The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased

The impact of non-nutritive sweeteners on fertility, maternal and child health outcomes: a review of human and animal studies

There is significant evidence that an unhealthy diet greatly increases the risk of complications during pregnancy and predisposes offspring to metabolic dysfunction and obesity. While fat intake is typically associated with the onset of obesity and its comorbidities, there is increasing evidence linking sugar, particularly high fructose corn syrup, to the global rise in obesity rates. Furthermore, the detrimental effects of added sugar intake during pregnancy on mother and child have been clearly outlined. Guidelines advising pregnant women to avoid food and beverages with high fat and sugar have led to an increase in consumption of 'diet' or 'light' options. Examination of some human birth cohort studies shows that heavy consumption (at least one beverage a day) of non-nutritive sweetener (NNS) containing beverages has been associated with increased risk of preterm birth and increased weight/BMI in male offspring independent of maternal weight, which appears to be offset by breastfeeding for 6 months. Rodent models have shown that NNS exposure during pregnancy can impact maternal metabolic health, adipose tissue function, gut microbiome profiles and taste preference. However, the mechanisms underlying these effects are multifaceted and further research, particularly in a translational setting is required to fully understand the effects of NNS on maternal and infant health during pregnancy. Therefore, this review examines maternal sweetener intakes and their influence on fertility, maternal health outcomes and offspring outcomes in human cohort studies and rodent models.

Effects of the COVID-19 Pandemic on Dairy Consumption Trends: An Empirical Investigation of Accounting Data in China

The COVID-19 pandemic may have had a negative impact on dairy consumption trends. Many dairy products are perishable and have relatively high income elasticity, causing their susceptibility to market fluctuations in general, including those specifically caused by the pandemic. However, the pandemic has also brought some other prospective possibilities. For example, during the pandemic, people paid more attention to nutrition and health issues and increased the number of meals prepared and eaten at home. In consideration of the particular circumstances during the pandemic, the Chinese government issued several policies to promote the population's dairy consumption, and the Chinese dairy cattle sector actively implemented the policy of "guarantee price, quality, and supply". These factors may have caused the Chinese population to increase their consumption of dairy products during the pandemic. Before the pandemic, the consumption of dairy products in the Chinese population showed an overall upward trend. The question addressed in this study is how has COVID-19 affected dairy consumption trends during the pandemic? This study uses accounting data from the Chinese dairy cattle sector to empirically analyze the impact of the COVID-19 pandemic on dairy consumption trends through economic theories and translog revenue function. Our study found that COVID-19 increased consumers' consumption of dairy products in China, but those people experiencing poverty may still have experienced inadequate dairy intake. This study has contributed to the body of work in this area in the literature and provides response strategies for the dairy cattle sector and the authorities.

Generating Political Commitment for Regulatory Interventions Targeting Dietary Harms and Poor Nutrition: A Case Study on Sugar-Sweetened Beverage Taxation in Australia

BACKGROUND

Sugar-sweetened beverage (SSB) taxes are an effective public health policy intervention for improving nutrition and public health. Although implemented in over 50 jurisdictions worldwide, this intervention remains vastly underutilised, and in Australia political commitment for such a tax is low. The aim of this study is to understand the politics of SSB taxation in Australia, what factors have constrained political commitment for a tax, and what might enable such commitment in future.

METHODS

We adopted a case study design, guided by a theoretical framework developed from the political economy of nutrition literature. Data were collected from 16 interviews with informants from multiple sectors, supported by media articles, journal articles, and grey literature. Data were coded and organized by thematic analysis, and synthesised into the final results.

RESULTS

Nutrition actors have made significant progress in generating commitment for a SSB tax by producing relevant evidence, raising awareness, advocating for action, employing resonating frames, collaborating with civil society organisations, and forming coalitions increasing their overall cohesion. Nevertheless, political commitment for a SSB tax is low and was found to be impeded by the powerful influence of the food, beverage, and sugar industries, opposition from both major Australian political parties, ideological resistance to regulation, a low quality monitoring and surveillance system for food and nutrition, and limited public advocacy. The influence of nutrition actors was also impeded by weak connections to key policy-makers and missed collaborative opportunities with pro-SSB tax organisations.

CONCLUSION

The identification of several impediments provides an explanation for why political commitment for a SSB tax is low in Australia and reveals several opportunities for how it might be generated in the future. Political commitment may come about through, for example, actions to limit the influence of industry in policy decision-making, and by strengthening the existing pro-SSB tax coalition.

