Intake of Sugar-Sweetened Beverages in Adolescents from Troms, Norway-The Tromsø Study: Fit Futures

Sugar-Sweetened Beverage Consumption and Its Association With Dental Caries Among Adolescents in Erbil, Iraq: A Cross-Sectional Study

Background Sugar-sweetened beverages are one of the most common sources of added sugar in the diet and have been associated with an increased risk of dental caries, obesity, major chronic diseases, and possibly cancer. Dental caries is a diet-related, highly prevalent, and preventable oral disease. The objective of this study was to assess the frequency of sugar-sweetened beverage consumption and its association with dental caries in adolescents in Erbil, Iraq. Methods This is a cross-sectional study that invited 11- to 16-year-old intermediate school students (n=380) in Erbil, Iraq. Data collection comprised a validated questionnaire and a clinical examination. In addition, dietary data were collected by using two non-consecutive 24-hour recalls. The mean of the daily consumption of sugar-sweetened beverages over a two-day period was calculated. Dental caries was diagnosed based on World Health Organization (WHO) criteria and was reported as a decayed, missing, and filled permanent tooth (DMFT). A multiple regression model was used to assess the influence of sugar-sweetened beverages on dental caries experience (DMFT). SPSS version 26 (Armonk, NY: IBM Corp) was used to analyze the data at the 5% significance level. Results Of the 380 students interviewed, one participant was excluded because of incomplete data. The participant's mean age and standard deviation (SD) were 13.3±1.2. A total of 54.1% of the students were female. The mean daily intake of sugar-sweetened beverages was 686.71±197.50 mL per day. Male students consumed more beverages than female students (p<0.001). The most frequently consumed sugar-sweetened beverages were sweetened tea and coffee, and the least frequently consumed beverages were milk and dairy products. The mean decayed, missing, and filled permanent tooth (DMFT) was 94.58±2.73. Results of multiple regression analysis showed that caries experience (DMFT) was associated with insufficient toothbrushing (p<0.001), plaque-affected sextants (p=0.001), and male sex (p=0.016). The model also showed a significant association between sugar-sweetened beverage consumption and dental caries experience (DMFT) (regression coefficient=0.008, CI: 0.006-0.009, p<0.001). Conclusions Adolescents in Erbil, Iraq, consumed sugar-sweetened beverages on a frequent basis, and male students consumed more sugary beverages than females. The higher frequency of these beverage consumptions was associated with a higher dental caries experience. Consequently, reducing sugar-sweetened beverage consumption could have a significant positive public health impact.

Children’s Participation in Free School Meals: A Qualitative Study among Pupils, Parents, and Teachers

School meals can have a key function in promoting children’s health. However, simply providing a free school meal is not a guarantee that pupils will eat the food. The purpose of this study was to explore factors influencing pupils’ participation in free school meal schemes in Oslo. The study has a qualitative research design, inspired by grounded theory. Data were collected through interviews with pupils, teachers, and parents, and participant observations in two schools participating in a pilot project funded by Oslo Municipality. Line-by-line coding, memo writing, and a constant comparative technique were used to analyze the data. One primary school and one lower-secondary school in different districts in Oslo that were implementing two different free school meal models took part in the study. In total, 39 pupils (5th–10th grade), 15 parents, and 12 school employees were included. Four main factors related to pupils’ participation in free school meals emerged from the analysis: the popularity of the food served, the attraction to the nearby shopping center, social aspects, and predictability. To promote pupils’ participation in free school meal schemes, schools need to solve the challenges of balancing between healthy food and popular but often unhealthy food. To implement school meals further, children and parents’ involvement, regularity of the meals provision, a good flow of information, and the creation of a friendly eating environment are recommended.

Limited consumption of 100% fruit juices and sugar sweetened beverages in Japanese toddler and preschool children

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Low total 100% fruit juice and SSB intake for Japanese children.

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Comparable rates of beverage introduction for Japanese and North American children.

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Higher proportional dairy/milk drink consumption for Japanese than North American children.

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Low SSB consumption may contribute to lower obesity rate in Japanese children.

Japanese toddler and preschool children, ages 1.5–5 years, have lower rates of obesity, ≥95 th percentile body mass index, compared with North American ones. We examined parental reported beverage consumption patterns in 3 Japanese based mother-child cohorts from three different regions of Japan compared with data from cross-sectional and longitudinal studies from North America. Specifically, we used data from the Hamamatsu Birth Cohort for Mothers and Children (HBC Study) in Hamamatsu (Shizuoka Prefecture), the Seiiku Boshi Birth Cohort from Setagaya, Tokyo and the TMM BirThree Cohort Study from Miyagi. We additionally compared cross-sectional data from preschoolers from 24 prefectures in Japan as previously reported from a national study. While Japanese children had lower but comparable rates to North American children for introduction of sugar-sweetened beverages and 100% fruit juices, Japanese children consumed these beverages daily at a much lower level than North American children. Additionally, North American children may get more added sugars from soda and fruit juices as a relative percentage of total added sugar. By contrast, Japanese children consume more sweetened dairy drinks as a relative percentage of total added sugar. Sweetened dairy drinks may have the added benefits of including fats, calcium and probiotics which may be associated with lower risk for obesity compared with consumption of other types of sugar sweetened beverages.

