affiliation(s)
- Kathryn A Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan (Dr Ohle); Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska (Drs Koller and Thomas and Ms Lee); Dietetics & Nutrition, University of Alaska Anchorage (Dr Walch); RurAL Cap Head Start, Anchorage, Alaska (Ms Palmer); and Center for Alaska Native Health Research, University of Alaska Fairbanks (Ms Nu)
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Hill CM, Paschall MJ, Koller KR, Day GM, Lee FR, O’Brien DM, King DK, Palmer L, Thomas TK, Bersamin A. Obesity Prevalence and Dietary Factors Among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the " Got Neqpiaq?" Study. Child Obes 2023; 19:498-506. [PMID: 36473164 PMCID: PMC10541932 DOI: 10.1089/chi.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska. Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured. Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels. Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.
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Affiliation(s)
- Courtney M. Hill
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kathryn R. Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gretchen M. Day
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Flora R. Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA
| | - Lea Palmer
- Head Start Program, Rural Alaska Community Action Program, Inc., Anchorage, AK, USA
| | - Timothy K. Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
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Margraf-Stiksrud J, Pieper K, Deinzer R. Assessing sugar intake rapidly - a short form of the Marburg Sugar Index (MSI). BMC Oral Health 2023; 23:702. [PMID: 37775765 PMCID: PMC10541712 DOI: 10.1186/s12903-023-03403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
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.
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Affiliation(s)
- Jutta Margraf-Stiksrud
- Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, D-35032, Marburg, Germany
| | - Klaus Pieper
- Centre for Dentistry, Oral and Maxillofacial Medicine, Philipps University of Marburg, Georg-Voigt-Strasse 3, D-35033, Marburg, Germany
| | - Renate Deinzer
- Department of Medical Psychology, Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, D-35392, Giessen, Germany.
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Hajishafiee M, Kapellas K, Listl S, Pattamatta M, Gkekas A, Moynihan P. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective. BMC Public Health 2023; 23:986. [PMID: 37237341 DOI: 10.1186/s12889-023-15884-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available. METHODS The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence. RESULTS From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period. CONCLUSION Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.
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Affiliation(s)
| | - Kostas Kapellas
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Madhuri Pattamatta
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Athanasios Gkekas
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paula Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
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Patil S, Jalal RAS, Albar DH, Bansal SJ, Patil S, Nagaral S, Finch J, Bernard CA, Baeshen HA, Awan KH. Intake of Artificial Sweeteners by Children: Boon or Bane? J Contemp Dent Pract 2023; 24:137-145. [PMID: 37272146 DOI: 10.5005/jp-journals-10024-3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sugar is the main culprit in many health dysfunctions. Excessive sugar intake can negatively affect oral health, precipitate diabetes, and lead to weight gain and obesity. Sucrose is the primary form of sugar, and is strongly correlated with dental caries. Artificial sweeteners are chemically synthesized sugar substitutes that are generally regarded as being low-calorie. OBJECTIVE This review examines the current evidence in the literature for the need for artificial sweeteners and outlines its implications for the health of children. We briefly outline its adverse effects, and concerns regarding their safety. REVIEW RESULTS Artificial sweeteners are a widely used food additive. Six main artificial sweeteners are approved by the food and drug administration (FDA). The conflicting results and divergent regulatory norms of each sweetener are a constant cause of concern and debate. However, most studies have spotlighted the beneficial effects of artificial sweeteners. Dental caries diminish with the increase in sweetener intake. An increase in appetite and eventually weight gain is observed in individuals consuming artificial sweeteners. CONCLUSION Artificial sweeteners are indeed a bane according to present studies, although more research on recently discovered non-nutritive artificial sweeteners is required. It also has a positive effect on overall health disorders. If one curbs the onset of dental caries, then the eventual rise is highly unlikely. CLINICAL SIGNIFICANCE Artificial sweeteners' effect on lowering dental caries will help to reduce the caries index in general. Oral hygiene is maintained, and the growth of oral bacterium is depressed. Research on novel sweeteners will help to compare their efficacy in caries prevention compared to existing ones. It is necessary to educate people on artificial sweeteners and its implication as one can use them by being aware of their properties.