The effect of aspartame and sucralose intake on body weight measures and blood metabolites: role of their form (solid and/or liquid) of ingestion

The ingestion of non-caloric sweeteners (NCS) from food and/or drink was intended to reduce caloric intake without compromising palatability. However, the inconclusive relation between NCS and body weight may partially relate to their form of ingestion (solid or liquid). Thus, two paralleled experiments (aspartame and sucralose) were conducted. In each, Sprague Dawley rats (7-week-old male) were randomly divided into four groups. In Expt 1, aspartame (0·05 %) was added to the diet (AD) or drinking water (AW) or both diet and water (ADW), and a control group (C) was given a non-sweetened diet with plain water. In Expt 2, sucralose (0·016 %) was similarly provided in the diet (SD) or drinking water (SW) or both diet and water (SDW), with a control group (C). All rats had free access to food and water for 7 weeks. Energy intake, body weight and body composition were monitored and blood metabolites were determined. Results showed that aspartame ingestion significantly increased body weight and fat mass mainly due to an increase in energy efficiency. The effect was related to the amount rather than the form of ingestion. Additionally, aspartame ingestion was associated with glucose intolerance. Sucralose ingestion had a similar impact to that of aspartame though to a lesser extent. In conclusion, 7-week ingestion of aspartame and sucralose had adverse effects on body measures that were not related to the form of ingestion.

The Impact of the COVID-19 Pandemic on Food Consumption Behavior: Based on the Perspective of Accounting Data of Chinese Food Enterprises and Economic Theory

Since the outbreak of the COVID-19 pandemic, the rapid spread of COVID-19 around the world has become one of the main focuses of concern in almost every country, and governments have taken numerous measures to prevent/mitigate the spread of the disease. As an essential social determinant, COVID-19 has significantly impacted consumers' food consumption behavior and healthy eating habits/behaviors. The purpose of this study is to analyze the impact of COVID-19 on food consumption behavior, and the main goal was to assess the possible problems (such as food waste and weight gain) caused by changes in food consumption behavior during the pandemic. Based on the accounting data of Chinese enterprises found in the China Stock Market and Accounting Research (CSMAR) database, this study uses economic theory and the translog function to conduct an average partial effect (APE) analysis of the pandemic, and finds that the COVID-19 pandemic has increased Chinese people's overall food consumption, and the consumption of food from large food enterprises has increased even more (APE = 0.11 vs. APE = 0.31). This study suggests that food waste and weight gain in the Chinese population may be more severe during the pandemic, and it is necessary to enhance food management and weight management through multiple pathways.

Does Subjective Dietary Knowledge Affect Sugar-Sweetened Carbonated Beverages Consumption and Child Obesity? Empirical Evidence from the Inner Mongolia Autonomous Region in China

Worldwide, overweight and obesity have become an important public health problem affecting the health of children and adolescents. In China, the prevalence of overweight and obesity has reached 19 percent among the 6–17-year-old age group. Although studies have shown that regular consumption of sugar-sweetened beverages (SSBs), especially sugar-sweetened carbonated beverages (SSCBs), is positively correlated with overweight and obesity among children, the research on ways to reduce SSBs consumption is scarce. This study fills this gap by analyzing data on nearly 4000 students aged between 9–15 from the Inner Mongolia Autonomous Region in China, exploring possible influential pathways between subjective dietary knowledge, SSCBs consumption, and child obesity. The estimation results show that SSCBs consumption significantly mediates the relationship between dietary knowledge and the incidence of overweight and obesity; the mediated effects are different among subgroups. Therefore, improving dietary knowledge related to the lowing of SSBs consumption to reduce the obesity risk may be considered a possible way to reduce the prevalence of overweight and obesity among children.

Trends in food sources of added sugar in Australian eating patterns between 1995 and 2012 using national consumption survey data

BACKGROUND

When aiming to develop dietary messaging to achieve reductions in added sugar intakes, it is necessary to identify key food contributors. Food contributors are not expected to remain static over time. Therefore, the present study aimed to compare the total added sugars (AS) intake and related food sources for adult respondents of two Australian national consumption surveys.

METHODS

Repeated 24-h recall data from the 1995 National Nutrition Survey (1995NNS, n = 10 851) and the 2011-12 National Nutrition and Physical Activity Survey (2012NNPAS, n = 9341) was used to estimate AS consumption. Food group sources of AS were examined per consumer and per capita and the food group predictors of energy provided by AS were determined.

RESULTS

A significant difference in total AS intake was identified by age and gender between the surveys (all P < 0.001). Increased variability in food group contributions per consumer was also identified. Nine of the top 20 food groups from the 1995NNS differed (P < 0.001) in their contribution to AS in 2012NNPAS per consumer. Fewer changes were apparent at the population level, with >40% AS coming from only three food groups. Age-stratified analyses showed that the 'sugar, honeys and syrups' and the 'sweetened beverages' food groups were the top contributors between the surveys up to the age group of 70 years. 'Sugar, honey and syrups', 'chocolate and chocolate-based confectionery,' and 'other confectionery' (all, P < 0.001) were significant predictors of AS intake (1995NNS, r²  = 0.755; 2012NNPAS r²  = 0.740).

CONCLUSIONS

At a population level, food group contributions to AS intakes for Australian adults have not changed substantially over time, yet notable shifts in AS can be seen when targeting only the consumers of these food sources. 'Cake type desserts' appear to be increasingly consumed though 'sweetened beverages' remain a major contributor to AS intakes warranting targeted public health strategies.

