Consumption of sugar sweetened beverage is associated with incidence of metabolic syndrome in Tehranian children and adolescents

Healthy beverage index is associated with metabolic syndrome: insights from the Ravansar non-communicable disease (RaNCD) cohort study

BACKGROUND

Dietary patterns play a crucial role in the development and management of metabolic syndrome (MetS). The Healthy Beverage Index (HBI) is a novel tool that assesses the quality of beverage choices in the diet and provides insights into their potential impact on metabolic health. The aim of this study was to investigate the association between the HBI and the MetS.

METHODS

This cross-sectional study was conducted using data collected at baseline from the Ravansar Noncommunicable Disease Cohort Study. A total of 9,025 participants aged 35 to 65 years were included in the analysis. HBI was calculated using food items from the Food Frequency Questionnaire (FFQ). MetS status was defined according to established criteria, and logistic regression analysis was performed to assess the association between HBI scores and MetS, adjusting for potential confounding variables.

RESULTS

In our study, 41.13% of the population was found to have MetS, with a significant association between MetS and tertiles of HBI. Furthermore, the logistic regression model showed a significant inverse association between HBI scores and the odds of developing a MetS (OR = 0.90; 95% CI: 0.86, 0.94), even after adjusting for confounding factors, emphasizing the potential protective effect of higher HBI scores.

CONCLUSION

Increased HBI scores were associated with lower risk of MetS, emphasizing the importance of choosing health-promoting beverages in controlling MetS. These findings support the association between dietary habits and metabolic health and provide practical guidance for individuals and public health initiatives aimed at improving metabolic outcomes.

Sugar intake and risk of hypertension: a systematic review and dose-response meta-analysis of cohort and cross-sectional studies

Several epidemiological studies have investigated the association between sugar intake, the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the risk of hypertension, but findings have been inconsistent. We carried out a systematic review and meta-analysis of observational studies to examine the associations between sugar intake, hypertension risk, and BP levels. Articles published up to February 2, 2021 were sourced through PubMed, EMBASE and Web of Science. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a fixed- or random-effects model. Restricted cubic splines were used to evaluate dose-response associations. Overall, 35 studies were included in the present meta-analysis (23 for hypertension and 12 for BP). Sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) were positively associated with hypertension risk: 1.26 (95% CI, 1.15-1.37) and 1.10 (1.07-1.13) per 250-g/day increment, respectively. For SBP, only SSBs were significant with a pooled β value of 0.24 mmHg (95% CI, 0.12-0.36) per 250 g increase. Fructose, sucrose, and added sugar, however, were shown to be associated with elevated DBP with 0.83 mmHg (0.07-1.59), 1.10 mmHg (0.12-2.08), and 5.15 mmHg (0.09-10.21), respectively. Current evidence supports the harmful effects of sugar intake for hypertension and BP level, especially SSBs, ASBs, and total sugar intake.

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.

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

BACKGROUND

Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.

OBJECTIVE

To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.

METHODS

PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).

RESULTS

Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty).

CONCLUSIONS

No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.

Impacts of gain versus loss frame messages about beverages on boy students, an application of extended parallel process model

Background

Unhealthy diet including consumption of high amounts of sugar-sweetened beverages is a key modifiable risk factor for obesity and NCDs which begin in childhood and adolescence. The study aimed to compare the effect of gain frame vs. loss frame messages on SSBs consumption intention and behavior of high school boy students.

Methods

In this quasi-experimental study, 270 students from three boy’s high schools were selected through a multistage random sampling. Data collection was done through a 15 items self-reported questionnaire before and two months after the intervention. Each of the two intervention groups received one of the two types of gain frame or loss frame designed pamphlets inspired with extended parallel process model. The control group received no pamphlet.

Results

In control, GFM and LFM groups 91, 86 and 89 students participated in the study, respectively. After the intervention, significant differences were observed in perceived efficacy and threat of the GFM group and perceived efficacy, threat and intention in the LFM group compared with before the intervention. The GFM group had higher perceived self-efficacy than the control group and lower perceived severity than the LFM group. Intention to consume SSBs reduced significantly in LFM group, compared with the control group.

Conclusions

A combination of LFM and GFM messages could more effectively lead to nutritional behavior change regarding the consumption of SSBs. Results help to design messages for educational programs and nutritional campaigns.

Sugar-sweetened beverages intake and the risk of obesity in children: An updated systematic review and dose-response meta-analysis

BACKGROUND

The prevalence of childhood obesity has increased worldwide and has reached alarming proportions. Contradictive results from studies and reviews have fuelled an endless debate on the role of SSBs in the development of childhood obesity.

OBJECTIVE

This study aimed to assess the impact of sugar-sweetened beverages (SSBs) intake on body mass index (BMI), body fat percentage (BFP), and waist circumference (WC) among children.

METHODS

Databases including PubMed/MEDLINE, Scopus, Cochrane Library, EMBASE, and Web of Science were searched up to August 2021. Observational studies reporting the relation between SSBs intake and BMI, BFP, and WC were included. STATA version 15 was used to analyse the data.

RESULTS

In this meta-analysis, 33 studies with 121 282 subjects were included. Excessive SSBs intake was associated with 0.75 kg/m² increase in BMI in children and adolescents (WMD: 0.75; CI 0.35-1.15; p < 0.001). In addition, high SSBs intake was significantly associated with higher WC (WMD: 2.35 cm; 95% CI, 1.34, 3.37; p = 0.016) and BFP (WMD: 2.81; CI 2.21-3.41; p < 0.001). No departure from linearity was detected in dose-response meta-analysis between SSBs consumption and changes in BMI, WC, and BFP.

CONCLUSION

High SSBs consumption was associated with increased BMI, WC, and BFP among children and adolescents. Further large prospective long-term interventions are recommended to confirm the observed relationships.

Trajectories of beverage consumption during adolescence

Beverages contribute substantially to daily energy and nutrient intakes. However, little is known about the co-development of beverage consumption throughout adolescence. This study aimed to investigate the presence of naturally occurring sub-groups of girls and boys following distinct trajectories of various types of beverage consumption (i.e. sugary beverages, tea and coffee, water, and milk) throughout adolescence. During the Monitoring Activities for Teenagers to Comprehend their Habits study, data were collected from 744 Canadian youths followed for six years (2013-2019). The participants were asked yearly (start-age 10-11 years old) to report how many times they consumed sugary beverages, tea and coffee, water, and milk in a week. Trajectories of beverage consumption were identified from age 11 to 18 using a person-centred approach, namely group-based multi-trajectory modelling. For girls, three different groups were identified: 'Water consumers' (62.7%), 'High beverage consumers' (20.9%), and 'Water and milk consumers' (16.4%). For boys, four different groups were identified: 'Water consumers' (39.1%), 'Water and milk consumers' (30.5%), 'Sugary drinks, coffee and tea consumers' (20.1%), and 'High beverage consumers' (10.4%). This study illustrates the complexity of beverage consumption patterns in adolescence. Various types of public health messaging and interventions may be required to promote healthier beverage consumption patterns among all adolescents.

Changes in ideal cardiovascular health among Iranian adolescents: 2007-2008 to 2015-2017

BACKGROUND

Assessment of both behavior and factors of health as ideal cardiovascular health (iCVH) in adolescence could contribute to cardiovascular disease prevention in adulthood.

AIMS

To explore the changes in the prevalence of iCVH and its components during a decade among Tehranian adolescents.

METHODS

The 12-19 years old adolescents were selected from the Tehran Lipid and Glucose Study(TLGS). The iCVH score was calculated in the study period 1 (2007-2008; n = 267) and 2 (2015-2017; n = 336). To calculate iCVH, body mass index(BMI), systolic and diastolic blood pressure (BP), total cholesterol, fasting plasma glucose (FPG), physical activity, smoking status, and dietary intakes were measured by standard protocols. The changes in iCVH components between the two study periods were reported by prevalence (95% confidence interval). A logistic regression model was conducted to test the effects of study periods, sex, and age groups on the iCVH(≥ 6 scores).