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Affiliation(s)
- Shankargouda Patil
- Department of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America, Phone: +91 3097036919, e-mail:
| | | | - Dhalia Hassan Albar
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Sandesh Jagdish Bansal
- Department of Pedodontics and Preventive Dentistry, Jawahar Medical Foundation, ACPM Medical College, Dhule, Maharashtra, India
| | - Sudha Patil
- Department of Pedodontics and Preventive Dentistry, Jawahar Medical Foundation, ACPM Medical College, Dhule, Maharashtra, India
| | - Suresh Nagaral
- Department of Prosthodontics, Jawahar Medical Foundation, ACPM Medical College, Dhule, Maharashtra, India
| | - Joshua Finch
- Department of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America
| | | | - Hosam Ali Baeshen
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kamran Habib Awan
- Department of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America
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Walch AK, Ohle KA, Koller KR, Alexie L, Lee F, Palmer L, Nu J, Thomas TK, Bersamin A. Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the "Got Neqpiaq?" Project. Int J Circumpolar Health 2022; 81:2024679. [PMID: 35037587 PMCID: PMC8765241 DOI: 10.1080/22423982.2021.2024679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.
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Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kathryn R. Koller
- Research Nurse Supervisor, Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation Research Department, Associate Research Coordinator, Bethel, Alaska, USA
| | - Flora Lee
- Epidemiology Research Nurse, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Lea Palmer
- Registered Dietitian Nutritionist, RurAL Cap Head Start, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K. Thomas
- Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
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11
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Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska. J Am Dent Assoc 2022; 153:1145-1153. [DOI: 10.1016/j.adaj.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
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12
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Children's and Parents' Marburg Sugar Index (MSI) Values: Are They Comparable? Nutrients 2022; 14:nu14081630. [PMID: 35458192 PMCID: PMC9029305 DOI: 10.3390/nu14081630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Studies on children’s nutritional behaviour (CNB) rarely compare children’s answers regarding the frequency of their sugar intake with the respective statements of their parents. Therefore, data from a prevention study were used to analyse this aspect, as well as a potential correlation between Marburg Sugar Index (MSI) values and caries experience of children. The present study based its questionnaire data on CNB and caries data. Pairs of questionnaires filled in separately by children and parents of the participating families were dichotomised by either having completed the diet section entirely (Group A) or in part (Group B). The MSI scores were calculated separately for children and parents. The statistical confidence level was set at α = 0.05 (two-sided). Furthermore, the Pearson correlation coefficient was calculated and tested for “r = 0”. Additionally, a test for equality of the correlations was applied. The number of available questionnaire pairs was 429 in Group A and 400 in Group B. In both groups, significant correlations between children’s and parents’ MSI scores (A: r = 0.301, p < 0.001; B: r = 0.226, p < 0.001) were found. Using Spearman’s Rho, a significant correlation between MSI scores and children’s caries experiences was observed in Group A. MSI scores based on dietary questionnaires can be used to obtain consistent information on children’s CNB provided by the children themselves or their parents. This is true even when the MSI score has to be calculated on the basis of incomplete questionnaires. Questionnaire-based CNB information can improve the effectiveness of individual or group preventive measures supplemented by individually adapted nutritional counselling.
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13
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Moores CJ, Kelly SAM, Moynihan PJ. Systematic Review of the Effect on Caries of Sugars Intake: Ten-Year Update. J Dent Res 2022; 101:1034-1045. [PMID: 35302414 DOI: 10.1177/00220345221082918] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An update of the systematic review of evidence on the association between amount of sugars intake and dental caries, as well as on the effect of restricting sugars intake to <10% and <5% energy (E) on caries, was conducted, almost 10 y since the review that informed the World Health Organization (WHO) Guideline on Sugars. The aim was to systematically review epidemiological data published from 2011 to 2020 on the amount of sugars consumption and levels of caries and to report the findings for adults and children. Data sources included MEDLINE, EMBASE, Cochrane Database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences, China National Knowledge Infrastructure, Scopus, and Google Scholar. Eligible studies reported the amount of sugars and caries, measured as prevalence, incidence, or severity. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Risk of bias was assessed using the Office of Health Assessment and Translation tool. Vote counting and harvest plots provided the basis for evidence synthesis. From 488 new papers identified, 23 studies were eligible: 4 cohort, 1 case-controlled, 12 cross-sectional, and 6 ecological. Eleven of 15 studies in children and 6 of 8 studies in adults reported at least 1 positive association between sugars and caries. Six of 7 studies in children and 4 of 4 studies in adults, with data enabling comparison of caries levels with sugars intakes >10%E and <10%E, showed lower caries when sugars intake was <10%E. Amalgamating with original studies yielded 64 of 78 studies showing at least 1 positive association, 20 of 78 a null association, and 3 of 78 a negative association between sugars and caries. GRADE profiles of new and original cohort data confirmed "moderate-quality" evidence that caries is lower when sugars intake is <10%E. Furthermore, new cohort data upgraded the quality of evidence (from "very low" to "low") for lower caries when free sugars are <5%E. The findings support and strengthen original evidence underpinning the WHO recommendations for sugars.