Trends in soft drink and sugar-sweetened beverage consumption among South Australians, focusing on distribution of intake by subpopulation

OBJECTIVE

This study focused on describing local trends in sugar-sweetened beverage (SSB) consumption, including variations between subgroups, to inform equitable health policy to curb soft drink consumption.

METHODS

Weighted data were obtained from the South Australian Monitoring and Surveillance System, a state-based population health survey that monitors trends in health risk factors and chronic disease via computer-assisted telephone interviewing. From 2008 onwards, participants provided an estimate of the average amount of soft drink they consumed per day.

RESULTS

From 2008-2017, there were significant decreases in the proportion of adults who consumed any SSBs, but the mean consumption per consumer increased. High-risk dietary and lifestyle behaviours are the strongest predictors for consumption of soft drink, but there is also a significant association with socioeconomic status.

CONCLUSIONS

Population trends mask increasing inequity. There is a societal trend away from the consumption of SSBs across all subgroups, but at-risk groups who engage in clusters of unhealthy behaviours remain high consumers. Implications for public health: The identification of at-risk populations allows research to focus more precisely on the structural barriers, beliefs, attitudes and facilitators of ongoing consumption of SSB in order to inform future health promotion efforts.

U.S. obesity as delayed effect of excess sugar

In the last century, U.S. diets were transformed, including the addition of sugars to industrially-processed foods. While excess sugar has often been implicated in the dramatic increase in U.S. adult obesity over the past 30 years, an unexplained question is why the increase in obesity took place many years after the increases in U.S. sugar consumption. To address this, here we explain adult obesity increase as the cumulative effect of increased sugar calories consumed over time. In our model, which uses annual data on U.S. sugar consumption as the input variable, each age cohort inherits the obesity rate in the previous year plus a simple function of the mean excess sugar consumed in the current year. This simple model replicates three aspects of the data: (a) the delayed timing and magnitude of the increase in average U.S. adult obesity (from about 15% in 1970 to almost 40% by 2015); (b) the increase of obesity rates by age group (reaching 47% obesity by age 50) for the year 2015 in a well-documented U.S. state; and (c) the pre-adult increase of obesity rates by several percent from 1988 to the mid-2000s, and subsequent modest decline in obesity rates among younger children since the mid-2000s. Under this model, the sharp rise in adult obesity after 1990 reflects the delayed effects of added sugar calories consumed among children of the 1970s and 1980s.

The politics of voluntary self-regulation: insights from the development and promotion of the Australian Beverages Council's Commitment

OBJECTIVE

To analyse the evolution of the soft drink industry's use of self-regulation as a response to obesity and examine the motivations driving its development and the strategies used to promote it to policy makers.

DESIGN

We used a data set of industry documents published by the Australian Beverages Council (ABC) between 1998 and 2016. We analysed how the ABC voiced its political motivations about self-regulation and what internal nutrition policies it developed prior to its public launch of self-regulation. We also analysed two promotional strategies: funding research and writing policy submissions.

SETTING

Australia.

RESULTS

Between 1998 and 2006, the ABC shifted from a defensive strategy that denied the role of its products in obesity to more conciliatory strategy that emphasised the role of the soft drink industry in solutions to obesity. The ABC deliberately timed the launch of its self-regulation to coincide with an international public health congress. Following its launch, the ABC funded research demonstrating the efficacy of self-regulation and wrote submissions to government nutrition policies arguing that further regulation was unnecessary.

CONCLUSIONS

The soft drink industry uses self-regulation to bolster its reputation and influence nutrition policy. Strategic timing plays a key role in the political influence of self-regulation.

The Failure to Measure Dietary Intake Engendered a Fictional Discourse on Diet-Disease Relations

Controversies regarding the putative health effects of dietary sugar, salt, fat, and cholesterol are not driven by legitimate differences in scientific inference from valid evidence, but by a fictional discourse on diet-disease relations driven by decades of deeply flawed and demonstrably misleading epidemiologic research. Over the past 60 years, epidemiologists published tens of thousands of reports asserting that dietary intake was a major contributing factor to chronic non-communicable diseases despite the fact that epidemiologic methods do not measure dietary intake. In lieu of measuring actual dietary intake, epidemiologists collected millions of unverified verbal and textual reports of memories of perceptions of dietary intake. Given that actual dietary intake and reported memories of perceptions of intake are not in the same ontological category, epidemiologists committed the logical fallacy of "Misplaced Concreteness." This error was exacerbated when the anecdotal (self-reported) data were impermissibly transformed (i.e., pseudo-quantified) into proxy-estimates of nutrient and caloric consumption via the assignment of "reference" values from databases of questionable validity and comprehensiveness. These errors were further compounded when statistical analyses of diet-disease relations were performed using the pseudo-quantified anecdotal data. These fatal measurement, analytic, and inferential flaws were obscured when epidemiologists failed to cite decades of research demonstrating that the proxy-estimates they created were often physiologically implausible (i.e., meaningless) and had no verifiable quantitative relation to the actual nutrient or caloric consumption of participants. In this critical analysis, we present substantial evidence to support our contention that current controversies and public confusion regarding diet-disease relations were generated by tens of thousands of deeply flawed, demonstrably misleading, and pseudoscientific epidemiologic reports. We challenge the field of nutrition to regain lost credibility by acknowledging the empirical and theoretical refutations of their memory-based methods and ensure that rigorous (objective) scientific methods are used to study the role of diet in chronic disease.