RESULTS

Overall, there was a reduction in the prevalence of ideal FPG (97.4 vs. 91.1%) and ideal BP(91.8 vs. 82.7%). Girls had a decrease in the prevalence of ideal BP(91.2 vs. 79.4%) as well as an increase in non-smoking status(77.6 vs. 89.7%). However, the prevalence of ideal FPG (96.5 vs. 88.5%) and ideal BP(92.2 vs 85.0%) decreased in boys. Study period 2, compared to period 1 was associated with lower odds of having iCVH. Furthermore, boys were 1.57 folds more likely to have ideal CVH factors than girls.

CONCLUSION

There was a decrease in the prevalence of ideal CVD metrics, including FPG and BP, after one decade. Generally, adolescent boys had higher odds of having ideal CVH compared to girls.

The association between Healthy Beverage Index and psychological disorders among overweight and obese women: a cross-sectional study

BACKGROUND AND AIMS

The Healthy Beverage Index (HBI) is a valuable technique to estimate the synergistic effects of overall beverage consumption. Several studies have evaluated the associations between HBI and beneficial changes in the health status. however, there is no study on the association between patterns of beverage consumption and mental health status. Therefore, this study sought to examine the association between HBI and psychological disorders among overweight and obese women.

METHODS

199 overweight and obese women, between the ages of 18 and 55 y, were enrolled in this cross-sectional study in Tehran, Iran. To collect beverage dietary data, a validated semi-quantitative food-frequency questionnaire (FFQ) was used. Furthermore, the DASS-21 questionnaire was used to assess psychological profile states.

RESULTS

The association of total depression anxiety stress (DASS) score with healthy beverage index (HBI) tertiles in models was marginally significant (OR =: 0.78; 95% CI 0.30-2.02; P-value = 0.074; (OR = 0.77; 95% CI 0.28-2.16; P-value = 0.062), respectively. In terms of stress, anxiety, and depression, after adjusting for confounders, participants with higher HBI in the third tertile had lower odds of depression vs. the first tertile (OR = 0.99; 95% CI 0.35-2.81; P-trend = 0.040).

CONCLUSION

We demonstrate that the total DASS score was associated with HBI tertiles. We also found that participants with higher HBI had lower odds of depression. However, additional well-designed studies are needed to confirm the veracity of these findings.

Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review

Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.

Tolerable upper intake level for dietary sugars

Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50-75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (> 15-50% probability) and very low for hypertension (0-15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.

Sugar-sweetened beverage consumption and overweight and obesity in adolescents in Ho Chi Minh City, Vietnam: a population-based analysis

BACKGROUND

The aim of this research was to describe the patterns of consumption of multiple sugar-sweetened beverages (including modern and traditional ones) among adolescents in Ho Chi Minh City and to identify a possible relationship between this consumption and overweight, obesity, and other factors.

METHODS

A secondary analysis from a cross-sectional study of 11-15-year-old students from 31 junior high schools across Ho Chi Minh City was used. We measured the students' anthropometric status and assessed beverage consumption using a validated Food Frequency Questionnaire. Multivariate logistic regression models were used to identify the association between the consumption of sugar-sweetened beverages, obesity and other factors.

RESULTS

The sugar-sweetened beverages (SSB) ranged widely from modern soft drinks and powdered drinks to traditional sugar-added fruit and leaf juices, and milk-based drinks. These beverages were very popular among 2,660 participants with 36% consuming at least one variety daily. Factors positively associated with sugar-sweetened beverage consumption included a higher level of physical activity, higher consumption of fast foods, and daily fruit and vegetable consumption. We found a negative association between milk-based SSBs and the overweight and obesity status of the students, i.e. every kcal more of fresh milk with sugar and condensed milk can reduce an obesity odd of 0.005 (95% CI [0.002-0.008], p < 0.001) and 0.004 (95% CI [0.002-0.010], p = 0.044) consecutively. None of the other SSBs was significantly related to adolescent overweight and obesity.

CONCLUSIONS

Milk-based drinks potentially protect adolescents against overweight and obesity. Further research to assess this protection is needed.

The association between Sugars Sweetened Beverages (SSBs) and lipid profile among children and youth: A systematic review and dose-response meta-analysis of cross-sectional studies

BACKGROUND

The relationship between sugar-sweetened beverages (SSBs) intake and serum lipids among children and youth has been reported in several studies, but the results are still controversial.

OBJECTIVE

In the current study, we summarized the results of studies that assessed the relationship between SSBs consumption and serum lipids among children and youth in a systematic review and dose-response meta-analysis.

METHODS

The PubMed, Web of Sciences, Cochrane and Scopus electronic databases were searched for observational studies reporting an association between SSBs intake and serum lipids among children and youth that were published before May 2020. For data extracted from cohort studies, only cross-sectional baseline data were included in the current meta-analysis. The Random effects model was used to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed with the Cochran Q test and I² statistics.

RESULTS

In our search, 1845 studies were retrieved of which 13 studies (two cohorts and eleven cross-sectional) were included. High SSB consumption was associated with 1.21 mg/dL increase in low-density lipoprotein cholesterol (LDL-C; pooled WMD: 1.21 mg/dL; 95% CI: 0.23, 2.20; P = .01), 1.45 mg/dL decrease in high-density lipoprotein cholesterol (HDL-C, pooled WMD: -1.46 mg/dL; 95% CI, -2.25, -0.67; P < .0001) and 2.49 mg/dL decrease in total cholesterol (TC, pooled WMD: -2.49 mg/dL; 95% CI, -2.89, -2.10; P < .0001). In dose-response meta-analysis, there was an evidence of departure from linearity in the relationship between SSB consumption and change in LDL-C (P-_nonlinearity  = .03) and TC (P-_nonlinearity  = .01). However, no departure from linearity was observed between SSB intake and change in HDL-C (P-_nonlinearity  = .56) or triglyceride (TG) values (P-_nonlinearity  = .85).

CONCLUSION

According to our results, high SSB consumption was significantly associated with higher LDL-C and lower HDL-C and TC among children and youth. However, owing to the limited number of the included studies, further well-designed interventional studies are needed to better elucidate causality.

How Does Being Overweight Moderate Associations between Diet and Blood Pressure in Male Adolescents?

Diet is one of the strongest modifiable risk factors for hypertension. In this study, we described the associations between dietary factors and blood pressure; and explored how weight status moderated these associations in a sample of New Zealand male adolescents. We collected demographics information, anthropometric, blood pressure, and dietary data from 108 male adolescents (15–17 years old). Mixed effects and logistic regression models were used to estimate relationships between dietary variables, blood pressure, and hypertension. Moderation effects of overweight status on the relationship between hypertension and diet were explored through forest plots. One-third (36%) of the sample was classified as hypertensive. Fruit intake was related to significantly lower systolic (−2.4 mmHg, p = 0.005) and diastolic blood pressure (−3.9 mmHg, p = 0.001). Vegetable and milk intake was related to significantly lower diastolic blood pressure (−1.4 mmHg, p = 0.047) and (−2.2 mmHg, p = 0.003), respectively. In overweight participants, greater vegetable and milk, and lower meat intake appeared to reduce the odds of hypertension. Certain dietary factors may have more prominent effects on blood pressure depending on weight status.

The association between Healthy Beverage Index and anthropometric measures among children: a cross-sectional study

PURPOSE

Several studies evaluated the associations between specific beverages and cardio-metabolic risks among children. However, the evidence on the association between patterns of the beverage consumption and children's anthropometric indices is rare. Therefore, this study was conducted to examine the association between Healthy Beverage Index (HBI) and anthropometric measures among 6-year-old girl children.

METHODS

In this cross-sectional study, 788 children selected from health centers in Tehran, Iran. Data on beverage intake, socio-demographic, physical activity, and anthropometric characteristics were evaluated using reliable and validated standard protocols. The predefined HBI was calculated based on the previous research.