Determinants of the Consumption of Regular Soda, Sport, and Energy Beverages in Spanish Adolescents

Increasing sugar-sweetened beverages (SSB) consumption and associated health impacts warrant health-policy action. We assessed associations of socioeconomic and lifestyle variables with adolescents’ consumption of regular soda (RSD), sport (SD), and energy (ED) drinks. Cross-sectional study of 3930 Spanish adolescents (2089 girls, 1841 boys) aged 13–18 years). We compared frequency of consuming each SSB type (European Food Safety Authority questionnaire) with sociodemographic and lifestyle variables (standardized questions). RSD, SD, and ED were consumed at least weekly by 72.7%, 32.3%, and 12.3% of participants, respectively, and more frequently (p < 0.001) by boys, compared to girls. Multivariate ordinal logistic regression showed inverse association between RSD, SD, and ED consumption and parental occupation-based socioeconomic status (p < 0.01). Daily smoking was associated (p < 0.001) with higher ED (OR 3.64, 95% CI 2.39–5.55) and RSD (OR 2.15, 95% CI 1.56–2.97) consumptions. SD intake was associated inversely with smoking (OR 0.60, 95% CI 0.40–0.89, p = 0.012) and directly with physical activity (OR 2.93, 95% CI 2.18–3.95, p < 0.001). School performance was lower among ED (OR 2.14, 95% CI, 1.37–3.35, p = 0.001) and RSD (OR 1.81, 95% CI 1.24–2.64, p = 0.002) consumers, compared to SD. Maleness and low socioeconomic status predicted SSB consumption. Smoking and low school performance were associated with higher ED and RSD intakes.

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

Background

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

Methods

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

Results

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

Conclusions

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

Health behavior patterns of sugar-sweetened beverage consumption among Brazilian adolescents in a nationally representative school-based study

Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12-17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Next Steps for Interventions Targeting Adolescent Dietary Behaviour

Adolescents in many countries consume poor quality diets that include high intakes of sugary drinks and fast food and low intakes of vegetables. The aims of this Special Issue on adolescent dietary behaviour were to identify methods and approaches for successful interventions to improve diet quality in this age group and identify at risk subgroups that need particular attention. In total, 11 manuscripts were published in this Special Issue-three qualitative studies which included a systematic review, five cross-sectional studies and three quantitative evaluations of interventions. This Editorial discusses the contribution of the studies and provides suggestions to improve the success of future interventions in adolescents. It is important that adolescents are involved in the design of interventions to improve social and cultural acceptability and relevance. Interventions targeting schools or communities framed within a larger food system such as issues around climate change and the carbon footprint of food may improve engagement. Furthermore, targeting adolescents in areas of lower deprivation is a priority where diet quality is particularly poor. Potentially successful interventions also include environmental policies that impact on the cost and marketing of food and drinks, although evaluations of these were not included in this issue.

Time trends (1995-2008) in dietary habits among adolescents in relation to the Norwegian school fruit scheme: the HUNT study

INTRODUCTION

The importance of healthy eating in adolescence is well established. The present study examined possible effects of the free Norwegian School Fruit Scheme (NSFS), changes in dietary habits between 1995 and 2008, and whether secular changes in dietary habits differed among schools who implemented the NSFS during September 2007.

METHOD

We used data from the Young-HUNT1 survey conducted from 1995 to 1997 and the Young-HUNT3 survey conducted from 2006 to 2008, which are part of the Nord-Trøndelag Health Study (HUNT), a longitudinal population health study. To evaluate the NSFS, the date Young-HUNT3 participants answered the questionnaire was used to identify affiliation to the intervention group (post-September 2007, n = 1892) or control group (pre-September 2007, n = 2855). To explore dietary habits over time, adolescents attending the same schools in Young-HUNT1 (n = 4137) and Young-HUNT3 (n = 4113) were included. Further, we investigated secular changes in dietary habits according to school type (intervention schools vs control schools). In all analysis, we explored possible differential effects according to socioeconomic status (SES) and gender. A questionnaire measured adolescents' consumption of fruit, vegetables, candy, potato chips, sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB). Educational intention was used as a proxy for SES. Multilevel logistic regression was used.

RESULTS

Within Young-HUNT3, the intervention group showed increased odds of daily consumption of fruit (aOR 1.7, 95% CI = 1.3-2.4) compared to the control group. Over time, adolescents were more likely to consume fruit (aOR = 1.48, 95% CI = 1.28-1.71), vegetables (OR = 1.41, 95% CI = 1.28-1.53), potato chips (aOR = 1.60, 95% CI = 1.26-2.04) and SSB (OR = 2.02, 95% CI = 1.66-2.45). Secular changes for fruit differed by school type: adolescents in intervention schools had higher odds of daily consumption (aOR = 1.82, 95% CI = 1.38-2.38) than those in control schools (aOR 1.26, 95% CI = 1.07-1.47).

CONCLUSION

The results indicated that the NSFS increased adolescents' fruit consumption. In the period assessed, the study identified positive and negative changes in adolescents' dietary habits.