The science against sugar, alone, is insufficient in tackling the obesity and type 2 diabetes crises – We must also overcome opposition from vested interests

No abstract available.

Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention

Background: Reduced intakes of added sugars and sugar-sweetened beverages (SSBs) have been the main focus of efforts to stall obesity. Although obesity has risen steeply in Australia, some evidence suggests that added-sugars and SSB intakes have declined over the same time frame.Objective: We investigated recent trends in the availability of sugars and sweeteners and changes in intakes of total sugars, added sugars, and SSBs in Australia by using multiple, independent data sources.Design: The study was designed to compare relevant data published by the Food and Agriculture Organization of the United Nations [FAO Statistics Division Database (FAOSTAT)], the Australian government, academia, and the food industry.Results: With the use of the FAOSTAT food balance sheets for Australia, the per capita availability of added or refined sugars and sweeteners was shown to have fallen 16% from 152 g/d in 1980 to 127 g/d in 2011 (P-trend = 0.001). In national dietary surveys in 1995 and 2011-2012, added-sugars intake declined markedly in adult men (from 72 to 59 g/d; -18%) but not in women (44-42 g/d; NS). As a proportion of total energy, added-sugars intake fell 10% in adult men but nonsignificantly in adult women. Between 1995 and 2011-2012, the proportion of energy from SSBs (including 100% juice) declined 10% in adult men and 20% in women. More marked changes were observed in children aged 2-18 y. Data from national grocery sales indicated that per capita added-sugars intakes derived from carbonated soft drinks fell 26% between 1997 and 2011 (from 23 to 17 g/d) with similar trends for noncarbonated beverages.Conclusions: In Australia, 4 independent data sets confirmed shorter- and longer-term declines in the availability and intake of added sugars, including those contributed by SSBs. The findings challenge the widespread belief that energy from added sugars or sugars in solution are uniquely linked to the prevalence of obesity.

Added sugars and risk factors for obesity, diabetes and heart disease

The effects of added sugars on various chronic conditions are highly controversial. Some investigators have argued that added sugars increase the risk of obesity, diabetes and cardiovascular disease. However, few randomized controlled trials are available to support these assertions. The literature is further complicated by animal studies, as well as studies which compare pure fructose to pure glucose (neither of which is consumed to any appreciable degree in the human diet) and studies where large doses of added sugars beyond normal levels of human consumption have been administered. Various scientific and public health organizations have offered disparate recommendations for upper limits of added sugar. In this article, we will review recent randomized controlled trials and prospective cohort studies. We conclude that the normal added sugars in the human diet (for example, sucrose, high-fructose corn syrup and isoglucose) when consumed within the normal range of normal human consumption or substituted isoenergetically for other carbohydrates, do not appear to cause a unique risk of obesity, diabetes or cardiovascular disease.

Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding

Added sugars are a controversial and hotly debated topic. Consumption of added sugars has been implicated in increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers. Support for these putative associations has been challenged, however, on a variety of fronts. The purpose of the current review is to summarize high impact evidence including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), in an attempt to provide an overview of current evidence related to added sugars and health considerations. This paper is an extension of a symposium held at the Experimental Biology 2015 conference entitled “Sweeteners and Health: Current Understandings, Controversies, Recent Research Findings and Directions for Future Research”. We conclude based on high quality evidence from randomized controlled trials (RCT), systematic reviews and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits. While it is prudent to consume added sugars in moderation, the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit.

Sugars, obesity, and cardiovascular disease: results from recent randomized control trials

The relationship between sugar consumption and various health-related sequelas is controversial. Some investigators have argued that excessive sugar consumption is associated with increased risk of obesity, coronary heart disease, diabetes (T2D), metabolic syndrome, non-alcoholic fatty liver disease, and stimulation of reward pathways in the brain potentially causing excessive caloric consumption. These concerns have influenced organizations such as the World Health Organization, the Scientific Advisory Committee on Nutrition in England not to exceed 5 % of total energy and the Dietary Guidelines for Americans Advisory Committee 2015 to recommend upper limits of sugar consumption not to exceed 10 % of calories. Data from many randomized control trials (RCTs) do not support linkages between sugar consumption at normal levels within the human diet and various adverse metabolic and health-related effects. Fructose and glucose are typically consumed together in roughly equal proportions from high-fructose corn syrup (also known as isoglucose in Europe) or sucrose. The purpose of this review is to present data from recent RCTs and findings from recent systematic reviews and meta-analyses related to sugar consumption and its putative health effects. This review evaluates findings from recent randomized controlled trials, systematic reviews and meta-analyses into the relationship of sugar consumption and a range of health-related issues including energy-regulating hormones, obesity, cardiovascular disease, diabetes, and accumulation of liver fat and neurologic responses. Data from these sources do not support linkages between sugar consumption at normal levels within the human diet and various adverse metabolic and health-related effects.

