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Clayton PK, Putnick DL, Trees IR, Robinson SL, O'Connor TG, Tyris JN, Yeung EH. Age of Juice Introduction and Cardiometabolic Outcomes in Middle Childhood. J Nutr 2024; 154:2514-2523. [PMID: 38936550 DOI: 10.1016/j.tjnut.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The American Academy of Pediatrics recommends juice introduction after 12 months of age. Juice consumption has been linked to childhood obesity and cardiometabolic risk. OBJECTIVES To examine the prospective relationship between the age of juice introduction and primary and secondary cardiometabolic outcomes in middle childhood. METHODS Parents reported the age of juice introduction on Upstate KIDS questionnaires completed between 4 and 18 months. The quantity and type of juice introduced were not measured. Anthropometry, blood pressure (BP), and arterial stiffness by pulse wave velocity (PWV) were measured for 524 children (age, 8-10 y) at study visits (2017-2019). Age- and gender-adjusted z-scores were calculated using the Centers for Disease Control and Prevention reference for anthropometrics. Plasma lipids, hemoglobin A1c (HbA1c), and C-reactive protein (CRP) in a subset of children were also measured (n = 248). Associations between age at juice introduction (categorized as <6, 6 to <12, ≥12 months), and outcomes were estimated using mean differences and odds ratios, applying generalized estimating equations to account for correlations between twins. RESULTS Approximately 18% of children were introduced to juice at <6 months, 52% between 6 and <12 months, and 30% ≥ 12 months of age. Children who were introduced to juice before 6 months had higher systolic BP (3.13 mmHg; 95% confidence interval [CI]: 0.52, 5.74), heart rate (4.46 bpm; 95% CI: 1.05, 7.87), and mean arterial pressure (2.08 mmHg; 95% CI: 0.15, 4.00) compared with those introduced ≥12 months after covariate adjustment including sociodemographic factors and maternal prepregnancy body mass index. No adjusted differences in anthropometry, lipids, HbA1c, and CRP levels were found. CONCLUSIONS Early juice introduction during infancy was associated with higher systolic BP, heart rate, and mean arterial pressure in middle childhood. This trial was registered at clinicaltrials.gov as NCT03106493 (https://clinicaltrials.gov/study/NCT03106493?term=upstate%20KIDS&rank=1).
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Affiliation(s)
- Priscilla K Clayton
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
| | - Ian R Trees
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
| | - Sonia L Robinson
- Violence Prevention Research Program, University of California at Davis, Sacramento, CA, United States; Department of Emergency Medicine, School of Medicine, UC Davis, Sacramento, CA, USA; California Firearm Violence Research Center, Sacramento, CA, USA.
| | - Thomas G O'Connor
- Department of Psychiatry, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States.
| | - Jordan N Tyris
- Division of Hospital Medicine, Children's National Hospital, Washington, DC, United States.
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
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Park M, Kim D, Choi M, Shin J. Difference in Sugar-Sweetened Beverage Consumption before and during the COVID-19 Pandemic among Korean Adolescents. J Nutr 2023; 153:2147-2153. [PMID: 37149286 PMCID: PMC10159663 DOI: 10.1016/j.tjnut.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Previous studies have identified various factors associated with sugar-sweetened beverage (SSB) consumption among children and adolescents. Recent studies attempted to analyze changes in SSB consumption of adolescents during the COVID-19 pandemic and showed conflicting results. OBJECTIVES This study aimed to estimate the difference in SSB consumption before (2018-2019) and during (2020-2021) the COVID-19 pandemic among Korean adolescents. METHODS The study population consisted of students (n = 227,139) aged 12-18 y from the Korean Youth Risk Behavior Web-based Survey (KYRBWS). Data collection was done between 2018 and 2021. The primary outcome was the difference in the SSB consumption status (none/<7 times/wk, ≥7 times/wk) before and during the COVID-19 pandemic. Multinomial logistic regression was used to examine the association. Additional analysises were also conducted by gender, school grades, household income, grade point average, region, household members, fast-food intake, and fruit intake. RESULTS The COVID-19 pandemic was associated with a decrease in adolescents' SSB intake. [(<7 times/wk) 2019: 59.4, 2020: 58.8, (≥7 times/wk) 2019: 35.3, 2020: 33.4]. CONCLUSIONS The study found a difference in SSB consumption among Korean adolescents between before and during the COVID-19 pandemic. These findings are noteworthy considering the importance of continuous care in managing SSB intake.
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Affiliation(s)
- Munsu Park
- Department of Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Dahyun Kim
- Department of Statistics, Sungshin Women's University, Seongbuk-gu, Seoul, Republic of Korea
| | - Mingee Choi
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Jaeyong Shin
- Institute of Health Policy and Management, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.
