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Riediger ND, Kidson MR, Mann K, Wood L, Beardy B, Champagne M, Dubois R, Beck K, Kisselgoff M, Harper MJ, Waugh A, Bombak A, Perchotte C, Theriault C. Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes. Can J Diabetes 2024; 48:163-170. [PMID: 38154553 DOI: 10.1016/j.jcjd.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners. METHODS In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically. RESULTS Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were. CONCLUSIONS Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.
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Affiliation(s)
- Natalie D Riediger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Mya Ruby Kidson
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelsey Mann
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larry Wood
- Four Arrows Regional Health Authority, Wasagamack Health Authority, Winnipeg, Manitoba, Canada
| | - Byron Beardy
- Four Arrows Regional Health Authority, Wasagamack Health Authority, Winnipeg, Manitoba, Canada
| | | | | | - Krista Beck
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Kisselgoff
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Jane Harper
- Four Arrows Regional Health Authority, Wasagamack Health Authority, Winnipeg, Manitoba, Canada
| | - Anne Waugh
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea Bombak
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Chantal Perchotte
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Céleste Theriault
- National Indigenous Diabetes Association, Winnipeg, Manitoba, Canada
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An JP, Wang Y, Munger SD, Tang X. A review on natural sweeteners, sweet taste modulators and bitter masking compounds: structure-activity strategies for the discovery of novel taste molecules. Crit Rev Food Sci Nutr 2024:1-24. [PMID: 38494695 DOI: 10.1080/10408398.2024.2326012] [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: 03/19/2024]
Abstract
Growing demand for the tasty and healthy food has driven the development of low-calorie sweeteners, sweet taste modulators, and bitter masking compounds originated from natural sources. With the discovery of human taste receptors, increasing numbers of sweet taste modulators have been identified through human taste response and molecular docking techniques. However, the discovery of novel taste-active molecules in nature can be accelerated by using advanced spectrometry technologies based on structure-activity relationships (SARs). SARs explain why structurally similar compounds can elicit similar taste qualities. Given the characterization of structural information from reported data, strategies employing SAR techniques to find structurally similar compounds become an innovative approach to expand knowledge of sweeteners. This review aims to summarize the structural patterns of known natural non-nutritive sweeteners, sweet taste enhancers, and bitter masking compounds. Innovative SAR-based approaches to explore sweetener derivatives are also discussed. Most sweet-tasting flavonoids belong to either the flavanonols or the dihydrochalcones and known bitter masking molecules are flavanones. Based on SAR findings that structural similarities are related to the sensory properties, innovative methodologies described in this paper can be applied to screen and discover the derivatives of taste-active compounds or potential taste modulators.
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Affiliation(s)
- Jin-Pyo An
- Food Science and Human Nutrition, Citrus Research and Education Center, University of Florida, Lake Alfred, FL, USA
| | - Yu Wang
- Food Science and Human Nutrition, Citrus Research and Education Center, University of Florida, Lake Alfred, FL, USA
| | - Steven D Munger
- Center for Smell and Taste, Department of Pharmacology and Therapeutics, Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Xixuan Tang
- Food Science and Human Nutrition, Citrus Research and Education Center, University of Florida, Lake Alfred, FL, USA
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3
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Sylvetsky AC, Rebolledo N, Krieger JW. Nonsugar Sweeteners-Time for Transparency and Caution. JAMA Pediatr 2024; 178:217-218. [PMID: 38252446 DOI: 10.1001/jamapediatrics.2023.6041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This Viewpoint discusses the growing presence of nonsugar sweeteners (NSSs) in the food supply and mounting concerns about their use, which suggest that disclosure of the amounts of NSS in food and beverages and restrictions on their use in products marketed to children are warranted.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Natalia Rebolledo
- Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases, Institute of Nutrition and Food Technology, University of Chile, Macul, Chile
| | - James W Krieger
- Healthy Food America, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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4
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Cohen JFW, Kesack A, Daly TP, Elnakib SA, Hager E, Hahn S, Hamlin D, Hill A, Lehmann A, Lurie P, Maroney M, Means J, Mueller MP, Olarte DA, Polacsek M, Schwartz MB, Sonneville KR, Spruance LA, Woodward AR, Chapman LE. Competitive Foods' Nutritional Quality and Compliance with Smart Snacks Standards: An Analysis of a National Sample of U.S. Middle and High Schools. Nutrients 2024; 16:275. [PMID: 38257169 PMCID: PMC10818474 DOI: 10.3390/nu16020275] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Snacks and beverages are often sold in addition to meals in U.S. schools ("competitive foods"), but their current nutritional quality and compliance with national Smart Snacks standards are unknown. This study assessed competitive foods in a national sample of 90 middle and high schools. Differences in compliance by school characteristics were measured using mixed methods analysis of variance. Overall, 80% of the schools in the sample sold competitive foods; but they were less commonly available in schools with universal free school meal (UFSM) policies. A total of 840 unique products were documented and, on average, 75% were compliant with Smart Snacks standards. A total of 56% aligned with recommended added sugar limits (<10% of calories); and 340 unique products (40%) aligned with both sugar and Smart Snacks standards. Approximately one-fifth of competitive foods contained synthetic dyes, and 31% of beverages contained artificial sweeteners. Smart Snacks standards compliance was greater when competitive foods were overseen by food service departments, in comparison with others (e.g., principals, student organizations, or outside vendors [77% vs. 59% compliance; p = 0.003]). Therefore, district wellness policies should consider requiring food service departments to oversee competitive foods. Federal and state policies should limit added sugars, artificial sweeteners, and synthetic dyes. This appears to be highly feasible, given the substantial number of products that meet these criteria. UFSM policies should also be considered to support healthier school meal environments more broadly.
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Affiliation(s)
- Juliana F. W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Ashley Kesack
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Tara P. Daly
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Sara A. Elnakib
- Department of Family and Community Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Erin Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Samuel Hahn
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Daniel Hamlin
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Annie Lehmann
- School of Allied Health, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Jaydn Means
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Megan P. Mueller
- Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Dr, Fort Collins, CO 80523, USA;
| | - Deborah A. Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, 716 Stevens Ave, Portland, ME 04103, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Health, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
| | - Kendrin R. Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Lori A. Spruance
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA;
| | | | - Leah E. Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
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Langevin B, Gopalakrishnan M, Kuttamperoor J, Van Den Anker J, Murphy J, Arcaro KF, Daines D, Sylvetsky AC. The MILK study: Investigating intergenerational transmission of low-calorie sweeteners in breast milk. Contemp Clin Trials Commun 2023; 36:101212. [PMID: 37881407 PMCID: PMC10594547 DOI: 10.1016/j.conctc.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/27/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Forty-four percent of lactating women in the United States consume beverages containing low calorie sweeteners (LCS), and the presence of LCS in the food supply has continued to increase in recent years. While LCS are approved by the United States Food and Drug Administration (FDA) and are believed to be safe for human consumption, intergenerational LCS transmission and the health impacts of early life LCS exposure are severely understudied. Methods and analysis In a tightly controlled, single site, prospective interventional study, mothers' plasma and breast milk, and infants' plasma will be collected from 40 mother-infant dyads over the course of 72 h, with rich sampling following maternal ingestion of a LCS sweetened beverage containing sucralose and acesulfame potassium (ace-K). Concentration-time data will be used to build maternal and infant pharmacokinetic models for future simulations and analysis. Conclusion This study aims to measure LCS concentrations in breast milk, maternal plasma, and infant plasma, to gain insight into infant exposure and inform recommendations for LCS consumption during breastfeeding.