Changes in Food Intake in Australia: Comparing the 1995 and 2011 National Nutrition Survey Results Disaggregated into Basic Foods

As nations seek to address obesity and diet-related chronic disease, understanding shifts in food intake over time is an imperative. However, quantifying intake of basic foods is not straightforward because of the diversity of raw and cooked wholefoods, processed foods and mixed dishes actually consumed. In this study, data from the Australian national nutrition surveys of 1995 and 2011, each involving more than 12,000 individuals and covering more than 4500 separate foods, were coherently disaggregated into basic foods, with cooking and processing factors applied where necessary. Although Australians are generally not eating in a manner consistent with national dietary guidelines, there have been several positive changes. Australians are eating more whole fruit, a greater diversity of vegetables, more beans, peas and pulses, less refined sugar, and they have increased their preference for brown and wholegrain cereals. Adult Australians have also increased their intake of nuts and seeds. Fruit juice consumption markedly declined, especially for younger Australians. Cocoa consumption increased and shifts in dairy product intake were mixed, reflecting one of several important differences between age and gender cohorts. This study sets the context for more detailed research at the level of specific foods to understand individual and household differences.

No Effect of Added Sugar Consumed at Median American Intake Level on Glucose Tolerance or Insulin Resistance

Excess sugar consumption may promote adverse changes in hepatic and total body insulin resistance. Debate continues over the effects of sugars at more typically consumed levels and whether the identity of the sugar consumed is important. In the present study participants (20–60 years old) were randomly assigned to one of five groups, three that consumed low fat milk with added fructose containing sugars in amounts equivalent to the 50th percentile of fructose consumption (US), one which consumed low-fat milk sweetened with glucose, and one unsweetened low-fat milk control group. The intervention lasted ten weeks. In the entire study population there was less than 1 kg increase in weight (73.6 ± 13.0 vs. 74.5 ± 13.3 kg, p < 0.001), but the change in weight was comparable among groups (p > 0.05). There were no changes in fasting glucose (49 ± 0.4 vs. 5.0 ± 0.5 mmol/L), insulin (56.9 ± 38.9 vs. 61.8 ± 50.0 pmol/L), or insulin resistance, as measured by the Homeostasis Model Assessment method (1.8 ± 1.3 vs. 2.0 ± 1.5, all p > 0.05). These data suggest that added sugar consumed at the median American intake level does not produce changes in measures of insulin sensitivity or glucose tolerance and that no sugar has more deleterious effects than others.

Worldwide trends in dietary sugars intake

Estimating trends in dietary intake data is integral to informing national nutrition policy and monitoring progress towards dietary guidelines. Dietary intake of sugars is a controversial public health issue and guidance in relation to recommended intakes is particularly inconsistent. Published data relating to trends in sugars intake are relatively sparse. The purpose of the present review was to collate and review data from national nutrition surveys to examine changes and trends in dietary sugars intake. Only thirteen countries (all in the developed world) appear to report estimates of sugars intake from national nutrition surveys at more than one point in time. Definitions of dietary sugars that were used include 'total sugars', 'non-milk extrinsic sugars', 'added sugars', sucrose' and 'mono- and disaccharides'. This variability in terminology across countries meant that comparisons were limited to within countries. Hence trends in dietary sugars intake were examined by country for the whole population (where data permitted), and for specific or combined age and sex subpopulations. Findings indicate that in the majority of population comparisons, estimated dietary sugars intake is either stable or decreasing in both absolute (g/d) and relative (% energy) terms. An increase in sugars intake was observed in few countries and only in specific subpopulations. In conclusion, the findings from the present review suggest that, in the main, dietary sugars intake are decreasing or stable. A consistent approach to estimation of dietary sugars intake from national nutrition surveys is required if more valid estimates of changes in dietary sugars intakes are required in the future.

Intake of total and added sugars and nutrient dilution in Australian children and adolescents

This analysis aimed to examine the association between intake of sugars (total or added) and nutrient intake with data from a recent Australian national nutrition survey, the 2007 Australian National Children’s Nutrition and Physical Activity Survey (2007ANCNPAS). Data from participants (n 4140; 51 % male) who provided 2×plausible 24-h recalls were included in the analysis. The values on added sugars for foods were estimated using a previously published ten-step systematic methodology. Reported intakes of nutrients and foods defined in the 2007ANCNPAS were analysed by age- and sex-specific quintiles of %energy from added sugars (%EAS) or %energy from total sugars (%ETS) using ANCOVA. Linear trends across the quintiles were examined using multiple linear regression. Logistic regression analysis was used to calculate the OR of not meeting a specified nutrient reference values for Australia and New Zealand per unit in %EAS or %ETS. Analyses were adjusted for age, sex, BMI z-score and total energy intake. Small but significant negative associations were seen between %EAS and the intakes of most nutrient intakes (all P<0·001). For %ETS the associations with nutrient intakes were inconsistent; even then they were smaller than that for %EAS. In general, higher intakes of added sugars were associated with lower intakes of most nutrient-rich, ‘core’ food groups and higher intakes of energy-dense, nutrient-poor ‘extra’ foods. In conclusion, assessing intakes of added sugars may be a better approach for addressing issues of diet quality compared with intakes of total sugars.