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Affiliation(s)
- C J Moores
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S A M Kelly
- Cambridge Public Health, University of Cambridge, Cambridge, UK.,THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - P J Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,School of Dental Sciences, Newcastle University, Newcastle, UK
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14
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Hill C, Nash SH, Bersamin A, Hopkins SE, Boyer BB, O’Brien DM, Chi DL. Seasonal variation in added sugar or sugar sweetened beverage intake in Alaska native communities: an exploratory study. Int J Circumpolar Health 2021; 80:1920779. [PMID: 33910491 PMCID: PMC8843354 DOI: 10.1080/22423982.2021.1920779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 10/24/2022] Open
Abstract
Excess added sugar intake contributes to tooth decay risk in Alaska Native communities. The goal of this exploratory study was to determine if there is seasonal variation in total added sugar intake or in the leading sources of added sugars in a Yup'ik population. Data were collected in spring and winter from 2008-2010 using self-reported intake data measured by 24-hour recall and by hair biomarker (carbon and nitrogen stable isotope). Seventy Yup'ik participants ages 14-70 years were recruited from two communities and data were collected twice from a subset of 38 participants. Self-reported added sugar intake (g/day), biomarker-predicted added sugar intake (g/day), and leading sources of added sugar were calculated. Seasonal variation was evaluated using a paired sample t-test. Total added sugar intake was 93.6 g/day and did not significantly differ by season. Sodas and other sugar-sweetened beverages (e.g. Tang, Kool-Aid) were the leading sources and added sugar from these sources did not significantly differ by season (p=.54 and p=.89, respectively). No seasonal variation in added sugar intake was detected by either self-report or biomarker. Dietary interventions that reduce intake of added sugars have the potential to reduce tooth decay in Yup'ik communities.
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Affiliation(s)
- Courtney Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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15
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Hedrick VE, Halliday TM, Davy BM, Zoellner JM, Jahren AH. A Single-Carbon Stable Isotope Ratio Model Prediction Equation Can Estimate Self-Reported Added Sugars Intake in an Adult Population Living in Southwest Virginia. Nutrients 2021; 13:3842. [PMID: 34836098 PMCID: PMC8617603 DOI: 10.3390/nu13113842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The δ13C value of blood is a novel proposed biomarker of added sugars (AS) intake. AS prediction equations using either a single- (δ13C) or dual-isotope model (δ13C and δ15N) were previously developed in an adult population with high AS intake living in southwest Virginia (reference group). The purpose of this investigation was to test the δ13C single- and δ13C and δ15N dual-isotope prediction equations for AS intake in adults with a lower mean AS intake and different demographic characteristics (test group). The blood samples for the reference (n = 257 for single-isotope, n = 115 for dual-isotope) and test groups (n = 56) were analyzed for δ13C and δ15N values using natural abundance stable isotope mass spectrometry and were compared to reported dietary AS intake. When the δ13C single-isotope equation was applied to the test group, predicted AS intake was not significantly different from reported AS intake (mean difference ± standard error = -3.6 ± 5.5 g, Z = -0.55, p = 0.51). When testing the dual-isotope equation, predicted AS was different from reported AS intake (mean difference ± SEM = 13.0 ± 5.4 g, Z = -2.95, p = 0.003). δ13C value was able to predict AS intake using a blood sample within this population subset. The single-isotope prediction equation may be an alternative method to assess AS intake and is more objective, cost-feasible, and efficient than traditional dietary assessment methods. However, more research is needed to assess this biomarker with rigorous study designs such as controlled feeding.