RESULTS

After controlling for several confounders [mother age, mother body mass index, mother physical activity, socioeconomic status, children physical activity and energy intake, total oils (all kinds of oils like animal and plant oils), and total sweet foods (sweet foods except sweetened beverages)], being in the third compared to the first tertile of HBI among children was associated with increased odds of wasting (OR: 5.16; 95% CI 1.5-17.79) and underweight/wasting (OR: 1.81; 95% CI 1.07-3.07). Among the HBI components, just being in the third compared to the first tertile of high-fat milk was inversely associated with decreased odds of wasting (OR: 0.18; 95% CI 0.04-0.73).

CONCLUSIONS

The HBI among children was associated with higher odds of wasting and underweight/wasting. In addition, high-fat milk consumption decreased the odds of wasting among children. Further prospective studies need to confirm these results.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Contribution of insulin resistance to the relationship between sugar-sweetened beverage intake and a constellation of cardiometabolic abnormalities in adolescents

BACKGROUND

Insulin resistance (IR) is a pathophysiological construct that derives a series of metabolic disturbances that promote cardiometabolic dysfunction. This study evaluated mediating and modifying effects of homeostatic model assessment-based IR (HOMA-IR) on the association between sugar-sweetened beverage (SSB) consumption and a constellation of adolescent cardiometabolic abnormalities.

METHODS

Comprehensive data on sociodemographics, diet, physical activity, and anthropometric and biochemical parameters for 1454 adolescents were obtained from a large-scale representative study for adolescent metabolic syndrome (MetS) conducted in Taiwan. The original (HOMA1-IR) and updated nonlinear (HOMA2-IR) HOMA-IR indicators were used as IR biomarkers. Principal component (PC) analysis was employed to create reduced groups of variables and risk scores for retained PCs.

RESULTS

Higher SSB intake was associated with higher levels of HOMA1-IR and HOMA2-IR, and the two IR biomarkers were positively correlated with metabolic dysfunction clustering. Compared with SSB nondrinkers, adolescents who consumed >500 mL/day of hand-shaken high-fructose corn syrup beverages (HHB) had a 0.22 increase in the number of abnormal MetS components, and HOMA-IR mediation explained 33.9-37.9% of the effect. IR biomarkers accounted for 26.5-31.0% of the relationship between >500 mL/day of SSB consumption and bodyweight-enhanced PC scores. The effects of HOMA-IR indicators on all bodyweight-related factors were consistently intensified among >350 mL/day HHB drinkers (all P_interaction < 0.05).

CONCLUSIONS

Fructose-rich SSB intake correlates with a constellation of cardiometabolic abnormalities in adolescents, and this association may be partly mediated by HOMA-IR levels. The adverse effects of HOMA-IR on bodyweight-associated cardiometabolic risk factors depend on the type of SSB consumption, with enhanced risks observed in the intake of high amounts of HFCS-containing SSBs.

Perception of oral health and medical conditions as possible predictors of oral health status in visually impaired adolescents: a cross-sectional study

Background

We aimed to assess oral health and oral hygiene status among visually impaired adolescents and also to evaluate the factors related to their oral health.

Methods

This was a cross-sectional study among 130 visually impaired adolescents in Tehran, Iran, in December 2018. Of three schools for visually impaired children in Tehran, children in the sixth to the tenth grade (aged 12–17 years) were included after obtaining their parents’ consent. WHO oral health questionnaire for children was filled out through face to face interviews. General characteristics were age, gender, status of visual impairment, place of residence, and parental education level. Oral health-related questions were perceived dental and gingival health, dental self-care, dental visits, medical conditions, and dietary habits. Oral examinations included Decayed, Missing, and Filled Teeth (DMFT) index, the Simplified Oral Hygiene Index (OHI‑S), and Bleeding on Probing (BOP). Univariate and multiple logistic regression tests were applied using STATA.

Results

The mean age (SD) of the adolescents was 14.45 (1.61) years. The fully blind children were 33.8%, and those with low vision were 66.2%. Regarding the perception of dental and gingival health, nearly half of the adolescents were satisfied. The mean DMFT and decayed component (DT) were 2.43 ± 2.24 and 1.92 ± 2.12, respectively. The frequency of DMFT ≥ 3 was 45.4%. The mean OHI-S was 2.01 ± 0.70, and OHI-S > 1.8 was reported in 60% of children. The prevalence of BOP was 79.2%. DMFT was significantly associated with toothache (P = 0.003, OR = 3.70, 95% CI: 1.54–9.09), perceived dental health (P = 0.005, OR = 3.06, 95% CI: 1.40–6.67), and medical conditions (P = 0.03, OR = 3.13, 95% CI: 1.13–8.68). In addition, OHI-S was related to gender (P = 0.02, OR = 0.36, 95% CI: 0.15–0.83), perceived dental health (P = 0.006, OR = 2.87, 95% CI: 1.35–6.12) and medical conditions (P = 0.04, OR = 3.05, 95% CI: 1.04–8.97). BOP was associated with perceived gingival health (P = 0.02, OR = 2.94, 95% CI: 1.18–7.33).

Conclusions

Medical conditions and perceived dental and gingival health are possible predictors for oral health status in these adolescents. Although these children could not visualize caries or gingival bleeding during the brushing time, they could perceive the status of their oral health correctly. Also, being involved in medical problems can make more ignorance of oral health.

DNA methylation during human adipogenesis and the impact of fructose

BACKGROUND

Increased adipogenesis and altered adipocyte function contribute to the development of obesity and associated comorbidities. Fructose modified adipocyte metabolism compared to glucose, but the regulatory mechanisms and consequences for obesity are unknown. Genome-wide methylation and global transcriptomics in SGBS pre-adipocytes exposed to 0, 2.5, 5, and 10 mM fructose, added to a 5-mM glucose-containing medium, were analyzed at 0, 24, 48, 96, 192, and 384 h following the induction of adipogenesis.

RESULTS

Time-dependent changes in DNA methylation compared to baseline (0 h) occurred during the final maturation of adipocytes, between 192 and 384 h. Larger percentages (0.1% at 192 h, 3.2% at 384 h) of differentially methylated regions (DMRs) were found in adipocytes differentiated in the glucose-containing control media compared to adipocytes differentiated in fructose-supplemented media (0.0006% for 10 mM, 0.001% for 5 mM, and 0.005% for 2.5 mM at 384 h). A total of 1437 DMRs were identified in 5237 differentially expressed genes at 384 h post-induction in glucose-containing (5 mM) control media. The majority of them inversely correlated with the gene expression, but 666 regions were positively correlated to the gene expression.

CONCLUSIONS

Our studies demonstrate that DNA methylation regulates or marks the transformation of morphologically differentiating adipocytes (seen at 192 h), to the more mature and metabolically robust adipocytes (as seen at 384 h) in a genome-wide manner. Lower (2.5 mM) concentrations of fructose have the most robust effects on methylation compared to higher concentrations (5 and 10 mM), suggesting that fructose may be playing a signaling/regulatory role at lower concentrations of fructose and as a substrate at higher concentrations.

Dose-response association between sugar- and artificially sweetened beverage consumption and the risk of metabolic syndrome: a meta-analysis of population-based epidemiological studies

OBJECTIVE

The associations between sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption and the risk of metabolic syndrome (MetS) remain controversial. A quantitative assessment of dose-response associations has not been reported. This study aims to assess the associations between the risk of MetS and SSB, ASB, and total sweetened beverage (TSB, the combination of SSB and ASB) consumption by reviewing population-based epidemiological studies.

DESIGN

Meta-analysis.

SETTING

We searched PubMed, Embase and Web of Science databases prior to 4 November 2019, for relevant studies investigating the SSB-MetS and ASB-MetS associations. A random effects model was used to estimate pooled relative risks (RR) and 95 % CI. Dose-response association was assessed using a restricted cubic splines model.

PARTICIPANTS

We identified seventeen articles (twenty-four studies, including 93 095 participants and 20 749 MetS patients).