Apparent consumption of refined sugar in Australia (1938-2011)

BACKGROUND/OBJECTIVES

In Australia, the Australian Bureau of Statistics discontinued collection of apparent consumption data for refined sugars in 1998/1999. The objectives of this study were to update this data series to determine whether it is a reliable data series that reflects consumption of refined sugars, defined as sucrose in the forms of refined or raw sugar or liquified sugars manufactured for human consumption.

SUBJECTS/METHODS

The study used the same methodology as that used by the Australian Bureau of Statistics to derive a refined sugars consumption estimate each year until the collection was discontinued. Sales by Australian refiners, refined sugars imports and the net balance of refined sugars contained in foods imported into, and exported from, Australia were used to calculate total refined sugars use for each year up to 2011. Per capita consumption figures were then derived.

RESULTS

During the period 1938-2011, apparent consumption of refined sugars in Australia fell 13.1% from 48.3 to 42.0 kg per head (R(2)=0.74). Between the 1950s and the 1970s, apparent consumption was relatively stable at about 50 kg per person. In the shorter period 1970-2011, refined sugars consumption fell 16.5% from 50.3 to 42.0 kg per head, though greater variability was evident (R(2)=0.53). An alternative data set showed greater volatility with no trend up or down.

CONCLUSIONS

The limited variability of the extended apparent consumption series and its consistency with recent national dietary survey data and sugar-sweetened beverage sales data indicate that it is a reliable data set that reflects declining intake of refined sugars in Australia.

Prevalence of Obesity: A Public Health Problem Poorly Understood

This review article discusses the Dietary Guidelines for Americans (DGA) in support of a total diet approach to achieving diet and health goals, especially as they relate to the obesity epidemic. However, some scientists and organizations have identified one food, food group, or nutrient as the cause of the obesity epidemic and recommend that simply reducing that food/food group/nutrient will solve the problem. This is simplistic and unlikely to be effective in long term management of the obesity problem. This article also acknowledges discrepancies in the literature and the lack of consensus opinions from systematic reviews. Failure to consider the evidence as a whole can lead to inaccurate reports which may, in turn, adversely influence clinical practice, public policy, and future research. This article also considers where the line should be drawn between individual choice and responsibility and public regulation. Using sugar sweetened beverages as an example, the article considers the lack of a consistent association between added sugars and weight in the literature and calls for policy recommendations that are based on science and emphasizes the need for evidence-based policies rather than policy-based evidence.

Estimated intakes and sources of total and added sugars in the Canadian diet

National food supply data and dietary surveys are essential to estimate nutrient intakes and monitor trends, yet there are few published studies estimating added sugars consumption. The purpose of this report was to estimate and trend added sugars intakes and their contribution to total energy intake among Canadians by, first, using Canadian Community Health Survey (CCHS) nutrition survey data of intakes of sugars in foods and beverages, and second, using Statistics Canada availability data and adjusting these for wastage to estimate intakes. Added sugars intakes were estimated from CCHS data by categorizing the sugars content of food groups as either added or naturally occurring. Added sugars accounted for approximately half of total sugars consumed. Annual availability data were obtained from Statistics Canada CANSIM database. Estimates for added sugars were obtained by summing the availability of "sugars and syrups" with availability of "soft drinks" (proxy for high fructose corn syrup) and adjusting for waste. Analysis of both survey and availability data suggests that added sugars average 11%-13% of total energy intake. Availability data indicate that added sugars intakes have been stable or modestly declining as a percent of total energy over the past three decades. Although these are best estimates based on available data, this analysis may encourage the development of better databases to help inform public policy recommendations.

Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children

OBJECTIVE

Longitudinal evidence of relationships between unhealthy diets and BMI in children is crucial for appropriately targeting obesity prevention activities. The objective was to determine the relationship between frequency of consumption of sugar sweetened beverages (SSBs) and high fat foods (HFFs) and body weight in Australian children aged from 4 to 10 years.

METHODS

Data from 4,164 children participating in four waves (wave 1, 2004; wave 2, 2006; wave 3, 2008; and wave 4, 2010) of the Longitudinal Study of Australian Children were analyzed. A multi-level growth model tested relationships between consumption of SSB and HFF and BMI z-scores.

RESULTS

BMI z-scores were associated with daily consumption of HFF, SSB and maternal BMI independent of BMI z-scores at wave 1 (baseline); with each additional occurrence of SSB and HFF consumption intake per day, BMI z-score increased by 0.015 U (P < 0.01) and 0.014 U (P < 0.001), respectively. With each additional maternal BMI unit, BMI z-score increased by 0.032 (P < 0.001).