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Affiliation(s)
- Valisa E. Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Tanya M. Halliday
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84112, USA;
| | - Brenda M. Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Jamie M. Zoellner
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA 24073, USA;
| | - A. Hope Jahren
- Centre for Earth Evolution and Dynamics, University of Oslo, 0371 Oslo, Norway;
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16
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Thomas TK, Lenaker D, Day GM, Wilson JC, Holck P, Newman J, Bruden D, Hennessy TW. Using electronic dental records to establish a surveillance system for dental decay in rural Western Alaska. J Public Health Dent 2021; 81:224-231. [PMID: 33283270 PMCID: PMC8337052 DOI: 10.1111/jphd.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Previous surveys have demonstrated high rates of early childhood caries (ECC) in the Alaska Native (AN) population of western Alaska. There are many challenges to providing dental care in this road-less Yukon-Kuskokwim Delta region. The regional Tribal Health Organization implemented an electronic dental record (EDR) system in the late 1990s. We explored use of the EDR to establish an oral health surveillance system in children. METHODS We contracted with EDR software developers to implement calculation of a summary count of decayed (d), missing (m) or filled (f) primary (dmft) score for each individual. We calculated the yearly average dmft scores for 2011-2019 for children aged 3 and 5 years with a comprehensive exam in a given year. We also assessed the number of children undergoing full mouth dental rehabilitation (FMDR). We used US census data population estimates for these age groups to calculate rates. RESULTS Over the 9-year period, 2,427 3-year-old children (47 percent of all 3-year olds over this period), received a comprehensive exam; increasing from 24 percent in 2011 to 62 percent in 2019. Their average dmft score over the 9-years was 6.4 with a significant annual decline over this period. Seventy percent of AN children who turned 6 between 2015 and 2019 had received at least one FMDR. CONCLUSIONS An oral health surveillance system has been established in western Alaska using the Electronic Dental Record. High rates of ECC and FMDR were observed. This surveillance system will allow assessments of ECC prevalence and impact of dental interventions.
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Affiliation(s)
| | - Dane Lenaker
- Yukon Kuskokwim Health Corporation, Bethel, AK, USA
| | - Gretchen M Day
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Peter Holck
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Dana Bruden
- Arctic Investigation Program, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Thomas W Hennessy
- Arctic Investigation Program, Centers for Disease Control and Prevention, Anchorage, AK, USA
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17
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Koller KR, Flanagan CA, Nu J, Lee FR, Desnoyers C, Walch A, Alexie L, Bersamin A, Thomas TK. Storekeeper perspectives on improving dietary intake in 12 rural remote western Alaska communities: the "Got Neqpiaq?" project. Int J Circumpolar Health 2021; 80:1961393. [PMID: 34350814 PMCID: PMC8344255 DOI: 10.1080/22423982.2021.1961393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low intake of fruits and vegetables and high intake of sugar-sweetened beverages persists as a public health concern in rural remote Alaska Native (AN) communities. Conducting key informant interviews with 22 storekeepers in 12 communities in the Yukon-Kuskokwim region of Alaska, we explored potential factors impeding or facilitating dietary change towards healthier food choices. We selected these sites as part of a multi-level intervention aimed at introducing more traditional AN subsistence foods, increasing fruit and vegetable intake, and decreasing SSB consumption among young children enrolled in Head Start (preschool) programmes (Clinicaltrials.gov #NCT03601299). Storekeepers in these communities agreed that seasonality and flight schedules were primary factors determining commercial foods’ availability. Several storekeepers noted that federal food assistance programmes that specify which food items may be purchased with funds received from the programme and community policies that set limits on less healthy items promote customer purchases of healthier products. The fact that storekeepers are comfortable enforcing government assistance programme guidelines, company policies, and tribal resolutions suggests an important role storekeepers play in improving nutritional intake in their communities.