RESULTS

The pooled RR for the risk of MetS were 1·51 (95 % CI 1·34, 1·69), 1·56 (1·32, 1·83) and 1·44 (1·19, 1·75) in high consumption group of TSB, SSB and ASB, respectively; and 1·20 (1·13, 1·28), 1·19 (1·11, 1·28) and 1·31 (1·05, 1·65) per 250 ml/d increase in TSB, SSB and ASB consumption, respectively. Additionally, we found evidence of non-linear, TSB-MetS and SSB-MetS dose-response associations and a linear ASB-MetS dose-response association.

CONCLUSIONS

TSB, SSB and ASB consumption was associated with the risk of MetS. The present findings provide evidence that supports reducing intake of these beverages to lower the TSB-, SSB- and ASB-related risk of MetS.

Sugar-sweetened beverages increases the risk of hypertension among children and adolescence: a systematic review and dose-response meta-analysis

BACKGROUND

In the current systematic review and meta-analysis, we summarized the studies that evaluated the effects of sugar-sweetened beverages (SSBs) intake on blood pressure among children and adolescents.

METHODS

In a systematic search from PubMed, Scopus, Embase and Cochrane electronic databases up to 20 April 2020, the observational studies that evaluated the association between sugar-sweetened beverages intake and hypertension, systolic or diastolic blood pressure (SBP, DBP) were retrieved.

RESULTS

A total of 14 studies with 93873 participants were included in the current meta-analysis. High SSB consumption was associated with 1.67 mmHg increase in SBP in children and adolescents (WMD: 1.67; CI 1.021-2.321; P < 0.001). The difference in DBP was not significant (WMD: 0.313; CI -0.131- 0.757; P = 0.108). High SSB consumers were 1.36 times more likely to develop hypertension compared with low SSB consumers (OR: 1.365; CI 1.145-1.626; P = 0.001). In dose-response meta-analysis, no departure from linearity was observed between SSB intake and change in SBP (P-nonlinearity = 0.707) or DBP (P-nonlinearity = 0.180).

CONCLUSIONS

According to our finding, high SSB consumption increases SBP and hypertension in children and adolescents.

Sugar-sweetened beverage consumption is associated with visceral fat in children

Sugar-sweetened beverage (SSB) consumption has been associated with visceral fat partitioning in adults; however, the underlying mechanisms in childhood remain unclear and warrant exploration. This cross-sectional study aimed to investigate the association between SSB consumption and body fat in children aged 9-13 years and the potential modifying effect of children's sex and serum cortisol levels. A sample of 2665 Greek schoolchildren participated in the 'Healthy Growth Study', and anthropometric, body composition, dietary intake and serum cortisol data were assessed. SSB consumption was defined as low (<1 serving/d), medium (1-2 servings/d) or high (>2 servings/d). We used linear regression models to assess the association between SSB consumption and measures of adiposity and to assess effect modification; models were stratified by sex and tertiles of morning serum cortisol. A significant positive association was observed between high SSB consumption and visceral adipose tissue (VAT) (β = 1·4, 95 % CI 0·4, 2·3, P = 0·01) but not BMI or BMI z-score. When stratified by sex, the association was observed in boys (β = 1·8, 95 % CI 0·3, 3·4, P = 0·02) but not in girls. When stratified by cortisol levels, SSB consumption was associated with VAT in children with cortisol levels in the lowest tertile (β = 2·8, 95 % CI 1·0, 4·6, P < 0·01). These results indicate that increased SSB consumption is associated with visceral adiposity in schoolchildren and this association may be modified by sex and morning serum cortisol. To prevent VAT accumulation and concomitant disease risk, dietary interventions should target SSB consumption during childhood.

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

IMPORTANCE

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION AND SYNTHESIS

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

MAIN OUTCOMES AND MEASURES

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

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

Prevalence and Incidence of Metabolic Syndrome in Iran: A Systematic Review and Meta-Analysis

Metabolic syndrome (MetS) is a predictor of several diseases such as cardiovascular diseases, diabetes, dyslipidemia, stroke, osteoarthritis, certain cancers, and death leading to public health concern in most societies. We aimed to estimate the pooled prevalence and incidence of MetS in Iranian population through a meta-analysis study. We included cross-sectional and cohort studies to estimate the overall prevalence and incidence rates of MetS in Iran National databases including MagIran, Science Information Database, IranMedex, and international databases including Medline, Web of Sciences, and Scopus were searched up to October 2017. Finally, 125 studies were included. The total sample size was 472,401 with a mean age of 38 ± 7.8 years. The overall pooled prevalence and incidence rate among the general population of Iran was 0.26 (95% CI: 0.26, 0.29) and 97.96 (95% CI: 75.98, 131.48), respectively. The pooled prevalence of MetS was higher in females and in urban areas. The highest and lowest prevalence of MetS was obtained by the Iranian definition criteria (0.43) and the NHANES III (0.12). The highest and lowest incidence rates of MetS were obtained by IDF (144.07 per 1000) and the JIS (89.73 per 1000). The prevalence of MetS was higher in women and those living in urban areas. Furthermore, the prevalence of MetS increased with increasing age in both genders.

Energy Dense Salty Food Consumption Frequency Is Associated with Diastolic Hypertension in Spanish Children

High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.

Drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake in Baoding, Hebei Province, China: a cross-sectional study

BACKGROUND

The purposes were to investigate the drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake.

METHODS

A cross-sectional study was conducted among 159 young adults aged 18-23 years in Baoding, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and duplicate portion method, respectively. The osmolality and electrolyte concentrations of the 24 h urine and fasting blood samples were tested. Differences in LD1 (low drinker), LD2, LD3 and HD (high drinker) groups, stratified according to the quartiles of total drinking fluids, were compared using one-way ANOVA, Kruskal-Wallis H test and chi-square test.

RESULTS

A total of 156 participants (80 males and 76 females) completed the study. HD group had greater amounts of TWI (Total Water Intake), water from food, higher and lower contributions of total drinking fluids and water from food to TWI, respectively, than LD1, LD2 and LD3 groups (p < 0.05). Participants in HD group had higher amounts of water and water from dishes than participants in LD1, LD2 and LD3 groups (p < 0.05). No significant differences were found in the contributions of different fluids to total drinking fluids within the four groups (p > 0.05). The osmolality of urine was 59-143 mOsm/kg higher in LD1 than that in LD2, LD3 and HD group (p < 0.05). The percentage of participants in optimal hydration status increased from 12.8% in LD1 group to 56.4% in HD group (p < 0.05). HD and LD3 groups had 386~793 higher volumes of urine than that of LD1 and LD2 groups (p < 0.05). Differences were found in the concentrations of electrolytes among the four groups (p < 0.05). No significant differences were found in the plasma biomarkers (p > 0.05), with the exception of higher concentration of Mg in LD3 and HD groups than that in LD1 and LD2 groups (p < 0.05).

CONCLUSIONS

Participants with higher total drinking fluids had better drinking pattern and hydration status. Interventions should be undertaken to advise adults to have adequate total drinking fluids, in order to keep in optimal hydration status.

TRIAL REGISTRATION

The registration number was ChiCTR-ROC-17010320, which was registered on the Chinese clinical trial registry.

The association between beverage consumption pattern and dental problems in Iranian adolescents: a cross sectional study

BACKGROUND

With regard to the increasing consumption rates of unhealthy beverages among adolescents, the main purpose of the present study was to determine the association between beverage intake pattern and dental caries and tooth erosion in this age group.

METHODS

A total sample of 600 adolescents was recruited in this study using a multistage cluster random sampling method in the city of Kerman, in the southeast of Iran, in 2017. Then, the Decayed, Missed and Filled Teeth (DMFT) index and the Tooth Wear Index (TWI) were registered for each participant. A Beverage Frequency Questionnaire was also employed to estimate typical beverage intake frequency. Correspondingly, negative binominal regression and logistic regression were performed to determine the independent variables associated with the DMFT index and the TWI.