CONCLUSIONS

Higher BMI z-scores were strongly associated with the consumption of SSBs and HFFs. Future efforts to prevent obesity should consider urgent action to address the impact of the consumption of SSBs and HFFs in childhood.

Fructose-containing sugars, blood pressure, and cardiometabolic risk: a critical review

Excessive fructose intake from high-fructose corn syrup (HFCS) and sucrose has been implicated as a driving force behind the increasing prevalence of obesity and its downstream cardiometabolic complications including hypertension, gout, dyslidpidemia, metabolic syndrome, diabetes, and non-alcoholic fatty liver disease (NAFLD). Most of the evidence to support these relationships draws heavily on ecological studies, animal models, and select human trials of fructose overfeeding. There are a number of biological mechanisms derived from animal models to explain these relationships, including increases in de novo lipogenesis and uric acid-mediated hypertension. Differences between animal and human physiology, along with the supraphysiologic level at which fructose is fed in these models, limit their translation to humans. Although higher level evidence from large prospective cohorts studies has shown significant positive associations comparing the highest with the lowest levels of intake of sugar-sweetened beverages (SSBs), these associations do not hold true at moderate levels of intake or when modeling total sugars and are subject to collinearity effects from related dietary and lifestyle factors. The highest level of evidence from controlled feeding trials has shown a lack of cardiometabolic harm of fructose and SSBs under energy-matched conditions at moderate levels of intake. It is only when fructose-containing sugars or SSBs are consumed at high doses or supplement diets with excess energy that a consistent signal for harm is seen. The available evidence suggests that confounding by excess energy is an important consideration in assessing the role of fructose-containing sugars and SSBs in the epidemics of hypertension and other cardiometabolic diseases.

Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis

OBJECTIVE

The nutrition transition model provides an integrated approach to analyse global changes in food consumption and lifestyle patterns. Whether variability in food availability for consumption, lifestyle and sociodemographic factors is associated with the worldwide prevalence distribution of overweight, obesity and hypertension is unclear.

DESIGN

Ecological analysis.

SETTING

Country-specific prevalence estimates of overweight, obesity and hypertension were obtained. Prevalence estimates were then matched to year- and country-specific food and energy availability for consumption of cereals, sugar, sweeteners and honey, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood. The per capita Gross Domestic Product (GDP), urbanization rates and prevalence of physical inactivity for each country were also obtained.

SUBJECTS

The overweight, obesity and hypertension databases included information from 128, 123 and seventy-nine countries, respectively.

RESULTS

Consumption of sugar and animal products were directly associated with GDP and urbanization rates. In a multivariate regression model, physical inactivity (B = 0·01, se = 0·005, P = 0·003), cereal consumption (B = -0·02, se = 0·006, P < 0·001) and sugar consumption (B = 0·03, se = 0·01, P = 0·03) were significant predictors of obesity prevalence. Midpoint age (B = 0·21, se = 0·10, P = 0·02), prevalence of overweight (B = 0·18, se = 0·08, P = 0·02) and consumption of cereals (B = -0·22, se = 0·10, P = 0·02) were significant predictors of hypertension. Women appeared to have a significant obesity excess compared with men.

CONCLUSIONS

High sugar consumption and sedentary lifestyle are associated with increased obesity prevalence. The non-linear association of sugar consumption with prevalence of obesity suggests that effective strategies to reduce its consumption may have differential effects in countries at different stages of the nutrition transition.

The Role of Fructose, Sucrose and High-fructose Corn Syrup in Diabetes

Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecological studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycaemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.

Trends in added sugar supply and consumption in Australia: there is an Australian Paradox

In 2011, Barclay and Brand-Miller reported the observation that trends in refined sugar consumption in Australia were the inverse of trends in overweight and obesity (The Australian Paradox). Rikkers et al. claim that the Australian Paradox is based on incomplete data because the sources utilised did not incorporate estimates for imported processed foods. This assertion is incorrect. Indeed, national nutrition surveys, sugar consumption data from the United Nations Food and Agricultural Organisation, the Australian Bureau of Statistics and Australian beverage industry data all incorporated data on imported products.

Association between sugar consumption, sociodemographic, anthropometric and biochemical profiles

Background

The increase in prevalence of coronary heart disease, type 2 diabetes, obesity and abnormal blood lipid levels has raised the question of a possible relationship between these conditions and the consumption of sugar.

Objectives

This study investigated the sugar consumption of financially-restricted Black women in Mangaung, South Africa.

Method

Five hundred women were selected randomly and divided into younger (25–34 years) and older (35–44 years) groups. Dietary intake, sociodemographic status, anthropometry and biochemical data were obtained. Total sugar (TS) and added sugar (AS) consumption were compared between older and younger women as well as sociodemographic, anthropometric and biochemical categories.