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Affiliation(s)
- Kathryn R Koller
- Research Nurse Supervisor,Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Christie A Flanagan
- Research Program Manager, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Flora R Lee
- Research Nurse, Alaska Native Tribal Health Consortium Research Services Anchorage, Alaska, USA
| | - Christine Desnoyers
- Research Coordinator, Yukon-Kuskokwim Health Corporation, Bethel Alaska, USA
| | - Amanda Walch
- Assistant Professor of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Associate Research Coordinator, Yukon-Kuskokwim Health Corporation Research Department, Bethel, Alaska, USA
| | - Andrea Bersamin
- Associate Professor, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K Thomas
- Director,Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
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18
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Te Morenga L, Kruimer D, McLean R, Sabadel AJM, van Hale R, Tatin X, Hindmarsh JH, Mann J, Merriman T. Associations Between Sugars Intakes and Urinary Sugars Excretion and Carbon Stable Isotope Ratios in Red Blood Cells as Biomarkers of Sugars Intake in a Predominantly Māori Population. Front Nutr 2021; 8:637267. [PMID: 34277677 PMCID: PMC8278019 DOI: 10.3389/fnut.2021.637267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
Determining the extent to which added sugars intake contribute to non-communicable disease in various populations is challenging because it is difficult to accurately measure intakes. Biomarkers may provide a reliable and easily measured method of assessing intakes. In a predominantly Māori population we compared various sugars intake estimates derived from a 36 item sugar-specific food frequency questionnaire (FFQ) with biomarkers of sugars intake; urinary sugars excretion in random spot collections (n = 153) and carbon stable isotope ratios (n = 36) in red blood cells (RBCs, δ13CRBC) and in the alanine fraction of the RBCs (δ13Calanine). Estimated 24 h urinary sucrose+fructose excretion was statistically significantly correlated with intakes of total sugars (r = 0.23), sucrose (r = 0.26) and added sugars from sugar-sweetened beverages (SSBs; r = 0.26). δ13Calanine was correlated with added sugars (r = 0.40). In log linear multiple regression models adjusted with HbA1C and eGFR δ13Calanine predicted added sugars intakes (r 2 = 0.29) and estimated 24 h urinary sucrose+fructose excretion predicted intakes of total sugars (r 2 = 0.14), sucrose (r 2 = 0.17), added sugars (r 2 = 0.17) and sugars from SSBs (r 2 = 0.14). These biomarkers have potential for improving assessment of sugars intake in New Zealand populations enabling monitoring of the effectiveness of sugar reduction strategies designed to reduce risk of NCDs. However, further validation is required to confirm these preliminary findings.
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Affiliation(s)
- Lisa Te Morenga
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand.,Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand
| | - Devonia Kruimer
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand
| | - Rachael McLean
- Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Robert van Hale
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | | | | | - Jim Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Riddet Centre of Research Excellence, University of Otago, Dunedin, New Zealand.,Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Tony Merriman
- Edgar Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand.,Department of Biochemistry, University of Otago, Dunedin, New Zealand
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19
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Alhareky M. Taxation of Sugar-Sweetened Beverages and its Impact on Dental Caries: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:113-117. [PMID: 34084101 PMCID: PMC8152378 DOI: 10.4103/sjmms.sjmms_54_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022]
Abstract
Dental caries is one of the largest health concerns worldwide, and a key causative factor is excess sugar intake. Sugar-sweetened beverages (SSBs) are one of the largest sources of added sugars, which significantly contribute to adverse oral and general health. To reduce SSB consumption and its consequent impact on health, including dental caries, several interventional measures have been implemented; sugar taxation is one such measure. This review aimed at understanding the current knowledge available regarding the effect of sugar taxation on dental caries. Accordingly, PubMed, the Cochrane Library, Web of Science, and Scopus were searched with relevant keywords and findings from the identified studies are discussed in this review article.