RESULTS

The findings revealed that the highest consumed beverage in daily living was tea in both genders, followed by sweetened soft beverages, as well as milk and kefir/yogurt drink. The results of the DMFT index were also significantly different in participants that had never consumed milk compared with those who had used milk on a daily basis. Moreover, the DMFT index in participants who had never consumed sweetened soft beverages was 39%, less than those who had had a daily intake of such beverages. Also, the chance of tooth erosion for participants who had never used sweetened soft beverages was 94%, lower than that in daily consumers.

CONCLUSIONS

The results of this study revealed that adolescents had an unhealthy beverage intake pattern. Furthermore, milk consumption was beneficial to dental caries, whereas use of soft drinks associated with more dental caries and tooth erosion.

Association between soft drink consumption and handgrip strength in middle aged and older adults: the TCLSIH cohort study

A cross-sectional study was conducted to explore the association between soft drink consumption and handgrip strength (HGS) in subjects aged 40 years and older (n = 14,925). After multivariable-adjustment (including demographics, lifestyles, family history of diseases, dietary intake, and other beverages consumption), the least square means (95% confidence interval) of HGS across soft drink consumption categories were 43.1(42.7, 43.5) kg for almost never drink, 42.9(42.4, 43.4) kg for <1 cup/week, 42.8(42.1, 43.5) kg for 1-6 cups/week and 41.2(40.1, 42.6) kg for ≥1 cup/day (p for trend < 0.001) in men, and 26.6(25.9, 27.8) kg for almost never drink, 26.5(25.8, 27.1) kg for <1 cup/week, 26.3(25.7, 27.2) kg for 1-6 cups/week and 25.2(24.9, 27.0) kg for ≥1 cup/day (p for trend < 0.001) in women, respectively. Our findings suggest that higher consumption of soft drinks was significantly associated with lower HGS in middle-aged and older adults. Additional prospective or interventional studies are needed to confirm this issue.

A narrative review of the effects of sugar-sweetened beverages on human health: A key global health issue

The provision of healthy and safe food is vital for human health, and the addition of unnecessary sugars in foodstuffs is an important global issue, leading to multiple long- and short-term health issues and spiraling costs for individuals and governments alike. The negative effect of excess sugar consumption contributes to adverse health conditions, including obesity, type 2 diabetes, and poor oral health in both high and low resource settings. A key plank of governmental and health promotion bodies' nutritional guidance is to raise public awareness of "hidden" sugars, salt, and fats, such as found in processed foods and sugar-sweetened beverages (SSBs), and guide individuals to reduce their consumption. This rapid narrative review brings together some of the key issues identified in the literature around the consumption of SSBs, including patterns of consumption, the general impact on human health and nutrition, specific effects on oral health and the oral microbiome, and strategies to address over-consumption. The range of long-term adverse effects on health is often misunderstood or unknown by the public. However, some strategies have succeeded in reducing the consumption of SSBs, including public health strategies and interventions and the imposition of taxes or levies, and this article makes recommendations for action.

Association of sugar-sweetened beverage intake with risk of metabolic syndrome among children and adolescents in urban China

OBJECTIVE

High sugar-sweetened beverage (SSB) intake has been shown to correlate with a higher risk for CVD and metabolic disorders, while the association between SSB intake and the risk of metabolic syndrome (MetS) remains unclear. The present study aimed to explore the association between SSB intake and MetS among children and adolescents in urban China.

DESIGN

A cross-sectional study involving 7143 children and adolescents was conducted in urban China. MetS definition proposed by the International Diabetes Federation was adopted. Data on SSB intake, diet, physical activity and family environment factors were obtained through questionnaires. Logistic regression models with multivariable adjustment were adopted to analyse the association between SSB intake and the risk of MetS and its components.

SETTING

Primary and secondary schools in three urban cities of China.

PARTICIPANTS

Children and adolescents (n 5258) aged 7-18 years.

RESULTS

Among the participants, 29·9 % of them had high SSB intake (at least 0·3 servings/d) and the overall MetS prevalence was 2·7 %. Participants with high SSB intake were at higher risk for MetS (OR = 1·60; 95 % CI 1·03, 2·54) and abdominal obesity (OR = 1·55; 95 % CI 1·28, 1·83) compared with their counterparts with no SSB intake (0 servings/d).

CONCLUSIONS

High SSB intake is significantly associated with increased MetS and abdominal obesity risk among children and adolescents in urban China. These results suggest that strong policies focusing on controlling SSB intake might be effective in preventing MetS and abdominal obesity.

Important Food Sources of Fructose-Containing Sugars and Incident Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Background Sugar-sweetened beverages are associated with hypertension. We assessed the relation of important food sources of fructose-containing sugars with incident hypertension using a systematic review and meta-analysis of prospective cohort studies. Methods and Results We searched MEDLINE, EMBASE, and Cochrane (through December week 2, 2018) for eligible studies. For each food source, natural log-transformed risk ratios (RRs) for incident hypertension were pooled using pair-wise meta-analysis and linear and nonlinear dose-response meta-analyses. Certainty in our evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. We identified 26 reports, including 15 prospective cohorts (930 677 participants; 363 459 cases). Sugar-sweetened beverages showed harmful (RRper-355-mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper-240-g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper-125-g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range. One hundred percent fruit juice showed a protective association only at moderate doses (RRat-100-mL, 0.97 [95% CI, 0.94, 0.99]). The pair-wise protective association of dairy desserts was not supported by linear dose-response analysis. Fruit drinks or sweet snacks were not associated with hypertension. Certainty of the evidence was "low" for sugar-sweetened beverages, 100% fruit juice, fruit, and yogurt and "very low" for fruit drinks, sweet snacks, and dairy desserts. Conclusions The harmful association between sugar-sweetened beverages and hypertension does not extend to other important food sources of fructose-containing sugars. Further research is needed to improve our estimates and better understand the dose-response relationship between food sources of fructose-containing sugars and hypertension. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02702375.

The association of dietary patterns and adherence to WHO healthy diet with metabolic syndrome in children and adolescents: Tehran lipid and glucose study

BACKGROUND

The optimal dietary pattern for reducing the extent of metabolic syndrome (MetS) has not been well established yet. The aim of this study was to evaluate dietary patterns and adherence to WHO healthy diet in children and adolescents and their associations with MetS.

METHODS

Subjects of this cohort study were selected from among children and adolescents of the Tehran Lipid and Glucose Study participants, aged 6-18 years (n = 424). Dietary measurements were collected using a valid and reliable food frequency questionnaire. MetS was defined as the existence of at least 3 risk factors according to the Cook criteria. Diet was assessed based on dietary components of the WHO healthy diet. Dietary patterns were defined by principal component analysis.

RESULTS

The mean ± SD age of participants (42% boys and 57% girls) was 13.5 ± 3.7 years. The most consistency with the WHO healthy diet was observed for cholesterol, free sugar and protein consumption in both genders, and the least was for n-3 poly-unsaturated fatty acid, trans-fatty acid and salt. Intake of SFA up to 12% of energy intake (third quartile) reduced the risk of MetS, compared to the first quartile. Subjects in the third quartile of n-6 poly-unsaturated fatty acid intake (6.2% of energy) showed the lowest odds ratio of MetS compared to the first quartile (OR: 0.18, CI: 0.04-0.66). In the adjusted model, the risk of MetS reduced across quartiles of MUFA intake by 60% (OR: 1, 0.40, 0.40, 0.42; P trend = 0.05). No significant trends were observed in the risk of MetS components across quartiles of the WHO healthy diet components. Three major dietary patterns were identified, the healthy, unhealthy and cereal/meat. An increased risk of MetS was observed in the highest quartile of unhealthy dietary pattern score compared to the lowest quartile (OR: 1, 0.81, 0.93, 2.49; P trend = 0.03).