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Affiliation(s)
- Brooke Langevin
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, USA
| | - Mathangi Gopalakrishnan
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, USA
| | - Janae Kuttamperoor
- Department of Exercise and Nutrition Sciences, The George Washington University, Washington D.C., USA
| | - John Van Den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington D.C., USA
| | - Jeanne Murphy
- School of Nursing, The George Washington University, Washington D.C., USA
| | - Kathleen F. Arcaro
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Dina Daines
- Department of Obstetrics and Gynecology, The George Washington University, Washington D.C., USA
| | - Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, The George Washington University, Washington D.C., USA
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Arellano-Gómez LP, Jáuregui A, Nieto C, Contreras-Manzano A, Quevedo KL, White CM, Thrasher JF, Davis RE, Hammond D, Barquera S. Effects of front-of-package caffeine and sweetener disclaimers in Mexico: cross-sectional results from the 2020 International Food Policy Study. Public Health Nutr 2023; 26:3278-3290. [PMID: 37781769 PMCID: PMC10755452 DOI: 10.1017/s1368980023002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 08/12/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Front-of-package warning labels introduced in Mexico in 2020 included disclaimers that caution against allowing children to consume products with non-sugary sweeteners and caffeine. We examined the awareness and use of the disclaimers among Mexican adults and youth 1 month after the regulation was implemented. We also investigated their impact on the perceived healthfulness of industrialised beverages designed for children. DESIGN Data on the awareness and use of the disclaimers were analysed. Two between-subjects experiments examined the effect of a sweetener disclaimer (Experiment 1, youth and adults) or a caffeine disclaimer (Experiment 2, only adults) on the perceived healthfulness of industrialised beverages. Interactions between experimental conditions and demographic characteristics were tested. SETTING Online survey in 2020. PARTICIPANTS Mexican adults (≥18 years, n 2108) and youth (10-17 years, n 1790). RESULTS Most participants (>80 %) had seen the disclaimers at least rarely, and over 60 % used them sometimes or frequently. The sweetener disclaimer led to a lower perceived healthfulness of a fruit drink (adults: 2·74 ± 1·44; youth: 2·04 ± 0·96) compared with the no-disclaimer condition (adults: 3·17 ± 1·54; youth: 2·32 ± 0·96) (t's: >4·0, P values: <0·001). This effect was larger among older adults and male youth. The caffeine disclaimer did not affect adult's perceived healthfulness of a caffeinated drink (t = 0·861, P value = 0·3894). CONCLUSIONS There were high awareness and use of the sweeteners and caffeine disclaimers shortly after the warning labels were implemented. The sweetener disclaimer appears to be helping consumers modify their perceptions regarding industrialised beverages for children. Findings may help decision-makers improve the regulation and better target communication strategies.
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Affiliation(s)
- Laura Patricia Arellano-Gómez
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
- Department of Psychology, Education and Health, Nutrition and Food Sciences, ITESO Jesuit University of Guadalajara, Guadalajara, Mexico
| | - Alejandra Jáuregui
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Claudia Nieto
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Alejandra Contreras-Manzano
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
- National Council for Science and Technology (CONACYT), Mexico City, Mexico
| | - Kathia Larissa Quevedo
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rachel E Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Simón Barquera
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
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7
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Jensen ML, Fleming-Milici F, Harris JL. Are U.S. food and beverage companies now advertising healthy products to children on television? An evaluation of improvements in industry self-regulation, 2017-2021. Int J Behav Nutr Phys Act 2023; 20:118. [PMID: 37789328 PMCID: PMC10548587 DOI: 10.1186/s12966-023-01517-y] [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: 02/28/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Through the Children's Food and Beverage Advertising Initiative (CFBAI), U.S. food companies pledge to only advertise healthier products in children's television (TV) programming, but previous research shows that highly advertised products do not qualify as nutritious according to independent nutrition criteria. In 2020, the CFBAI implemented stricter nutrition criteria for products that may be advertised to children, but the potential impact of these changes has not been assessed. This observational study evaluates (1) improvements in energy and individual nutrient composition of products that companies indicated may be advertised to children (i.e., CFBAI-listed products) in 2020 versus 2017, (2) amount of advertising on children's TV for CFBAI-listed versus other products in 2021, and 3) the nutrition quality of advertised versus non-advertised CFBAI-listed products. METHODS Data include energy, saturated fat, sodium, and sugar content and overall nutrition quality (Nutrition Profile Index [NPI] scores) of CFBAI-listed products in 2017 (n = 308) and 2020 (n = 245). Nielsen data provided total ad spending and children's exposure to ads on children's TV channels for all foods and beverages in 2021. RESULTS From 2017 to 2021, energy, saturated fat and sugar declined for CFBAI-listed products in three of six food categories (yogurt, sweet and salty snacks). Although CFBAI-listed products accounted for 79% of food ads viewed by children on children's TV channels, just 50% of CFBAI-listed food and 36% of drink brands were advertised on children's TV. Moreover, advertised products were significantly less nutritious than non-advertised CFBAI-listed products. CONCLUSION Despite revised nutrition standards and improvements in nutrient content of some product categories, participating companies continued to primarily advertise nutritionally poor food and beverages on children's TV. CFBAI companies have not delivered on their promises to advertise healthier products to children.
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Affiliation(s)
- Melissa L Jensen
- UConn Rudd Center for Food Policy and Health, University of Connecticut, One Constitution Plaza Suite 600, Hartford, CT, 06103, USA.
- School of Nutrition, University of Costa Rica, San José, Costa Rica.
| | - Frances Fleming-Milici
- UConn Rudd Center for Food Policy and Health, University of Connecticut, One Constitution Plaza Suite 600, Hartford, CT, 06103, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Health, University of Connecticut, One Constitution Plaza Suite 600, Hartford, CT, 06103, USA
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Chen ZW, Shen ZW, Hua ZL, Li XQ. Global development and future trends of artificial sweetener research based on bibliometrics. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 263:115221. [PMID: 37421893 DOI: 10.1016/j.ecoenv.2023.115221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
Artificial sweeteners have sparked a heated debate worldwide due to their ambiguous impacts on public and environmental health and food safety and quality. Many studies on artificial sweeteners have been conducted; however, none scientometric studies exist in the field. This study aimed to elaborate on the knowledge creation and development of the field of artificial sweeteners and predict the frontiers of knowledge based on bibliometrics. In particular, this study combined VOSviewer, CiteSpace, and Bibliometrix to visualize the mapping of knowledge production, covered 2389 relevant scientific publications (1945-2022), and systematically analyzed articles and reviews (n = 2101). Scientific publications on artificial sweeteners have been growing at an annual rate of 6.28% and globally attracting 7979 contributors. Susan J. Brown with total publications (TP) of 17, average citation per article (AC) of 36.59, and Hirsch (h)-index of 12 and Robert F. Margolskee (TP = 12; AC = 2046; h-index = 11) were the most influential scholars. This field was clustered into four groups: eco-environment and toxicology, physicochemical mechanisms, public health and risks, and nutrition metabolism. The publications about environmental issues, in particular, "surface water," were most intensive during the last five years (2018-2022). Artificial sweeteners are gaining importance in the monitoring and assessment of environmental and public health. Results of the dual-map overlay showed that the future research frontiers tilt toward molecular biology, immunology, veterinary and animal sciences, and medicine. Findings of this study are conducive to identifying knowledge gaps and future research directions for scholars.
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Affiliation(s)
- Zi-Wei Chen
- Ministry of Education Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, College of Environment, Hohai University, Nanjing 210098, PR China
| | - Zhi-Wei Shen
- Jiangsu Construction Engineering Branch, Shanghai Dredging Co., Ltd., China Communications Construction Co., Ltd., Nanjing 210000, PR China
| | - Zu-Lin Hua
- Ministry of Education Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, College of Environment, Hohai University, Nanjing 210098, PR China; Yangtze Institute for Conservation and Development, Nanjing 210098, PR China.
| | - Xiao-Qing Li
- Ministry of Education Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, College of Environment, Hohai University, Nanjing 210098, PR China; Yangtze Institute for Conservation and Development, Nanjing 210098, PR China
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9
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Sylvetsky AC, Moore HR, Zhu X, Kaidbey JH, Kang L, Saeed A, Khattak S, Grilo MF, Vallone N, Kuttamperoor J, Cogen FR, Elmi A, Walter PJ, Cai H, DiPietro L, Goran MI, Streisand R. Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study. Nutrients 2023; 15:3867. [PMID: 37764650 PMCID: PMC10534616 DOI: 10.3390/nu15183867] [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: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Low-calorie sweeteners (LCS) are commonly consumed by children with type 1 diabetes (T1D), yet their role in cardiometabolic health is unclear. This study examined the feasibility, acceptability, and preliminary effects of 12 weeks of LCS restriction among children with T1D. Children (n = 31) with T1D completed a two-week run-in (n = 28) and were randomly assigned to avoid LCS (LCS restriction, n = 15) or continue their usual LCS intake (n = 13). Feasibility was assessed using recruitment, retention, and adherence rates percentages. Acceptability was assessed through parents completing a qualitative interview (subset, n = 15) and a satisfaction survey at follow-up. Preliminary outcomes were between-group differences in change in average daily time-in-range (TIR) over 12 weeks (primary), and other measures of glycemic variability, lipids, inflammatory biomarkers, visceral adiposity, and dietary intake (secondary). Linear regression, unadjusted and adjusted for age, sex, race, and change in BMI, was used to compare mean changes in all outcomes between groups. LCS restriction was feasible and acceptable. No between-group differences in change in TIR or other measures of glycemic variability were observed. However, significant decreases in TNF-alpha (-0.23 ± 0.08 pg/mL) and improvements in cholesterol (-0.31 ± 0.18 mmol/L) and LDL (-0.60 ± 0.39 mmol/L) were observed with usual LCS intake, compared with LCS restriction. Those randomized to LCS restriction did not report increases in total or added sugar intake, and lower energy intake was reported in both groups (-190.8 ± 106.40 kcal LCS restriction, -245.3 ± 112.90 kcal usual LCS intake group). Decreases in percent energy from carbohydrates (-8.5 ± 2.61) and increases in percent energy from protein (3.2 ± 1.16) and fat (5.2 ± 2.02) were reported with usual LCS intake compared with LCS restriction. Twelve weeks of LCS restriction did not compromise glycemic variability or cardiometabolic outcomes in this small sample of youth with T1D. Further examination of LCS restriction among children with T1D is warranted.