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Affiliation(s)
- Muhanad Alhareky
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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20
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Yeung CHC, Louie JCY. Methodology for the assessment of added/free sugar intake in epidemiological studies. Curr Opin Clin Nutr Metab Care 2019; 22:271-277. [PMID: 31033579 DOI: 10.1097/mco.0000000000000567] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW High-sugar intake has been linked to increased risk of diseases but an accurate assessment of added/free sugar intake has always been a challenge in research. This review summarizes the methodologies for assessing added/free sugar intake reported in recent literature. RECENT FINDINGS Four different methods for added/free sugar-intake assessment are discussed, including the carbon isotope ratio (δC) method, Food Patterns Equivalent Database, disaggregation method and the 10-step systematic method. These methods have different strengths and limitations in terms of requirement for background knowledge, flexibility to sugar definition, level of subjectivity, accuracy and needs for recalculation/modification when used in different countries or food products. SUMMARY Although advances have been made in the methodologies for assessing added/free sugar intake, accurate assessment continues to be difficult. Of the methods reviewed, the 10-step systematic method could be a simpler method to provide relatively accurate estimation of added/free sugar intake. Further improvements or combining with other methods may allow more accurate and flexible estimation. Development of a completely objective biomarker for added/free sugar intake is unlikely to be achievable, therefore future research may need to focus on developing correction equations for use with biomarkers such as δC to improve their specificity to added/free sugar intake.
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Affiliation(s)
- Chris H C Yeung
- Division of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health
| | - Jimmy C Y Louie
- Discipline of Food and Nutritional Sciences, Faculty of Science, School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR
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21
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Chi DL, Coldwell SE, Mancl L, Hopkins S, Senturia K, Randall CL, Orr E, Cruz S. Alaska Native Children Do Not Prefer Sugar-Sweetened Fruit Drinks to Sugar-Free Fruit Drinks. J Acad Nutr Diet 2019; 119:984-990. [PMID: 30987919 PMCID: PMC6536342 DOI: 10.1016/j.jand.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alaska Native children, including children of Yup'ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks. OBJECTIVE The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks. DESIGN This was an experimental two-alternative forced-choice paired preference test. PARTICIPANTS/SETTING The study focused on a convenience sample of Yup'ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89). INTERVENTION Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs. MAIN OUTCOME MEASURES The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink. STATISTICAL ANALYSES PERFORMED A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests. RESULTS The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup'ik and non-Yup'ik children, boys and girls, and children of different ages. CONCLUSIONS Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup'ik children in Alaska Native communities.
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Affiliation(s)
- Donald L. Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Susan E. Coldwell
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Lloyd Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Scarlett Hopkins
- Oregon Health Sciences University, School of Medicine, Department of Obstetrics and Gynecology, Portland, OR 97239, USA; Phone: 503 494-8311; Fax: 206-685-4258; scarlett.
| | - Kirsten Senturia
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Cameron L. Randall
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Eliza Orr
- University of Alaska Fairbanks, Center for Alaska Native Health Research, 216B Arctic Health Research Bldg, Fairbanks, AK, 99775, USA; Phone: 907-474-5172; Fax: 206-685-4258;
| | - Stephanie Cruz
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
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22
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Abstract
Excess added sugars, particularly in the form of sugar-sweetened beverages, is a leading cause of tooth decay in US children. Although added sugar intake is rooted in behavioral and social factors, few evidence-based, theory-driven socio-behavioral strategies are currently available to address added sugar intake. Dental health professionals are in a position to help identify and address problematic sugar-related behaviors in pediatric patients and advocate for broader upstream approaches, including taxes, warning labels, and policy changes, that can help reduce added sugar intake, prevent tooth decay, and improve health outcomes in vulnerable child populations.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, School of Dentistry, Box 357475, B509 Health Sciences Building, Seattle, WA 98195-7475, USA.
| | - JoAnna M Scott
- Research and Graduate Programs, University of Missouri Kansas City, School of Dentistry, 650 E. 25th Street, Kansas City, MO 64108, USA
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23
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Abstract
Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.