Results

AS intake contributed 12% and 13% of total energy intake in younger and older women, respectively. AS consumption was higher in younger women living in brick houses and those who possessed a microwave oven. In older women, it was higher in husband-headed households. Underweight women with the lowest body mass index had higher sugar consumption than overweight and/or obese women. Women with a lower body fat percentage had a higher AS consumption than women with a high body fat percentage. Sugar consumption was significantly lower in younger women with elevated serum lymphocyte counts. TS and AS consumption was higher in younger women with elevated serum glucose levels. Older women with elevated serum insulin had a significantly higher TS consumption compared to those with normal insulin concentrations.

Conclusion

The amounts of TS and AS consumed by women in this observational study were unlikely to contribute to overweight and/or obesity.

A systematic review of the effectiveness of taxes on nonalcoholic beverages and high-in-fat foods as a means to prevent obesity trends

BACKGROUND

As part of the efforts to curb obesity, a new focus seems to be put on taxing foods that are perceived as being associated with obesity (eg, sugar-sweetened beverages and foods high in fat, sugar, and salt content) as a policy instrument to promote healthier diets.

OBJECTIVE

To assess the possible effects of such taxation policies by identifying and analyzing all studies which investigate the impact of price increases on consumption, caloric intake, or weight outcomes.

METHODS

Electronic data bases were searched with appropriate terms and their combinations. Thereafter, abstracts were reviewed and studies were selected based on predefined criteria. The characteristics of the selected studies and the results were extracted in a special form and consequently were reviewed and synthesized.

RESULTS

Price increase may lead to a reduction in consumption of the targeted products, but the subsequent effect on caloric intake may be much smaller. Only a limited number of the identified studies reported weight outcomes, most of which are either insignificant or very small in magnitude to make any improvement in public health.

CONCLUSION

The effectiveness of a taxation policy to curb obesity is doubtful and available evidence in most studies is not very straightforward due to the multiple complexities in consumer behavior and the underling substitution effects. There is need to investigate in-depth the potential underlying mechanisms and the relationship between price-increase policies, obesity, and public health outcomes.

Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements

The negative impact of consuming sugar-sweetened beverages on weight and other health outcomes has been increasingly recognized; therefore, many people have turned to high-intensity sweeteners like aspartame, sucralose, and saccharin as a way to reduce the risk of these consequences. However, accumulating evidence suggests that frequent consumers of these sugar substitutes may also be at increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease. This paper discusses these findings and considers the hypothesis that consuming sweet-tasting but noncaloric or reduced-calorie food and beverages interferes with learned responses that normally contribute to glucose and energy homeostasis. Because of this interference, frequent consumption of high-intensity sweeteners may have the counterintuitive effect of inducing metabolic derangements.

Trends in sugar supply and consumption in Australia: is there an Australian Paradox?

Background

High consumption of refined carbohydrate, in particular sugar, has been identified as a possible contributory factor in greater risk of excess weight gain. In spite of data limitations, one recent paper suggests that Australian sugar consumption has decreased over the same time period that obesity has increased, a so called ‘Australian Paradox’. Given the significant public health focus on nutrition, we aimed to estimate Australian sugar supply and consumption over recent decades, to determine whether these data could be used to make any conclusions about sugar’s role in obesity.

Methods

Foods high in sugar were identified. Data relating to sugar supply and consumption from 1988 to 2010 were obtained from multiple sources. Using these data we attempted to generate a time series estimate of sugar in Australia’s food supply.

Results

Australia produces and exports sugar from sugar cane and the sugar in imported foods has received little attention. We were unable to produce a reliable and robust estimate of total sugars in the Australian diet due to data limitations and a lack of current data sources. However, available Import data showed large increases in the volume and value of imported sweetened products between 1988 and 2010 to over 30 grams of sugar per person per day. Value estimates of local production of sweetened products also show substantial increases in this period.

Conclusion

The Australian Paradox assertion is based on incomplete data, as it excludes sugar contained in imported processed foods, which have increased markedly. A major Australian public health target is to improve the quality of the food supply, and actions have been set in terms of achieving broader environmental changes. However, evaluation of progress is hampered by lack of high quality data relating to supply and consumption. We recommend the regular collection of comprehensive food supply statistics, which include both local production and imports. This would provide an inexpensive addition to survey data and could assist in monitoring sugar consumption trends in food supply. Such information would also help inform public health policy.

A review about the effect of life style modification on diabetes and quality of life

The aim of this review is to examine diabetes and quality of life improvements through modifying life style. The data was collected by reviewing published articles from PubMed, Medline, Web of Science, and Google open access publications. The review identified prevention strategies can reduce the risk and complications of diabetes. Life style modification in relation to obesity, eating habit, and physical exercise can play a major role in the prevention of diabetes. Nowadays, there has been progress in the development of behavioural strategies to modify these life style habits and it is not easy to accept for long term basis. If people maintain a balanced diet and physical exercise this can have real and potential benefits for their prevention and control of complications from chronic diseases particularly for cardiovascular risk and diabetes. Healthy life style may best be achieved through public private partnerships involving government, partners organizations, health services providers, community and people living with diabetes. Effective strategies to reduce the incidence of diabetes globally and assist in managing the disease are urgently required.