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Affiliation(s)
- Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Hailey R. Moore
- Division of Psychology & Behavioral Health, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; (H.R.M.); (L.K.); (R.S.)
| | - Xinyu Zhu
- Nutrition and Health Sciences Program, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA;
| | - Jasmine H. Kaidbey
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Leyi Kang
- Division of Psychology & Behavioral Health, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; (H.R.M.); (L.K.); (R.S.)
| | - Abbas Saeed
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Shazmeena Khattak
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Mariana F. Grilo
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Natalie Vallone
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Janae Kuttamperoor
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Fran R. Cogen
- Division of Endocrinology, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA;
- School of Medicine and Health Sciences, The George Washington University, 2300 I St. NW, Washington, DC 20052, USA
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA;
| | - Peter J. Walter
- Clinical Mass Spectrometry Lab, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD 20892, USA; (P.J.W.); (H.C.)
| | - Hongyi Cai
- Clinical Mass Spectrometry Lab, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD 20892, USA; (P.J.W.); (H.C.)
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA; (J.H.K.); (A.S.); (S.K.); (M.F.G.); (N.V.); (J.K.); (L.D.)
| | - Michael I. Goran
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA;
| | - Randi Streisand
- Division of Psychology & Behavioral Health, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; (H.R.M.); (L.K.); (R.S.)
- School of Medicine and Health Sciences, The George Washington University, 2300 I St. NW, Washington, DC 20052, USA
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10
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Grilo MF, Taillie LS, Sylvetsky AC. The widespread presence of non-nutritive sweeteners challenges adherence to beverage guidance for children. Front Public Health 2023; 11:1221764. [PMID: 37663855 PMCID: PMC10472131 DOI: 10.3389/fpubh.2023.1221764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Mariana Fagundes Grilo
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
- Sumner M. Redstone Global Center for Prevention and Wellness, The George Washington University, Washington, DC, United States
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
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11
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Alharthi SAS, Alaisayi KHA, Alalawi LYS, Alamri ROS, Abu-Elfotuh K, Alenazi TS, Amirthalingam P, Albariqi HAH, Mohammed AA, Alsubayti N, Hamdan AME, Kozman MR. The consumption pattern and perception of using artificial sweeteners among the public in Tabuk region, Saudi Arabia. Front Public Health 2023; 11:1166868. [PMID: 37427264 PMCID: PMC10323410 DOI: 10.3389/fpubh.2023.1166868] [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] [Received: 02/15/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Background Obesity and weight gain have become major problems worldwide. Thus, several forms of alternative intense sweeteners are extensively used, offering a non-caloric sweet taste. To the best of our knowledge, no research has studied either the consumption pattern or the perception of using artificial sweeteners in Saudi Arabia. Objectives Our research aimed to study the usage pattern of such artificial sweeteners in the Tabuk region and estimate the knowledge of and attitudes toward their usage among the population. Methods A cross-sectional study promoted on multiple social media platforms and face-to-face interviews in different malls and hospitals in the Tabuk region. We grouped the participants into two major groups: the users and the non-users of artificial sweeteners. Each group has been subdivided into a healthy subgroup and those with a medical record subgroup. Participants' characteristics and their choice of sweeteners were analyzed using bivariate analysis. The age, gender, and education level of the participants were adjusted using binary logistic regression in order to adjust for potential confounders. Results A total of 2,760 participants were included in our study. We found that more than 59% of the participants that were over 45 years old were non-hospitalized non-hospitalized diseased irrespective of their usage of artificial sweeteners. Furthermore, females, graduates, diabetics were significantly high irrespective of their subgroup. Moreover, Steviana® is the most commonly used artificial sweetener. In addition, healthy participants showed a greater perception of the usage and adverse effects of artificial sweeteners. Furthermore, bivariate analysis using logistic regression revealed significant associations (p < 0.05) with confounders such as gender, age, and education level. Conclusion Educational programs and nutritional advice for the safe consumption and the daily permissible doses of artificial sweeteners are essential and should be directed specifically at females.
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Affiliation(s)
| | | | | | | | - Karema Abu-Elfotuh
- Clinical Pharmacy Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Tahani S. Alenazi
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | | | | | - Asmaa A. Mohammed
- Pharmacology and Toxicology Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | | | - Ahmed M. E. Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Magy R. Kozman
- Clinical Pharmacy Department, Faculty of Pharmacy, Misr University for Science and Technology, Giza, Egypt
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12
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Brunacci KA, Salmon L, McCann J, Gribble K, Fleming CAK. The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia. BMC Public Health 2023; 23:656. [PMID: 37024884 PMCID: PMC10077707 DOI: 10.1186/s12889-023-15492-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. METHODS Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims. RESULTS 276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of 'no added sugar' were made for 59% of pouches, despite the addition of free sugars. CONCLUSIONS Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0-36 months and better inform parents.
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Affiliation(s)
- Kaitlyn A Brunacci
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - Libby Salmon
- School of Regulation and Global Governance, The Australian National University, Canberra, Australia
| | | | - Karleen Gribble
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Catharine A K Fleming
- School of Health Sciences, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Western Sydney University, Sydney, Australia
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13
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Hu S, Liu X, Zhang S, Quan D. An Overview of Taste-Masking Technologies: Approaches, Application, and Assessment Methods. AAPS PharmSciTech 2023; 24:67. [PMID: 36788171 DOI: 10.1208/s12249-023-02520-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
It is well-known that plenty of active pharmaceutical ingredients (API) inherently possess an unpleasant taste, which influences the acceptance of patients, especially children. Therefore, manufacturing taste-masked dosage forms has attracted a lot of attention. This review describes in detail the taste-masking technologies based on the difference in the taste transmission mechanism which is currently available. In particular, the review highlights the application of various methods, with a special focus on how to screen the appropriate masking technology according to the properties of API. Subsequently, we overviewed how to assess taste-masking efficacy, guiding researchers to rationally design taste-masking formulations.
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Affiliation(s)
- Shuqin Hu
- Institute of Advanced Drug Delivery Technology, No.10 Xinghuo Avenue Jiangbei New Area, Nanjing, 210032, People's Republic of China.,China Pharmaceutical University, No. 639 Longmian Avenue, Nanjing, 211198, People's Republic of China
| | - Xiaoxuan Liu
- China Pharmaceutical University, No. 639 Longmian Avenue, Nanjing, 211198, People's Republic of China
| | - Shuangshuang Zhang
- Institute of Advanced Drug Delivery Technology, No.10 Xinghuo Avenue Jiangbei New Area, Nanjing, 210032, People's Republic of China
| | - Danyi Quan
- Institute of Advanced Drug Delivery Technology, No.10 Xinghuo Avenue Jiangbei New Area, Nanjing, 210032, People's Republic of China.