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24
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Pieper K, Winter J, Heinzel-Gutenbrunner M, Margraf-Stiksrud J. Association between a New Sugar Index and Caries Experience: Results of a Cross-Sectional Field Study. Caries Res 2018; 53:160-167. [PMID: 30089280 DOI: 10.1159/000486102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to test the relationship between a newly developed sugar index and caries experience in 4th- and 6th-graders. MATERIALS AND METHODS A total of 1,019 fourth-graders and 925 sixth-graders from 2 regions in Northern Germany participated in the study. Caries experience was recorded by applying the ICDAS criteria. Tooth-brushing habits and other independent variables were examined psychometrically. Structured questions were formulated that were related to specific everyday eating situations, especially between main meals, which proved to be relevant for a higher caries risk. To compare mean caries scores, nonparametric tests were applied. The Pearson coefficient was calculated in order to verify the correlation between the sugar index and the caries experience. The influence of various independent variables on caries experience was assessed by stepwise backward logistic regression analysis. RESULTS With regard to the primary teeth of the 4th-graders, significant correlations with values > 0.1 were found for all ICDAS outcome variables. With regard to the permanent teeth of the 6th-graders, the only significant correlations with the sugar index were for the ICDAS outcome variables D3-6MFT and D3-6FS. CONCLUSION The results of our study show that not only the correlation between the sugar index and caries experience was stronger for 4th-graders than for 6th-graders, but also more distinctly visible differences were observed when comparing extreme groups. This indicates that protective factors, such as fluoridation and the preventive sealing of fissures, help level out the differences in caries occurrence in older children when compared to younger children.
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Affiliation(s)
- Klaus Pieper
- Department of Pediatric and Community Dentistry, Philipps University, Marburg,
| | - Julia Winter
- Department of Pediatric and Community Dentistry, Philipps University, Marburg, Germany
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Grummon AH, Sokol RL, Hecht CA, Patel AI. Measuring beverage consumption in US children and adolescents: a systematic review. Obes Rev 2018; 19:1017-1027. [PMID: 29938891 PMCID: PMC6103833 DOI: 10.1111/obr.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 01/14/2023]
Abstract
Beverage consumption habits are associated with weight outcomes for children and adolescents. Many studies have examined youth's beverage consumption, but little is known about what methods are commonly used to assess youth beverage consumption and whether these strategies are valid and reliable. This study aimed to systematically review articles assessing beverage consumption among children and adolescents. We searched PubMed and Scopus for English-language articles published between February 2007 and February 2017 that measured and reported on American youth's (ages 2-18 years) beverage consumption. Searches yielded 17,165 articles, of which 589 articles describing 615 measures were extracted. We examined the types of assessment methods used, characteristics of these methods (e.g. validity, reliability, and literacy level), characteristics of study samples, and beverages assessed. The most common assessment methods were questionnaires/screeners (used by 65.4% of articles) and recalls (24.4%). About three-quarters of articles did not address validity (70.5%) or reliability (79.5%) of any measures used. Study populations were diverse: 54.7% of articles included low-income children, and 90.2% included non-White children. The most commonly assessed beverage category was sugar-sweetened beverages. Findings suggest that improved measurement techniques and reporting are both needed to track progress towards a goal of ensuring all youth have healthy beverage consumption.
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Affiliation(s)
- Anna H. Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Chapel Hill, NC
- Carolina Population Center, University of North Carolina, Chapel Hill; Chapel Hill, NC
| | - Rebeccah L. Sokol
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Chapel Hill, NC
| | - Christina A. Hecht
- Division of Agriculture and Natural Resources, University of California; Berkeley, CA
| | - Anisha I. Patel
- Department of Pediatrics, School of Medicine, University of California, San Francisco; San Francisco, CA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Chi DL, Lenaker D, Mancl L, Dunbar M, Babb M. Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta. J Public Health Dent 2018; 78:175-182. [PMID: 29377127 PMCID: PMC6019600 DOI: 10.1111/jphd.12263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/14/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental Health Aide Therapists (DHATs) have been part of the dental workforce in Alaska's Yukon-Kuskokwim (YK) Delta since 2006. They are trained to provide preventive and restorative care such as filling and extractions. In this study, we evaluated community-level dental outcomes associated with DHATs. METHODS This was a secondary data analysis of Alaska Medicaid and electronic health record data for individuals in Alaska's YK Delta (2006-2015). The independent variable was the number of DHAT treatment days in each community. Child outcomes were preventive care, extractions, and general anesthesia. Adult outcomes were preventive care and extractions. We estimated Spearman partial correlation coefficients to test our hypotheses that increased DHAT treatment days would be associated with larger proportions utilizing preventive care and smaller proportions receiving extractions at the community-level. RESULTS DHAT treatment days were positively associated with preventive care utilization and negatively associated with extractions for children and adults (P < 0.0001). DHAT treatment days were not associated with increased dental treatment under general anesthesia for children. CONCLUSIONS Dental therapists are associated with more preventive care and fewer extractions. State-level policies should consider dental therapists as part of a comprehensive solution to meet the dental care needs of individuals in underserved communities and help achieve health equity and social justice.