CONCLUSIONS

Our results demonstrated that the majority of our population did not meet some components of WHO healthy diet recommendations. The quality and quantity of fatty acid intakes were associated with risk of MetS. Adherence to unhealthy dietary pattern was associated with two-fold increase in MetS risk.

The Association between Various Lifestyle Patterns and the Body Mass Index in Adolescents

Objective: The study aims to analyze obesogenic behavioral patterns of adolescents living in Mureş County, Romania, as well as to establish a relationship between these behaviors and their Body Mass Index (BMI), in an attempt to provide effective prevention strategies for obesity.

Material and Methods: 153 students between 9th to 12th grade, aged between 14 and 19 years old, from the Vocational and Art Highschool of Târgu Mureş were included in the study. All the candidates filled out an evaluation questionnaire of lifestyle and risky behaviors. The analyzed data were sex, age, residence, BMI and risky eating behavior defined as the consumption of carbohydrates (bread, potatoes, sweets), sodas, junk food, alcohol (wine, distilled beverages, beer), beer separately, level of physical activity (school and extra-school sports activities), sedentary behaviors (≥2 hours/day in front of a screen: personal computer-PC and television-TV), and spending ≥2 hours/day separately on the PC and on the TV.

Results: A statistically significant association was observed between BMI and consumption of fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC. Moreover, there was a statistically significant difference between the BMI values of adolescents presenting all studied risk behaviors compared to those who did not.

Conclusions: Obesity among adolescents from Mureş County is influenced by lifestyle choices like fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC.

Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence

Sugar-sweetened beverages (SSBs) have little nutritional value and a robust body of evidence has linked the intake of SSBs to weight gain and risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and some cancers. Metabolic Syndrome (MetSyn) is a clustering of risk factors that precedes the development of T2D and CVD; however, evidence linking SSBs to MetSyn is not clear. To make informed recommendations about SSBs, new evidence needs to be considered against existing literature. This review provides an update on the evidence linking SSBs and cardiometabolic outcomes including MetSyn. Findings from prospective cohort studies support a strong positive association between SSBs and weight gain and risk of T2D and coronary heart disease (CHD), independent of adiposity. Associations with MetSyn are less consistent, and there appears to be a sex difference with stroke with greater risk in women. Findings from short-term trials on metabolic risk factors provide mechanistic support for associations with T2D and CHD. Conclusive evidence from cohort studies and trials on risk factors support an etiologic role of SSB in relation to weight gain and risk of T2D and CHD. Continued efforts to reduce intake of SSB should be encouraged to improve the cardiometabolic health of individuals and populations.

Nutrition and Diabetes, Cardiovascular and Chronic Kidney Diseases: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

The high prevalence of chronic diseases can be prevented or managed by specific changes in lifestyle patterns of individuals of which dietary factors is emphasized. The objective of this study was to review all findings of the Tehran Lipid and Glucose Study regarding validity and reliability of food frequency questionnaire (FFQ), evaluating dietary quality and association of dietary factors in relation to diabetes, dysglycemia, cardiovascular (CVD) and chronic kidney disease (CKD).

EVIDENCE ACQUISITION

Related documents were searched through PubMed and Scopus databases, in English language from 2000 to 2017. Finally, 52 relevant documents were eligible for inclusion in this review.

RESULTS

The FFQ proved to be an acceptable tool for assessing nutrient and food group intakes and rank individuals accurately according to the levels of their dietary intakes. After 8 years of follow-up, the western dietary pattern (DP) was fairly stable but there was instability of traditional Iranian DP. DPs of over two-thirds of Tehranian populations were not in accordance with the dietary recommendations. Higher dietary scores of variety and healthy DPs were also associated with reduced odds of dysglycemia. The main dietary factor related to increased risk of CVD in our population was western DP. Patterns of amino acid intakes may contribute to the development of CVD. Higher intakes of several micronutrients and macronutrients, DPs and some vegetables decrease the risk of CKD. In conclusion DPs of most Tehranian adults need improvement.

CONCLUSIONS

This review showed that higher adherence to healthy food choices was associated with reduced odds of dysglycemia and CVD. Dietary sources of renal-protective nutrients should be encouraged among the general population.

Nutrition and Cardio-Metabolic Risk Factors: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

Genetic and environmental factors contribute to the incidence of metabolic syndrome (MetS). This study aimed to review all findings of studies conducted in framework of the Tehran lipid and glucose study (TLGS) regarding the association of dietary factors with cardio-metabolic risk factors.

EVIDENCE ACQUISITION

All English-language studies were searched using PubMed and Scopus databases from 2000 to 2017. Finally, 105 relevant papers were included in this review.

RESULTS

Whole grains, legumes, nuts and healthy dietary patterns (DPs) reduced risk of MetS, while white rice, salty/sweet snacks increased this. The western DP had a significant interaction with APOC3, APOA1 and MC4R polymorphisms in relation to MetS. After 6.5 years of follow-up, odds of reaching menarche ≤ 12 years was significantly higher in girls with higher intakes of milk, calcium, magnesium, and phosphorous. Among children and adolescents, higher adherence to the dietary approaches to stop hypertension (DASH)-style diet decreased the risk of abdominal obesity, whereas increased adherence to the western DP could contribute to general and abdominal obesity. A three-year follow-up of adult participants showed that higher intakes of phytochemical-rich foods were inversely related to development of insulin resistance. Higher adherence to the healthy DPs was associated with the reduced risk of hyperlipidemia and hypertention. Nutrition interventions postponed rise in the prevalence of MetS. The DASH diet resulted in weight reduction compared to control diet.

CONCLUSIONS

Higher adherence to healthy food choices was associated with reduced odds of MetS, abdominal obesity, dyslipidemia and hypertension. The western DP accentuated the association of polymorphisms with MetS.

Association between early introduction of fruit juice during infancy and childhood consumption of sweet-tasting foods and beverages among children exposed and unexposed to gestational diabetes mellitus in utero

BACKGROUND

Children exposed to gestational diabetes mellitus (GDM) in utero are at high-risk of obesity. Given that nutritional habits can track from infancy to childhood, the aim of this study was to evaluate the association between the timing of fruit juice introduction in infancy and later consumption of sweet-tasting foods and beverages among children exposed (GDM+) and unexposed (GDM-) to GDM.

METHODS

A total of 107 GDM+ and 59 GDM- participated in the project. Data on the timing of fruit juice introduction during infancy were retrospectively collected for 62 GDM+ and 32 GDM- children. Current dietary intakes were collected with two 24-hour dietary recall questionnaires. Children were divided into groups according to the median timing of juice introduction (9 months).

RESULTS

Mean age of children was 6.3 ± 2.6 and 7.6 ± 3.7 years for GDM+ and GDM- children, respectively (p = 0.08). Mean age of fruit juice introduction was similar between groups (p > 0.05). Consuming >1 serving of fruit juice per day was 2.72 times more prevalent among GDM+ children introduced to fruit juice <9 months, compared to GDM+ children introduced ≥9 months (CI: 1.19-6.20). This association was not observed in the GDM- group. The timing of fruit juice introduction was not associated with later consumption of sweets, desserts and sweet-tasting beverages when adjustment for children's age was made among GDM+ and GDM- children.

CONCLUSION

Early introduction of fruit juice in infant diet is associated with higher prevalence of consumption of >1 serving of fruit juice per day in GDM+ children.

Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010)

OBJECTIVE

To verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.

DESIGN

Cross-sectional analysis of the ELSA-Brasil baseline (2008-2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals' total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake.

SETTING

Six Brazilian capital cities, 2008-2010.

SUBJECTS

Active and retired civil servants, aged 35-64 years, from universities and research organizations (n 8977).

RESULTS

Ultra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (β; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose-response gradient.

CONCLUSIONS

Results indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

Health Warning Labels Correct Parents' Misperceptions About Sugary Drink Options

INTRODUCTION

Noncarbonated sugar-sweetened beverages, such as fruit drinks, sports drinks, and sweetened teas are increasingly promoted to and consumed by youth. These beverages may be perceived as healthier options than soda. To educate consumers about beverages high in added sugar, several cities and states have proposed policies mandating health warning labels on sugar-sweetened beverages.