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14
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Rebolledo N, Bercholz M, Adair L, Corvalán C, Ng SW, Taillie LS. Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools. Curr Dev Nutr 2023; 7:100016. [PMID: 37180088 PMCID: PMC10111599 DOI: 10.1016/j.cdnut.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Chile's landmark food labeling and advertising policy led to major reductions in sugar purchases. However, it is unclear whether this led to increases in the purchases of nonnutritive sweeteners (NNS). Objectives The objective of this study was to assess the changes in NNS and caloric-sweetened (CS) products purchased after the law's first phase. Methods Longitudinal data on food and beverage purchases from 2,381 households collected from January 1, 2015 to December 31, 2017, were linked to nutritional information and categorized into added sweetener groups (unsweetened, NNS-only, CS-only, or NNS with CS). Logistic random-effects models and fixed-effects models were used to compare the percentage of households purchasing products and the mean volume purchased by sweetener category to a counterfactual based on pre-regulation trends. Results Compared with the counterfactual, the percentage of households purchasing any NNS beverages (NNS-only or NNS with CS) increased by 4.2 percentage points (pp) (95% CI: 2.8, 5.7; P < 0.01). This increase was driven by households purchasing NNS-only beverages (12.1 pp, 95% CI: 10.0, 14.2; P < 0.01). The purchased volume of beverages with any NNS increased by 25.4 mL/person/d (95% CI: 20.1, 30.7; P < 0.01) or 26.5%. Relative to the counterfactual, there were declines of -5.9 pp in households purchasing CS-only beverages (95% CI: -7.0, -4.7; P < 0.01). Regarding the types of sweeteners purchased, we found significant increases in the amounts of sucralose, aspartame, acesulfame K, and steviol glycosides purchased from beverages. Among foods, differences were minimal. Conclusions The first phase of Chile's law was associated with an increase in the purchases of beverages containing NNS and decreases in beverages containing CS, but virtually no changes in foods.
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Affiliation(s)
- Natalia Rebolledo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Macul, Chile
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Rebolledo N, Reyes M, Popkin BM, Adair L, Avery CL, Corvalán C, Ng SW, Taillie LS. Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile's Law of Food Labelling and Advertising. Pediatr Obes 2022; 17:e12895. [PMID: 35088571 DOI: 10.1111/ijpo.12895] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/10/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The first phase of Chile's Law of Food Labelling and Advertising showed important declines in the sugar content of packaged foods, but it is unknown whether the law led to an increase in nonnutritive sweetener (NNS) intake, particularly among preschool children. OBJECTIVES Estimate the changes in preschoolers' NNS intake after the first phase of the Chilean law. METHODS We used 24-h dietary recalls collected in 2016 (pre-law) and 2017 (post-law) from a cohort of preschoolers (n = 875). The primary caretaker was the respondent of the recalls. Information on NNS was obtained from nutrition facts panels collected annually and linked to dietary data. We used logistic regression to estimate the changes in the proportion of preschoolers who consume NNS and two-part models to estimate the changes in mean intake. We determined the percentage of children that surpassed the acceptable daily intake (ADI) of each NNS using the National Cancer Institute method. RESULTS The proportion of consumers of at least one NNS increased from 77.9% to 92.0% (p-value < 0.01). The mean intake increased for sucralose, aspartame, acesulfame-K and steviol glycosides (+20.3, +15.1, +6.1 and +3.3 mg/day, respectively). In addition, NNS dietary sources changed for sucralose and steviol glycosides, becoming industrialized juices and dairy beverages more relevant while tabletop NNS became less relevant. None of the children surpassed the ADI. CONCLUSIONS NNS intake increased in preschoolers after the first phase of a national policy that promoted sugar reformulation.
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Affiliation(s)
- Natalia Rebolledo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcela Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Avery
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Bragg MA, Rummo PE, Greene T, Arshonsky J, Anekwe AV, Mezzacca TA, Farley SM. Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City. Health Equity 2022; 6:322-329. [PMID: 35557551 PMCID: PMC9081063 DOI: 10.1089/heq.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC). Design: Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level. Setting: We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts. Results: The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01). Conclusions: Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.
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Affiliation(s)
- Marie A Bragg
- Department of Population Health, New York University School of Medicine, New York, New York, USA.,New York University College of Global Public Health, New York, New York, USA
| | - Pasquale E Rummo
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Tenay Greene
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Josh Arshonsky
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Amaka V Anekwe
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, Long Island City, New York, USA
| | | | - Shannon M Farley
- ICAP, Columbia University, Columbia University Mailman School of Public Health, New York, NY USA
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17
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Choi YY, Jensen ML, Fleming-Milici F, Harris JL. Caregivers' provision of sweetened fruit-flavoured drinks to young children: importance of perceived product attributes and differences by socio-demographic and behavioural characteristics. Public Health Nutr 2022; 25:1-9. [PMID: 35440350 PMCID: PMC9991680 DOI: 10.1017/s1368980022000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Drinks containing added sugar and/or non-nutritive sweeteners are not recommended for children under 6 years. Yet, most young children consume these products. The current study examined factors associated with caregivers' provision of sweetened drinks to their young child. DESIGN Caregivers reported frequency of providing sweetened fruit-flavoured drinks (fruit drinks and flavoured water) and unsweetened juices (100 % juice and juice/water blends) to their 1- to 5-year-old child in the past month and perceived importance of product attributes (healthfulness, product claims and other characteristics), other drinks provided, reading the nutrition facts panel and socio-demographic characteristics. A partial proportional odds model measured the relationship between these factors and frequency of providing sweetened fruit-flavoured drinks. SETTING Online cross-sectional survey. PARTICIPANTS U.S. caregivers (n 1763) with a young child (ages 1-5). RESULTS The majority (74 %) of caregivers provided sweetened fruit-flavoured drinks to their child in the past month; 26 % provided them daily. Provision frequency was positively associated with some drink attributes, including perceived healthfulness, vitamin C claims and box/pouch packaging; child requests and serving other sweetened drinks and juice/water blends. Provision frequency was negatively associated with perceived importance of 'no/less sugar' and 'all natural' claims. Reading nutrition facts panels, serving water to their child and child's age were not significant. CONCLUSION Misunderstanding of product healthfulness and other marketing attributes contribute to frequent provision of sweetened drinks to young children. Public health efforts to address common misperceptions, including counter marketing, may raise awareness among caregivers about the harms of providing sweetened drinks to young children.
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Affiliation(s)
- Yoon Y Choi
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
- Korea Rural Economic Institute, Naju-Si, Jeollanam-do58321, Republic of Korea
| | - Melissa L Jensen
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
| | - Frances Fleming-Milici
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
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18
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Musicus AA, Hua SV, Moran AJ, Duffy EW, Hall MG, Roberto CA, Dillman Carpentier FR, Sorscher S, Wootan MG, Smith Taillie L, Rimm EB. Front-of-package claims & imagery on fruit-flavored drinks and exposure by household demographics. Appetite 2022; 171:105902. [PMID: 34968559 PMCID: PMC8821268 DOI: 10.1016/j.appet.2021.105902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/11/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
Abstract
Young children regularly consume sugary fruit drinks, in part because parents may falsely believe they are healthful due to front-of-package (FOP) claims and imagery. The goal of this study was to assess: 1) the prevalence of FOP claims/imagery on fruit-flavored beverages purchased by U.S. households with 0-5-year-olds, and 2) proportional differences in beverages purchased with FOP claims/imagery across household demographic groups. A content analysis of FOP claims/imagery (e.g., nutrient claims, fruit imagery) on beverages (n = 1365) purchased by households with 0-5-year-olds was conducted by linking beverage sales with FOP marketing data. Results were merged with purchasing data from a nationally representative sample of households (FoodAPS), and survey-weighted logistic regression was used to assess differences in the proportions of 100% juices and fruit drinks with specific FOP claims/imagery purchased by household race/ethnicity, income, and SNAP/WIC participation. The most common claims on fruit-flavored beverages included nutrient claims (fruit drinks: 73%; 100% juices: 68%; flavored waters: 95%), which most commonly highlighted vitamin C (35-41% across beverage categories) and the absence of sugar (31-48%). Most beverages also contained implied-natural claims (fruit drinks: 60%; 100% juices: 64%; flavored waters: 95%) and natural imagery (fruit drinks: 97%; 100% juices: 96%; flavored waters: 73%). A large proportion of fruit drinks and 100% juices purchased by households across all demographic groups contained FOP claims and imagery, with a few minor differences between racial/ethnic groups. In conclusion, most fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds contained FOP claims and imagery that may lead consumers to believe the beverages are healthy and natural. FDA regulations should ensure parents are not misled by this marketing.