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Affiliation(s)
- Donald L Chi
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, AK, USA
| | - Lloyd Mancl
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Matthew Dunbar
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Michael Babb
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
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Bleich SN, Vercammen KA. The negative impact of sugar-sweetened beverages on children's health: an update of the literature. BMC OBESITY 2018; 5:6. [PMID: 29484192 PMCID: PMC5819237 DOI: 10.1186/s40608-017-0178-9] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/26/2017] [Indexed: 11/21/2022]
Abstract
While sugar sweetened beverage (SSB) consumption has declined in the last 15 years, consumption of SSBs is still high among children and adolescents. This research synthesis updates a prior review on this topic and examines the evidence regarding the various health impacts of SSBs on children's health (overweight/obesity, insulin resistance, dental caries, and caffeine-related effects). We searched PubMed, CAB Abstracts and PAIS International to identify cross-sectional, longitudinal and intervention studies examining the health impacts of SSBs in children published after January 1, 2007. We also searched reference lists of relevant articles. Overall, most studies found consistent evidence for the negative impact of SSBs on children's health, with the strongest support for overweight/obesity risk and dental caries, and emerging evidence for insulin resistance and caffeine-related effects. The majority of evidence was cross-sectional highlighting the need for more longitudinal and intervention studies to address this research question. There is substantial evidence that SSBs increase the risk of overweight/obesity and dental caries and developing evidence for the negative impact of SSBs on insulin resistance and caffeine-related effects. The vast majority of literature supports the idea that a reduction in SSB consumption would improve children's health.
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Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Kelsey A. Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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MacDougall CR, Hill CE, Jahren AH, Savla J, Riebl SK, Hedrick VE, Raynor HA, Dunsmore JC, Frisard MI, Davy BM. The δ13C Value of Fingerstick Blood Is a Valid, Reliable, and Sensitive Biomarker of Sugar-Sweetened Beverage Intake in Children and Adolescents. J Nutr 2018; 148:147-152. [PMID: 29378049 PMCID: PMC6251656 DOI: 10.1093/jn/nxx017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022] Open
Abstract
Background Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults. Objective The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents. Methods Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity. Results Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively). Conclusions The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388.
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Affiliation(s)
- Carly R MacDougall
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Catelyn E Hill
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | | | - Jyoti Savla
- Department of Human Development, Virginia Tech, Blacksburg, VA
| | - Shaun K Riebl
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee at Knoxville, Knoxville, TN
| | | | - Madlyn I Frisard
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
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Abstract
PURPOSE OF REVIEW Added sugar consumption is associated with adverse health outcomes, including weight gain and cardio-metabolic disease, yet the reliance on self-reported methods to determine added sugar intake continues to be a significant research limitation. The purpose of this review is to summarize recent advances in the development of two potential predictive biomarkers of added sugar intake: δC and urinary sugar excretion. RECENT FINDINGS The results of numerous cross-sectional investigations have indicated modest associations of the δC sugar biomarker measured in a variety of sample types (e.g., fingerstick blood, serum, red blood cells, and hair) with self-reported added sugar and sugar-sweetened beverage intake, and δC values have been reported to change over time with changes in reported sugar-sweetened beverage intake. Results from large-scale trials have suggested modest associations of urinary sugar excretion with reported sugar intake, and a dose-response relation has been demonstrated between urinary sugar excretion and actual sugar intake. SUMMARY Valid markers of sugar intake are urgently needed to more definitively determine the health consequences of added sugar intake. Adequately powered controlled feeding studies are needed to validate and compare these two biomarkers of sugar intake, and to determine what individual characteristics and conditions impact biomarker results.
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Affiliation(s)
- Brenda Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech
| | - Hope Jahren
- Department of Geology and Geophysics, University of Hawaii at Manoa
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