METHODS

In 2015, a total of 2,381 parents were randomized to a no label, calorie label, or warning label condition. An online survey asked about the healthfulness of different beverages, and asked parents to select a beverage for their child in a choice task. Regressions compared the warning and calorie label groups to the control group and measured mediating effects of health beliefs on beverage choice. Data were analyzed in 2016.

RESULTS

Parents viewed fruit drinks, sports drinks, and sweetened teas as healthier and less likely to cause disease than soda. Compared with no label, warning labels significantly increased parents' risk perceptions for all beverages except soda. Warning labels significantly reduced the odds of selecting fruit drinks for the child (OR=0.42, 95% CI=0.32, 0.56), and this effect was mediated by changes in health beliefs and risk perceptions.

CONCLUSIONS

Fruit drinks, sports drinks, and sweetened teas are increasingly promoted to youth. Parents believe these beverages are healthier and less likely to cause disease than soda, and warning labels may correct these misperceptions.

Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD)

The uremic syndrome, which is the clinical expression of chronic kidney disease (CKD), is a complex amalgam of accelerated aging and organ dysfunctions, whereby cardio-vascular disease plays a capital role. In this narrative review, we offer a summary of the current conservative (medical) treatment options for cardio-vascular and overall morbidity and mortality risk in CKD. Since the progression of CKD is also associated with a higher cardio-vascular risk, we summarize the interventions that may prevent the progression of CKD as well. We pay attention to established therapies, as well as to novel promising options. Approaches that have been considered are not limited to pharmacological approaches but take into account lifestyle measures and diet as well. We took as many randomized controlled hard endpoint outcome trials as possible into account, although observational studies and post hoc analyses were included where appropriate. We also considered health economic aspects. Based on this information, we constructed comprehensive tables summarizing the available therapeutic options and the number and kind of studies (controlled or not, contradictory outcomes or not) with regard to each approach. Our review underscores the scarcity of well-designed large controlled trials in CKD. Nevertheless, based on the controlled and observational data, a therapeutic algorithm can be developed for this complex and multifactorial condition. It is likely that interventions should be aimed at targeting several modifiable factors simultaneously.

Modified Healthy Eating Index and Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

OBJECTIVE

To assess the relationship between modified healthy eating index (mHEI) with the development of metabolic syndrome (MetS) among children and adolescents.

STUDY DESIGN

Dietary data were collected using a food frequency questionnaire among 424 healthy subjects, aged 6-18 years. The components of mHEI were grains, vegetables and fruits, dairy, red to white meat ratio, butter, sweet snacks, sweetened beverages, salty snacks, and fast food. Multivariable logistic regression models were used to estimate the incidence of MetS after 3.6 years of follow-up in each quartile of the mHEI score, adjusted for baseline age, sex, total energy intake, physical activity, and body mass index.

RESULTS

The mean ± SD age and mHEI scores of participants were 13.6 ± 3.7 years and 55.9 ± 10.0, respectively, at baseline. MetS developed in 11% of the participants at the end of follow-up. After adjustment for confounders, the occurrences of MetS decreased in the highest quartile compared with the lowest quartile of the mHEI score (OR = 0.35, 95% CI 0.13-0.98, P for trend = .025). In addition, higher scores of mHEI components including fruits, salty snacks, and fast food were associated with lower risk of MetS.

CONCLUSIONS

Higher scores of mHEI as an indicator of diet quality may hinder the development of MetS among children and adolescents.

Consumption and correlates of sweet foods, carbonated beverages, and energy drinks among primary school children in Saudi Arabia

Objectives:

To assess the consumption of sweets, carbonated beverages, and energy drinks along with their correlates among primary school children.

Methods:

A total of 725 children (7-12 years old) were randomly recruited from 10 elementary schools from Al-Baha city, Saudi Arabia in 2013, using a multi-stage stratified sampling technique and pre-tested validated questionnaire.

Results:

Approximately 26.1% of children reported consuming sweets on daily basis, and 63.4% consumed sweets occasionally during the week. Approximately 56.3% children were reportedly drinking carbonated beverages weekly and 17.1% in daily basis. Weekly consumption of energy drinks was reported in 21.9% and daily consumption in 4.3% of the children. Daily sweets consumption was positively associated with children age (odds ratio [OR]=1.5, 95% confidence interval [CI]: 4.5-9.5, p=0.035), consuming carbonated beverages (OR=3.4, 95% CI: 2.2-5.2, p<0.001), energy drinks (OR=2.5, 95% CI: 1.1-5.4, p=0.029), eating high fat food (OR= 1.6, 95% CI: 1.1 - 2.4, p=0.023), and inversely with children body mass index (BMI) (OR=0.9, 95% CI: 0.8-0.9, p<0.001). Consuming carbonated beverages on regular basis was positively associated with consuming energy drinks (OR=9.0, 95% CI: 4.0-21.0, p<0.001).

Conclusion:

Unhealthy dietary choices were found to be prevalent at early age. Comprehensive intervention programs should be established to prevent unhealthy dietary choices and promote healthier dietary behaviors. Qualitative studies are needed for better understanding of children’s dietary behaviors.

Adolescent Sugar-Sweetened Beverage Intake is Associated With Parent Intake, Not Knowledge of Health Risks

PURPOSE

To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent knowledge of SSB-related health risks.

DESIGN

Quantitative, cross-sectional.

SETTING

2014 SummerStyles survey.

SUBJECTS

Nine hundred and ninety parent and adolescent (12-17 years) pairs.

MEASURES

The outcome was self-reported adolescent intake (0, >0 to <1, or ≥1 time/day) of SSBs (soda, fruit drinks, sports/energy drinks, other SSBs). The exposures were self-reported parent SSB intake (0, >0 to <1, ≥1 to <2, or ≥2 times/day) and parent and adolescent knowledge of SSB-related health risks (weight gain, diabetes, and dental caries).

ANALYSIS

Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aORs) for adolescent SSB intake ≥1 time/day (ref: 0 times/day), according to (1) parent SSB intake and (2) parent and (3) adolescent knowledge.

RESULTS

About 31% of adolescents consumed SSBs ≥1 time/day, and 43.2% of parents consumed SSBs ≥2 times/day. Adolescent and parent knowledge that SSB intake is related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/day was associated with parent intake ≥2 times/day (aOR = 3.30; 95% confidence interval = 1.62-6.74) but not with parent or adolescent knowledge of health risks.

CONCLUSION

Parental SSB intake may be an important factor in understanding adolescent behavior; knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior.

A Western dietary pattern is associated with elevated level of high sensitive C-reactive protein among adolescent girls

BACKGROUND

Serum high sensitive C-reactive protein (hs-CRP), is an indicator of low-grade inflammation, and is associated with several non-communicable diseases. The effects of diet on inflammation have not been extensively investigated, particularly among adolescents. We aimed to examine the association between major dietary patterns and elevated serum level of hs-CRP among Iranian adolescent girls.

MATERIALS AND METHODS

In this cross-sectional study, a total of 670 adolescent girls were recruited from several schools in different areas of Mashhad and Sabzevar cities, Iran. The dietary intakes of study participants were collected using a 147-item food frequency questionnaire. To identify major dietary patterns based on the 40 food groups, we used principal component analysis. Serum concentration of hs-CRP was measured using commercial kits and the BT-3000 auto-analyser. To investigate the association between dietary patterns and elevated serum level of hs-CRP, we used logistic regression analysis.

RESULTS

Three specific dietary patterns were identified: (i) healthy, (ii) traditional and (iii) western dietary patterns. A significant association was found between more adherence to Western dietary pattern and elevated serum level of hs-CRP (OR: 1.58; 95% CI: 1.02-2.42, P-trend = .03); these association remained significant after adjustment for potential confounders. However, there was no significant relationship between healthy and traditional dietary patterns and elevated serum level of hs-CRP.