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Affiliation(s)
- Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alyssa J Moran
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily W Duffy
- Department of Nutrition, Gillings School of Global Public Health; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health; Carolina Population Center, And Lineberger Comprehensive Cancer Center; University of North Carolina, Chapel Hill, NC, USA
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, DC, USA
| | | | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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19
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Fleming-Milici F, Phaneuf L, Harris JL. Marketing of sugar-sweetened children's drinks and parents' misperceptions about benefits for young children. MATERNAL & CHILD NUTRITION 2022; 18:e13338. [PMID: 35199914 PMCID: PMC9218304 DOI: 10.1111/mcn.13338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/17/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Despite expert recommendations, US parents often serve sugar‐sweetened children's drinks, including sweetened fruit‐flavoured drinks and toddler milks, to young children. This qualitative research explored parents' understanding of common marketing tactics used to promote these drinks and whether they mislead parents to believe the drinks are healthy and/or necessary for children. We conducted nine focus groups in Washington, DC and Hartford, CT with parents of children (9–36 months) of diverse race/ethnicity and socioeconomic status (N = 50). Semistructured discussions elicited parents' responses to four concepts designed to correct common misperceptions about toddler milks and sweetened fruit‐flavoured drinks (fruit drinks and flavoured waters) by providing information about drink ingredients and potentially misleading marketing tactics. Participants expressed widespread misperceptions about sweetened fruit‐flavoured drinks and toddler milks, including perceived healthfulness and benefits for children and confusion between sweetened and unsweetened drink categories (sweetened fruit‐flavoured drinks vs. juice, toddler milk vs. infant formula). They confirmed that common marketing strategies contributed to misperceptions, including front‐of‐package claims and marketing messages that imply benefits for children and/or hide problematic ingredients; cross‐branding and product extensions from trusted brands; side‐by‐side shelf placement at retailers; lower price than healthier products; and targeted marketing to children and parents. Some parents expressed anger about deceptive marketing and supported increased regulation and consumer education campaigns. Findings support the need for policies to address potentially misleading marketing of sweetened fruit‐flavoured drinks and toddler milks and revealed opportunities to reduce parents' provision of these drinks through countermarketing campaigns communicated via trusted sources. Marketing messages for sweetened fruit‐flavoured drinks and toddler milks can mislead parents to believe these sugar‐sweetened products are healthful options for young children. Parents described front‐of‐package label claims, images, and other marketing messages on sugar‐sweetened children's drinks as confusing, deceptive, and misleading. They also raised issues about targeted marketing to children and parents and lower prices for less‐healthy products. Findings support opportunities for countermarketing campaigns to correct misleading marketing messages and the need for government policies, such as restricting front‐of‐package claims and requiring consistent ingredient reporting, to assist parents in making healthier drink selections for their children.
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Affiliation(s)
- Frances Fleming-Milici
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | | | - Jennifer L Harris
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
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Choi YY, Andreyeva T, Fleming-Milici F, Harris JL. U.S. Households' Children's Drink Purchases: 2006-2017 Trends and Associations With Marketing. Am J Prev Med 2022; 62:9-17. [PMID: 34922654 DOI: 10.1016/j.amepre.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/20/2021] [Accepted: 06/11/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Sugar-sweetened beverages contribute a large proportion of added sugar in young children's diets; yet, companies market sugar-sweetened children's drinks extensively to children and parents. This study examines the changes in children's drink purchases by U.S. households with young children and the associations with marketing practices. METHODS Longitudinal Nielsen U.S. household panel data provided monthly volume purchases by children's drink category (sugar-sweetened fruit drinks and flavored water and unsweetened juices) among households with young children (aged 1-5 years) from 2006 to 2017. Differences by household race/ethnicity and income were assessed. The 2-part models examined the associations between household purchases and marketing (including price and brand TV advertising) for each category, controlling for sociodemographics. Data were collected and analyzed in 2019-2020. RESULTS Households' volume purchases of children's fruit drinks and unsweetened juices declined from 2006 to 2017, whereas flavored water purchases increased. Non-Hispanic Black households purchased significantly more fruit drinks (351.23 fluid ounces/month, 95% CI=342.63, 359.82) than non-Hispanic White (204.43 fluid ounces/month, 95% CI=201.81, 207.05) and Hispanic (222.63 fluid ounces/month, 95% CI=217.11, 228.15) households. Low-income households purchased more fruit drinks and fewer unsweetened juices than higher-income households (p<0.001). TV brand advertising was positively associated with purchases across all categories, and this relationship was stronger for low-income households (p<0.05). CONCLUSIONS Despite expert recommendations that young children do not consume Sugar-sweetened beverages, households with young children purchase more sweetened fruit drinks than unsweetened juices. Extensive TV advertising for children's drink brands may exacerbate the racial and income disparities in sugar-sweetened beverage purchases. Public health initiatives to address sugar-sweetened beverage consumption by young children and restrictions on marketing sugar-sweetened beverages to children are necessary.
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Affiliation(s)
- Yoon Y Choi
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut.
| | - Tatiana Andreyeva
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut; Department of Agricultural & Resource Economics, University of Connecticut, Storrs, Connecticut
| | | | - Jennifer L Harris
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut
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Jensen ML, Choi YY, Fleming-Milici F, Harris JL. Caregivers' Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling. Curr Dev Nutr 2022; 6:nzab151. [PMID: 35047722 PMCID: PMC8760421 DOI: 10.1093/cdn/nzab151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Against expert recommendations, sugar-sweetened beverages, especially fruit drinks, are consumed by young children. Misperceptions about drink ingredients and healthfulness can contribute to caregivers' provision. OBJECTIVES To assess caregivers' reasons for serving sweetened fruit-flavored drinks and unsweetened juices to their young children (1-5 y) and perceptions of product healthfulness and drink ingredients. METHODS A cross-sectional online survey assessed participants' (n = 1614) perceptions of sweetened fruit-flavored drinks (fruit drinks and flavored water) and unsweetened juices (100% juice and water/juice blends) provided to their child in the past month, including product healthfulness, reasons for providing, and knowledge of product ingredients [added sugar, nonnutritive sweeteners (NNSs), percentage juice]. One-factor ANOVA compared perceived healthfulness of drink categories and types of sugar and NNSs, and differences between participants who could compared with those who could not accurately identify drink ingredients. RESULTS Participants' top reasons for providing sweetened drinks included child liking it, being inexpensive, child asking for it, and being a special treat. Participants perceived 100% juice as healthiest, followed by juice/water blends, flavored waters, and, lastly, fruit drinks (P < 0.05). Many participants inaccurately believed the fruit drink or flavored water they served their child most often did not contain NNSs (59.0% and 64.9%) and/or added sugars (20.1% and 42.2%), when in fact they did, and 81.3-91.1% overestimated the percentage juice in the drink. Perceived healthfulness of fruit drinks was associated with caregivers' belief that the drink contained added sugar (P < 0.05), but not with their belief that it contained NNS; increased accuracy was associated with decreased perceived healthfulness (P < 0.05). CONCLUSIONS Inaccurate understanding of added sugar, NNSs, and percentage juice in drinks served to young children was common and could contribute to sugary drink provision. Public health efforts should seek to improve labeling practices and revise nutrition education messages.
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Affiliation(s)
- Melissa L Jensen
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- School of Nutrition, University of Costa Rica, San José, Costa Rica
| | - Yoon Y Choi
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Frances Fleming-Milici
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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Zancheta Ricardo C, Corvalán C, Smith Taillie L, Quitral V, Reyes M. Changes in the Use of Non-nutritive Sweeteners in the Chilean Food and Beverage Supply After the Implementation of the Food Labeling and Advertising Law. Front Nutr 2021; 8:773450. [PMID: 34859036 PMCID: PMC8630583 DOI: 10.3389/fnut.2021.773450] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 01/03/2023] Open
Abstract
Reductions on the sugars content of the food supply have been described after the initial implementation Chilean Labeling Law, but it is unclear if sugars were replaced by non-caloric sweeteners (NNS). We evaluated changes in the NNSs use in foods and beverages after the initial implementation of the labeling law. We used longitudinal data on packaged foods and beverages collected in six major supermarkets and three candy distributors in Santiago, Chile, in January-February 2015/2016 and in January-February 2017. We included in the analysis beverages, dairy-based beverages, yogurts, breakfast cereals, desserts and ice creams, candies and sweet confectioneries, and sweet spreads with a market share ≥1% of their food groups (n = 999). We compared the use of any NNS, the number of different NNSs used, and the combined use of NNSs and ingredients adding sugars using non-parametric tests for matched samples. We evaluated the association between a reduction in sugars and starting NNS use in the post-implementation period using negative binomial regression. The use of any NNS increased from 37.9 to 43.6% (p < 0.001) after the law's implementation, NNSs increased among beverages, dairy-based beverages, yogurts, and desserts and ice creams (p < 0.05), driven mostly by increases in sucralose and stevia use (p < 0.05). We found that reformulated products that reduced the amount of sugars below the law's cutoff were more likely to start using an NNS in the post-implementation period (prevalence ratio: 12.1; 95%CI: 7.2-20.2; p < 0.001). Our results suggest that NNSs likely replaced sugars after the initial implementation of the law. Further analyses should explore how these changes may impact NNS consumption.
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Affiliation(s)
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Vilma Quitral
- Escuela de Nutrición y Dietética, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Qi H, Dun J, Zhao F, Qi X. In-vitro and in-vivo evaluation of taste-masked ibuprofen formulated in oral dry emulsions. Drug Dev Ind Pharm 2021; 47:1318-1325. [PMID: 34605349 DOI: 10.1080/03639045.2021.1989458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to develop a pediatric oral preparation for ibuprofen. SIGNIFICANCE Ibuprofen is widely used for defervescence in children, but medication compliance is poor due to its bitter taste. Dry emulsions possess good stability and can be transported and stored in solid form; they can be dispersed into liquid emulsions with water and easily administered to children. METHODS In this study, a dry emulsion excipient was prepared by spray drying: a mixture of orange peel and corn oils (3:7, w/w) was used as the oil phase and solvent for ibuprofen; gum arabic and gum tragacanth were chosen as emulsifiers; and maltodextrin was used as a solid carrier. RESULTS The particle sizes of the liquid and reconstituted emulsions were 5.75 µm and 6.11 µm, respectively; the average particle size distribution of the dry emulsion powder was 8.13 µm; scanning electron microscopy showed that the dry emulsion powder was composed of evenly distributed smooth spheres. At a drug loading of 36.52 ± 1.15 mg/g, 90% of ibuprofen was released from the dry emulsion excipient within 30 min. Sensory evaluations using human volunteers, rats, and an electronic tongue demonstrated that the emulsion had a taste-masking effect on ibuprofen. It was further corroborated by in vivo studies using a rat model that highlighted a 1.76-fold increase in ibuprofen absorption when the drug was administered as an emulsion compared with granules. CONCLUSIONS These results indicate that the dry emulsion for taste-masking is promising and valuable in the development of ibuprofen for pediatrics.
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Affiliation(s)
- Haojun Qi
- Department of Pharmaceutics, School of Pharmacy, Hebei Medical University, Shijiazhuang, PR China
| | - Jiening Dun
- Department of Pharmaceutics, School of Pharmacy, Hebei Medical University, Shijiazhuang, PR China
| | - Feng Zhao
- Department of Pharmaceutics, School of Pharmacy, Hebei Medical University, Shijiazhuang, PR China
| | - Xiaodan Qi
- Department of Pharmaceutics, School of Pharmacy, Hebei Medical University, Shijiazhuang, PR China
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Harris JL, Pomeranz JL. Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children's drinks: Experimental and cross-sectional study with U.S. parents of young children (1-5 years). Pediatr Obes 2021; 16:e12791. [PMID: 33829664 DOI: 10.1111/ijpo.12791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/08/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experts recommend against serving sugary drinks and non-nutritive sweeteners to young children, but misperceptions about drink ingredients may contribute to consumption. OBJECTIVES Assess parents' ability to identify added sugar, non-nutritive sweeteners and juice in children's drinks. METHODS Researchers recruited U.S. parents of young children (1-5 years) through an online survey panel (N = 1603). In a randomized experiment, participants indicated whether eight popular children's drink products contained added sugar or non-nutritive sweeteners and percentage of juice after viewing (a) front-of-package alone or (b) front-of-package plus nutrition/ingredient information. Participants also viewed common statements of identity on children's drinks to identify product ingredients. RESULTS When viewing front-of-packages alone, most participants accurately identified products with (83%-90%) and without (51%-65%) added sugar. Showing nutrition/ingredient information increased accuracy. However, the majority could not identify drinks with non-nutritive sweeteners (53%-58%), and many incorrectly believed that unsweetened juices contained added sugar (38%-43%), sweetened flavoured waters had no added sugar (24%-25%), and 100% juice contained less than 100% juice (37%). Furthermore, the majority could not identify product ingredients from statement of identity terms. CONCLUSIONS Misperceptions about product ingredients under current labelling practices indicate that updated regulations are necessary, including clear disclosures of sweetener and juice content on package fronts.
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Affiliation(s)
- Jennifer L Harris
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Jennifer L Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York, USA
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25
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Inhibitory Effects of Artificial Sweeteners on Bacterial Quorum Sensing. Int J Mol Sci 2021; 22:ijms22189863. [PMID: 34576027 PMCID: PMC8472786 DOI: 10.3390/ijms22189863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Despite having been tagged as safe and beneficial, recent evidence remains inconclusive regarding the status of artificial sweeteners and their putative effects on gut microbiota. Gut microorganisms are essential for the normal metabolic functions of their host. These microorganisms communicate within their community and regulate group behaviors via a molecular system termed quorum sensing (QS). In the present study, we aimed to study the effects of artificial sweeteners on this bacterial communication system. Using biosensor assays, biophysical protein characterization methods, microscale thermophoresis, swarming motility assays, growth assays, as well as molecular docking, we show that aspartame, sucralose, and saccharin have significant inhibitory actions on the Gram-negative bacteria N-acyl homoserine lactone-based (AHL) communication system. Our studies indicate that these three artificial sweeteners are not bactericidal. Protein-ligand docking and interaction profiling, using LasR as a representative participating receptor for AHL, suggest that the artificial sweeteners bind to the ligand-binding pocket of the protein, possibly interfering with the proper housing of the native ligand and thus impeding protein folding. Our findings suggest that these artificial sweeteners may affect the balance of the gut microbial community via QS-inhibition. We, therefore, infer an effect of these artificial sweeteners on numerous molecular events that are at the core of intestinal microbial function, and by extension on the host metabolism.
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Diet Beverage Intake during Lactation and Associations with Infant Outcomes in the Infant Feeding Practices Study II. Nutrients 2021; 13:nu13093154. [PMID: 34579031 PMCID: PMC8472746 DOI: 10.3390/nu13093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants' weight and health. This study aims to examine cross-sectional associations between infants' LCS exposure via maternal DB intake during lactation and infants' health outcomes. Six hundred and eighty-two mother-infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005-2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants' LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants' LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants' LCS exposure and BMI-for-age or risk of overweight, infants' LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05-7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.
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Hofman KJ, Stacey N, Swart EC, Popkin BM, Ng SW. South Africa's Health Promotion Levy: Excise tax findings and equity potential. Obes Rev 2021; 22:e13301. [PMID: 34060197 PMCID: PMC8349837 DOI: 10.1111/obr.13301] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/26/2022]
Abstract
In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened.
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Affiliation(s)
- Karen J Hofman
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Nicholas Stacey
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa.,DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Nutritional Strategies for Childhood Obesity Prevention. Life (Basel) 2021; 11:life11060532. [PMID: 34201017 PMCID: PMC8227398 DOI: 10.3390/life11060532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the spread of obesity represents a challenge for clinicians in which obesity prevention plays a key role in achieving this purpose. The aim of this review is to analyze the nutritional interventions that can be implemented to prevent childhood obesity. METHODS Searching PubMed and Cochrane Library between 2019 and 2021. Further searching with no date range for articles selected for their specific relevance in the pediatric area or for their scientific relevance. A total of 871 articles were identified and 90 were included. RESULTS We organized the results of the selected articles into age groups, and according to the subjects targeted for interventions or to the site of interventions, reserving an in-depth analysis on specific nutritional aspects. Promotion of breastfeeding, reduction of protein content of formulated milks, and diet of the first 12-24 months, involving family and schools in interventions that promote physical activity and healthy diet, are promising strategies for reduction of the risk of obesity. To increase the efficacy of interventions, a multidimensional approach is crucial. CONCLUSIONS A multidimensional approach, which takes into consideration different areas of intervention, is pivotal for childhood obesity prevention. Integrated programs involving several components (nutrition and physical activity at first) at different levels (individual, family, school, and institutional) are crucial.