CONCLUSION

Our results indicate that there is a significant positive association between more adherence to Western dietary pattern and higher serum levels of hs-CRP among Iranian adolescent girls. Further studies, particularly longitudinal intervention studies may be required to clarify these relationships.

Consumo de refrigerantes e índice de massa corporal em adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar

RESUMO: Objetivo: Estimar a associação entre consumo de refrigerantes e o índice de massa corporal (IMC) em adolescentes eutróficos e com excesso de peso. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. Considerou-se como variável de desfecho os tercis do escore de IMC (zIMC) e como variável de exposição principal, o consumo de refrigerantes adoçados com açúcar. Idade, tipo de escola, escore de bens e serviços do domicílio e escolaridade materna foram incluídos nos modelos como variáveis de ajuste. Modelos de regressão multinomial, estratificados por sexo e pelos subgrupos de eutrofia e de excesso de peso foram utilizados para estimar a associação entre exposição e desfecho. Resultados: Dos adolescentes avaliados, 23,8% apresentaram excesso de peso e 21,7% relataram o consumo de refrigerantes diariamente. Nos meninos eutróficos, o consumo de refrigerantes esteve associado à maior chance de estar nos tercis mais altos de zIMC comparados aos não consumidores. Já nos adolescentes com excesso de peso, tanto do sexo masculino quanto feminino, o consumo de refrigerantes esteve associado à menor chance de estar no tercil mais alto de escore zIMC. Conclusão: Os resultados evidenciam a possibilidade de causalidade reversa entre o consumo de refrigerantes adoçados e zIMC no grupo de adolescentes com excesso de peso. Nos adolescentes eutróficos do sexo masculino, o consumo de refrigerantes pode, potencialmente, aumentar as chances de ter zIMC mais alto, o que reforça a necessidade de medidas visando à ampla redução do consumo dessa bebida.

Sugar-Sweetened Beverage Consumption and Risks of Obesity and Hypertension in Chinese Children and Adolescents: A National Cross-Sectional Analysis

We investigated the consumption of sugar-sweetened beverage (SSB) and its association with obesity and hypertension in a national sample of children and adolescents in China, where many low- and middle-income families live. Data were obtained from a 2014 national intervention program against obesity in Chinese children and adolescents aged 6–17 years. Height, weight, waist circumference, and blood pressure were measured. Information of SSB consumption, socioeconomic status, dietary intake, screen time, and physical activity were self-reported. Multivariate logistic regression was used to assess the association of SSB consumption with obesity and hypertension. A total of 66.6% of the 53,151 participants reported consuming SSB. The per capita and per consumer SSB intake were 2.84 ± 5.26 servings/week and 4.26 ± 5.96 servings/week, respectively. Boys, older children, and adolescents, and individuals with long screen time or high physical activity or low parental education level were more likely to consume SSB. Participants who were high SSB consumers had a higher odds ratio (1.133, 95% CI: 1.054–1.217) than non-consumers for having abdominal obesity after adjustment for age, sex, residence, socioeconomic status, diet, screen time, and physical activity. However, SSB consumption was not associated with general obesity or hypertension in children and adolescents. In conclusion, more than half of the children and adolescents in China consumed SSB, which was independently related to a high risk of abdominal obesity. The results of this study indicated that SSB reduction strategies and policies may be useful in preventing obesity among Chinese children and adolescents.

Soft drink intake and the risk of metabolic syndrome: A systematic review and meta-analysis

BACKGROUND

It is unclear whether consumption of sugar- or artificially sweetened beverages is independently associated with the development of metabolic syndrome. A systematic review and meta-analysis was performed to evaluate whether soft drink consumption is associated with the development of metabolic syndrome.

METHODS

Medline and EMBASE were searched in November 2015 for studies which considered soft drink (sugar-sweetened beverage [SSB] and artificially sweetened beverage [ASB]) intake and risk of metabolic syndrome. Pooled risk ratios for adverse outcomes were calculated using inverse variance with a random effects model, and heterogeneity was assessed using the I² statistic.

RESULTS

A total of 12 studies (eight cross-sectional, four prospective cohort studies) with 56 244 participants (age range 6-98 years) were included in the review. Our pooled analysis found that soft drink intake is associated with metabolic syndrome. This relationship is shown in cross-sectional studies of SSB consumption (RR 1.46, 95% CI 1.18-1.91) and both cross-sectional and prospective studies of ASB consumption (RR 2.45; 95% CI 1.15-5.14; RR 1.32, 95% CI 1.21-1.44, respectively). However, pooled results of prospective cohort studies of SSB consumption found no association between intake and risk of developing metabolic syndrome.

CONCLUSIONS

Sugar-sweetened beverage and ASB intake are both associated with metabolic syndrome. This association may be driven by the fact that soft drink intake serves as a surrogate for an unhealthy lifestyle, or an adverse cardiovascular risk factor profile.

Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies

OBJECTIVE

Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults.

METHODS

Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted.

RESULTS

30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry.

CONCLUSION

Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water.

Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Evidence of the negative effects of sugar-sweetened beverages (SSBs) on mental health has not been convincing, although a few studies have found an association between high SSB levels and attention problems in children. This study aimed to test the hypothesis that SSB consumption is associated with ADHD among children. Doctor-diagnosed ADHD cases (n = 173) and non-ADHD controls (n = 159) between age 4 to 15 were recruited. SSB consumption, socio-demographic and lifestyle characteristics of the children, as well as of their mothers' characteristics during pregnancy, were collected using a questionnaire. Blood lead levels and polymorphisms of two commonly verified dopaminergic-related genes (the D4 dopamine receptor gene DRD4 and the dopamine transporter gene DAT1) were also analyzed. There was a dose-response relationship between SSB consumption and ADHD. After covariates were adjusted, children who consumed SSBs at moderate levels and high levels had 1.36 and 3.69 odds, respectively, of having ADHD, compared with those who did not consume SSBs (p for trend < 0.05). Similar results were obtained when females were excluded. Our findings highlighted the adverse correlation between SSB consumption and ADHD and indicated a dose-response effect even after covariates were adjusted.

Associations between the consumption of carbonated beverages and periodontal disease: The 2008-2010 Korea national health and nutrition examination survey

Consumption of carbonated beverages was reported to be associated with obesity and other adverse health consequences. This study was performed to assess the relationship between the consumption of carbonated beverages and periodontal disease using nationally representative data.The data from the Korea National Health and Nutrition Examination Survey conducted between 2008 and 2010 were used; the analysis in this study was confined to a total of 5517 respondents >19 years old who had no missing values for the consumption of carbonated beverages or outcome variables. The community periodontal index greater than or equal to code 3 was defined as periodontal disease.The odds ratios of the percentage of individuals with periodontal treatment needs tended to increase with the consumption of carbonated beverages. Adjusted odds ratios and their 95% confidence intervals adjusted for various factors including age, sex, body mass index, smoking, drinking, exercise, metabolic syndrome, frequency of tooth brushing per day, use of secondary oral products, dental checkup within a year, consumption of coffee of the individuals with the consumption of carbonated beverages once or less per month, once or less per week and twice or more per week were 1.109(0.804,1.528), 1.404(1.035,1.906), and 1.466(1.059,2.029), respectively. A subgroup analysis revealed that in individuals with body mass index < 25 or waist circumference < 90 cm for males or < 80 cm for females, the prevalence of periodontal disease increased with higher consumption of carbonated beverages (P for trend < 0.05).Consumption of carbonated beverages was positively associated with the risk of periodontal disease in Korean adults. In a subgroup analysis, the individuals consuming carbonated beverages with body mass index < 25 or waist circumference < 90 cm for males or < 80 cm for females were more likely to have periodontal disease. Consumption of carbonated beverages may be considered to be an independent risk indicator for periodontal disease and periodontal health of nonobese individuals may benefit from reduction of carbonated beverage consumption.