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Fitch SE, Payne LE, van de Ligt JLG, Doepker C, Handu D, Cohen SM, Anyangwe N, Wikoff D. Use of acceptable daily intake (ADI) as a health-based benchmark in nutrition research studies that consider the safety of low-calorie sweeteners (LCS): a systematic map. BMC Public Health 2021; 21:956. [PMID: 34016063 PMCID: PMC8138992 DOI: 10.1186/s12889-021-10934-2] [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: 07/29/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is well-recognized that consumers face many challenges in understanding and applying nutritional guidance for low-calorie sweeteners (LCS). Thus, this research aims to (1) assess how benchmarks for safe levels of consumption of LCS are utilized by researchers, and (2) understand how varying use of such benchmarks may contribute to challenges in understanding and applying nutritional guidance for LCS consumption. METHODS A systematic mapping exercise was employed to characterize when and how acceptable daily intake (ADI) values are used as health-based benchmarks in nutrition research studies that consider the safety of LCS. RESULTS Based on results from charting 121 studies, our findings demonstrate that comparisons of LCS intake to an ADI derived by an authoritative body have been made in a diverse set of published literature, varying widely in their objectives, approaches, and populations of interest. The majority of studies compared the ADI to intake in a population under study; these represent the type of comparison that is most consistent with the intent of the ADI. Other applications of the ADI included use as a benchmark in experimental studies, risk-benefit analyses, and metabolism studies. CONCLUSION Although most instances of ADI use were reasonable within the context of the individual studies' objectives, the diversity in use by original-study authors amplifies the continued need for development of "best practices" regarding the use and interpretation of the ADIs in current research. Using comparisons to the ADI can be a helpful way to provide context to research findings. However, in doing so, it is important that researchers utilize the value in a manner specific with its intent, as the ADI is a metric that represents an estimate of the amount of a substance that can be consumed daily over a lifetime without presenting an appreciable risk to health.
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Affiliation(s)
- Seneca E Fitch
- ToxStrategies, 23501 Cinco Ranch Blvd, Suite B226, Katy, TX, 77494, USA
| | - Lauren E Payne
- ToxStrategies, 31 College Place, Suite B118, Asheville, NC, 28801, USA
| | - Jennifer L G van de Ligt
- ToxStrategies, 23501 Cinco Ranch Blvd, Suite B226, Katy, TX, 77494, USA
- College of Veterinary Medicine, University of Minnesota, 1365 Gortner Ave, St Paul, MN, 55108, USA
| | - Candace Doepker
- ToxStrategies, 187 Pavilion Pkwy #223, Newport, KY, 41071, USA
| | - Deepa Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL, 60606, USA
| | - Samuel M Cohen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE, USA
| | - Njwen Anyangwe
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, 5001 Campus Drive, College Park, MD, 20740, USA
| | - Daniele Wikoff
- ToxStrategies, 31 College Place, Suite B118, Asheville, NC, 28801, USA.
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Rationale and design of DRINK-T1D: A randomized clinical trial of effects of low-calorie sweetener restriction in children with type 1 diabetes. Contemp Clin Trials 2021; 106:106431. [PMID: 33974993 DOI: 10.1016/j.cct.2021.106431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low-calorie sweeteners (LCSs) provide sweetness without sugar or calories and are used to replace added sugars by many children with type 1 diabetes (T1D). However, the role of LCSs in diabetes management and cardiometabolic health is unclear. OBJECTIVE The Diabetes Research in Kids Study (DRINK-T1D) aims to investigate effects of LCS restriction on glycemic variability, visceral adiposity, lipid profiles, and systemic inflammation among children 6-12 years old with T1D. METHODS Children with T1D, who report habitual consumption of foods and beverages containing LCSs, are recruited from the Washington Nationals Diabetes Care Complex (DCC) at Children's National Hospital (CNH) in Washington, DC. Following a phone screening and two-week run-in period involving continuation of usual LCS intake, children are randomized to 12 weeks of LCS restriction (replacement of diet beverages with still or sparkling water and avoidance of other sources of LCSs) or continued usual LCS intake (control). The primary outcome is the difference in change in glycemic variability in the LCS restriction group versus the control group. Change in glycemic variability will be assessed as the difference in daily average time-in-range (TIR), measured using continuous glucose monitoring (CGM) during two weeks at the end of the 12-week intervention, compared with during the two-week run-in period prior to randomization. Participants also complete a variety of anthropometric, metabolic, dietary, and behavioral assessments throughout the 14-week study. CONCLUSIONS DRINK-T1D is an innovative, randomized controlled trial, evaluating effects of LCS restriction on glycemic variability and cardiometabolic health in children with T1D. Findings of DRINK-T1D will support or challenge the common practice of recommending LCS use in this patient population and will have clinically relevant implications for pediatric T1D management. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04385888.
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Normand M, Ritz C, Mela D, Raben A. Low-energy sweeteners and body weight: a citation network analysis. BMJ Nutr Prev Health 2021; 4:319-332. [PMID: 34308140 PMCID: PMC8258071 DOI: 10.1136/bmjnph-2020-000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions. DESIGN A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited. MAIN OUTCOME MEASURES (OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews. RESULTS From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies. CONCLUSIONS Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW. TRIAL REGISTRATION NUMBER Prior to data analysis, the protocol was registered with the Open Science Framework (https://osf.io/9ghws).
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Affiliation(s)
- Mie Normand
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | | | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Hojsak I, Chourdakis M, Gerasimidis K, Hulst J, Huysentruyt K, Moreno-Villares JM, Joosten K. What are the new guidelines and position papers in pediatric nutrition: A 2015-2020 overview. Clin Nutr ESPEN 2021; 43:49-63. [PMID: 34024560 DOI: 10.1016/j.clnesp.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations. METHODS The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice. RESULTS Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables. CONCLUSION Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.
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Affiliation(s)
- Iva Hojsak
- Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia; University J.J. Strossmayer Medical School, Osijek, Croatia.
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, Royal Hospital for Sick Children, University of Glasgow, Glasgow, United Kingdom.
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics and Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Koen Huysentruyt
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | | | - Koen Joosten
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, the Netherlands.
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Sylvetsky AC, Chandran A, Talegawkar SA, Welsh JA, Drews K, El Ghormli L. Consumption of Beverages Containing Low-Calorie Sweeteners, Diet, and Cardiometabolic Health in Youth With Type 2 Diabetes. J Acad Nutr Diet 2021; 120:1348-1358.e6. [PMID: 32711855 DOI: 10.1016/j.jand.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low-calorie sweetened beverages (LCSBs) are commonly used as a lower-calorie alternative to sugar-sweetened beverages (SSBs) by individuals with type 2 diabetes. However, little is known about how intake of LCSBs is related to dietary intake and cardiometabolic health, particularly among youth. OBJECTIVE To test the hypothesis that having higher baseline LCSB intake and increasing LCSB intake over 2 years of follow-up are associated with poorer dietary intake and higher cardiometabolic risk factors among youth enrolled in the Treatment Option for Type 2 Diabetes in Adolescents and Youth (TODAY) study. DESIGN Secondary, exploratory, analysis of baseline and longitudinal data from the TODAY study, which was a randomized, multisite trial conducted from 2004 to 2012, to compare effects of 3 interventions (metformin alone, metformin + rosiglitazone, and metformin + intensive lifestyle intervention) on glycemic control in youth with type 2 diabetes. PARTICIPANTS/SETTING The study included 476 children and adolescents (10-17 years, mean body mass index 34.9 ± 7.8 kg/m2), who were participants in the multicenter (n = 15) TODAY study. MAIN OUTCOME MEASURES Diet was assessed using a food frequency questionnaire. Differences in energy intake, macronutrients, food group intakes, and cardiometabolic biomarkers were evaluated in 3 groups of LCSB consumers at baseline (low [1-4 servings/wk], medium [5-11 servings/wk], and high [≥12 servings/wk]), each compared with nonconsumers, and between 4 groups of change in LCSB intake (nonconsumption at start of study and nonconsumption after 2 years, increase in consumption after 2 years, decrease in consumption after 2 years, and high consumption at start of study and high consumption after 2 years). STATISTICAL ANALYSES PERFORMED Multivariable linear regression was performed at baseline and longitudinally over 2 years of follow-up. RESULTS Energy (kilocalories), fiber, carbohydrate, total fat, saturated fat, and protein intake (grams) were higher among high LCSB consumers compared with nonconsumers at baseline. No associations were observed between LCSB consumption and cardiometabolic risk factors at baseline. Change in LCSB intake between baseline and follow-up was not associated with change in energy intake or cardiometabolic risk factors. Participants who decreased LCSB consumption reported greater increases in sugar intake (18.4 ± 4.8 g) compared with those who increased LCSB consumption (5.7 ± 4.9 g) or remained high LCSB consumers (5.9 ± 7.4 g), but this trend was not statistically significant after a correction for multiple testing. CONCLUSIONS LCSB consumption was associated with higher energy intake in youth with type 2 diabetes, with the highest energy intakes reported in high LCSB consumers. Those who reduced LCSB consumption tended to report greater increases in sugar intake during follow-up, but further studies are needed to better understand this trend.
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Genovesi S, Giussani M, Orlando A, Orgiu F, Parati G. Salt and Sugar: Two Enemies of Healthy Blood Pressure in Children. Nutrients 2021; 13:nu13020697. [PMID: 33671538 PMCID: PMC7927006 DOI: 10.3390/nu13020697] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of essential arterial hypertension in children and adolescents has grown considerably in the last few decades, making this disease a major clinical problem in the pediatric age. The pathogenesis of arterial hypertension is multifactorial, with one of the components being represented by incorrect eating habits. In particular, excessive salt and sugar intake can contribute to the onset of hypertension in children, particularly in subjects with excess weight. Babies have an innate predisposition for sweet taste, while that for salty taste manifests after a few weeks. The recent modification of dietary styles and the current very wide availability of salt and sugar has led to an exponential increase in the consumption of these two nutrients. The dietary intake of salt and sugar in children is in fact much higher than that recommended by health agencies. The purpose of this review is to explore the mechanisms via which an excessive dietary intake of salt and sugar can contribute to the onset of arterial hypertension in children and to show the most important clinical studies that demonstrate the association between these two nutrients and arterial hypertension in pediatric age. Correct eating habits are essential for the prevention and nondrug treatment of essential hypertension in children and adolescents.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (F.O.); (G.P.)
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, 20100 Milan, Italy;
- Correspondence: ; Tel.: +39-0392332376
| | - Marco Giussani
- Family Pediatrician, Agenzia Tutela Salute, 20100 Milan, Italy;
| | - Antonina Orlando
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, 20100 Milan, Italy;
| | - Francesca Orgiu
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (F.O.); (G.P.)
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (F.O.); (G.P.)
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, 20100 Milan, Italy;
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Gallagher AM, Ashwell M, Halford JCG, Hardman CA, Maloney NG, Raben A. Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference. J Nutr Sci 2021; 10:e7. [PMID: 33889390 PMCID: PMC8057368 DOI: 10.1017/jns.2020.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.
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Affiliation(s)
- Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, ColeraineBT52 1SA, Northern Ireland, UK
| | | | | | | | - Niamh G. Maloney
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, FrederiksbergDK-1958, Denmark
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Rozga M, Handu D. Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2501-2523. [PMID: 33495106 DOI: 10.1016/j.jand.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.
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Duffy EW, Hall MG, Dillman Carpentier FR, Musicus AA, Meyer ML, Rimm E, Smith Taillie L. Nutrition Claims on Fruit Drinks Are Inconsistent Indicators of Nutritional Profile: A Content Analysis of Fruit Drinks Purchased by Households With Young Children. J Acad Nutr Diet 2021; 121:36-46.e4. [PMID: 32978105 PMCID: PMC7752796 DOI: 10.1016/j.jand.2020.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fruit drinks are the most commonly consumed sugar-sweetened beverage among young children. Fruit drinks carry many nutrition-related claims on the front of package (FOP). Nutrition-related claims affect individuals' perceptions of the healthfulness of products and purchase intentions, often creating a "health halo" effect. OBJECTIVE The aims of this study were to describe the prevalence of FOP nutrition-related claims on fruit drinks purchased by households with young children and to examine the association between claims and the nutritional profile of fruit drinks. DESIGN The sample included 2059 fruit drinks purchased by households with children 0 to 5 years old participating in Nielsen Homescan in 2017. FOP labels were obtained from 2 databases that contain bar code-level information on all printed material on product labels. A codebook was used to code for presence of FOP nutrition-related claims. The coded claims data were linked by bar code with Nutrition Facts label data. Claim type prevalence was calculated, and the association between claim types and median calories and total grams of sugar per 100 mL was analyzed using Wilcoxon rank-sum tests. The percentages of products containing noncaloric sweeteners (NCSs) with and without each claim type were also calculated and compared. RESULTS Almost all (97%) fruit drinks sampled had at least 1 nutrition-related FOP claim. Implied natural claims such as "natural flavors" were the most common (55% of products), followed by claims about the presence of juice or nectar (49%). Claims about vitamin C (33%), sugar (29%), and calories (23%) were also common. Fruit drinks with vitamin C, juice or nectar, fruit or fruit flavor, and overt natural claims were higher in calories and sugar and less likely to contain NCSs compared with products without these claims. Fruit drinks with calorie, sugar, NCS, implied natural, and other claims were lower in calories and sugar and more likely to contain NCSs compared with products without these claims. CONCLUSIONS Claims are prevalent on fruit drinks purchased by households with young children. This is concerning given prior research demonstrating that claims can mislead consumers. Regulatory actions such as requiring a warning or disclosure on drinks that contain added sugars or NCSs should be considered.
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Affiliation(s)
- Emily W Duffy
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | | | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michele L Meyer
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lindsey Smith Taillie
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC.
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The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) can begin in youth. Prevention is essential to reducing the burden of CVD-related risk factors in childhood and disease development in adulthood. This review addresses the clinical scope of CVD prevention, including a review of conditions encountered, proposed diagnostic criteria, and management strategies. We also highlight the impact of the intrauterine environment on the development of CVD risk. Finally, we highlight the potential role of telehealth in the management of pediatric patients with risk factors for premature CVD. RECENT FINDINGS Growing evidence suggests that maternal obesity, diabetes, and preeclampsia may play an important role in the development of CVD risk among offspring contributing to the development of known traditional CVD risk factors among offspring. As the prevalence of CVD continues to rise, knowledge as well as appropriate diagnosis and management of primordial and traditional risk factors for CVD is needed. The diagnosis and management of CVD risk factors is a central role of the preventive pediatric cardiologist, but it is imperative that the general physician and other pediatric subspecialists be aware of these risk factors, diagnoses, and management strategies. Finally, telehealth may offer an additional method for providing preventive care, including screening and counseling of at risk children and adolescents for traditional risk factors and for providing education regarding risk factors in cases of long distance care and/or during periods of social distancing.
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Torres-Álvarez R, Barrán-Zubaran R, Canto-Osorio F, Sánchez-Romero LM, Camacho-García-Formentí D, Popkin BM, Rivera JA, Meza R, Barrientos-Gutiérrez T. Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study. Pediatr Obes 2020; 15:e12636. [PMID: 32282131 DOI: 10.1111/ijpo.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/29/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In Mexico, a 10% tax to sugar-sweetened beverages was implemented in 2014. Projections of the potential health effect of this tax in children are not available. OBJECTIVE To estimate the 1-year effect of the tax on the body weight of children 5 to 17 years old, and estimated alternative scenarios with higher tax rates (20%, 30%, and 40%). METHODS We used a dynamical mathematical model, recalibrated to the Mexican population. Input data were obtained from the Mexican National Health and Nutrition Survey 2006 and 2012. We estimated the expected average weight reduction, stratified by category of sugar-sweetened beverages consumption. RESULTS With a 10% tax, we estimated an overall weight reduction of 0.26 kg for children and 0.61 kg for adolescents; in high consumers, the reduction could reach 0.50 and 0.87 kg, respectively. Higher tax rates would produce larger weight decreases; in high consumers a 40% tax would result in a reduction of 1.99 kg for children and 3.50 kg for adolescents. CONCLUSION The tax represents an effective component of any child or adolescent weight control program, and must be considered as part of any integrated population-level program for children and adolescent obesity prevention.
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Affiliation(s)
- Rossana Torres-Álvarez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rodrigo Barrán-Zubaran
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz M Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | | | - Barry M Popkin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Role of different nutrient profiling models in identifying targeted foods for front-of-package food labelling in Brazil. Public Health Nutr 2020; 24:1514-1525. [PMID: 32515717 PMCID: PMC8025091 DOI: 10.1017/s1368980019005056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels. Design: Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version. Setting: Brazil. Results: Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories. Conclusions: We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.
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Piekara A, Krzywonos M, Pstrowska K. Lollipop supplements- nutrient-dense foods or sweets in disguise? J Food Compost Anal 2020. [DOI: 10.1016/j.jfca.2020.103436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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