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3
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Markey O, Pradeilles R, Goudet S, Griffiths PL, Boxer B, Carroll C, Rousham EK. Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies. J Nutr 2023; 153:176-189. [PMID: 36913452 PMCID: PMC10127523 DOI: 10.1016/j.tjnut.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease. OBJECTIVE To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers. METHODS PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure). RESULTS Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty). CONCLUSIONS No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.
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Affiliation(s)
- Oonagh Markey
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sophie Goudet
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Paula L Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Benjamin Boxer
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Christopher Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Fernández-Aparicio Á, Perona JS, Schmidt-RioValle J, Montero-Alonso MA, Navarro-Pérez CF, González-Jiménez E. cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents. J Pers Med 2022; 13:jpm13010010. [PMID: 36675671 PMCID: PMC9865991 DOI: 10.3390/jpm13010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.
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Affiliation(s)
- Ángel Fernández-Aparicio
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, 52005 Melilla, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Javier S. Perona
- Department of Food and Health, Instituto de la Grasa-CSIC, Campus of the University Pablo de Olavide, 41013 Seville, Spain
| | - Jacqueline Schmidt-RioValle
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Correspondence: ; Tel.: +34-958-243-495
| | - Miguel A. Montero-Alonso
- Department of Statistics and O.I., Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Carmen Flores Navarro-Pérez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Emilio González-Jiménez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, Petherick ES, Pradeilles R. Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:1669-1696. [PMID: 35362512 PMCID: PMC9526862 DOI: 10.1093/advances/nmac032] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
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Affiliation(s)
- E K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - S Goudet
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - O Markey
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - P Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - B Boxer
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - C Carroll
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - E S Petherick
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom
| | - R Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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6
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Silva KBBD. Daily Consumption of Soft Drinks and Cardiovascular Risk in Adolescents. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Association between plant-based diets and metabolic health status in adolescents with overweight and obesity. Sci Rep 2022; 12:13772. [PMID: 35962035 PMCID: PMC9374681 DOI: 10.1038/s41598-022-17969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 08/03/2022] [Indexed: 11/08/2022] Open
Abstract
The association of plant-based diets with health status is underestimated in pediatrics. We aimed to examine the relation between plant-based diets (including overall plant-based index (PDI), healthy plant-based (hPDI) and unhealthy plant-based (uPDI)) and metabolic health status in Iranian adolescents with overweight/obesity. We conducted a cross-sectional study on 203 adolescents with overweight/obesity (12-18 years old) selected by a multistage cluster random-sampling method. Usual dietary intakes were assessed through a validated 147-item food frequency questionnaire (FFQ). Anthropometric indices and blood pressure values were measured and fasting blood samples were drawn. For classification of participants into metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO) groups, two methods of International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR) were applied. No significant association was observed between higher adherence to PDI and odds of MUO status defined by both IDF and IDF/HOMA-IR strategies. After adjustments for all potential confounders, adolescents in the highest tertile of hPDI, compared with those in the lowest tertile, had 85% (95% CI 0.05-0.43) and 84% (95% CI 0.05, 0.52) lower odds of being MUO based on IDF and IDF/HOMA-IR criteria, respectively. Greater adherence to uPDI was associated with odd of 3.95 (95% CI 1.41, 11.12) and 4.06 (95% CI 1.31, 12.57) of being MUO based on IDF and IDF/HOMA-IR definitions, after considering all potential confounders. Stratified analysis revealed that these associations were stronger in girls and overweight subjects. Adherence to healthy plant-based foods was inversely associated with odds of MUO status in Iranian adolescents. In contrast, unhealthy plant-based diets was directly associated with MUO in pediatrics. Further studies with prospective nature, are required to affirm these results.
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Fujiwara A, Omura Y, Oono F, Sugimoto M, Sasaki S, Takimoto H. A Scoping Review of Epidemiological Studies on Intake of Sugars in Geographically Dispersed Asian Countries: Comparison of Dietary Assessment Methodology. Adv Nutr 2022; 13:1947-1973. [PMID: 35641021 PMCID: PMC9526866 DOI: 10.1093/advances/nmac061] [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: 01/03/2022] [Revised: 03/10/2022] [Accepted: 05/26/2022] [Indexed: 01/28/2023] Open
Abstract
Previous systematic reviews, which focused on sugar intake and its relation with health issues, were mainly conducted in Western countries, not Asian countries characterized by differences in dietary habits and disease prevalence. The scarcity of Asian studies may be attributed to the lack of assessment tools for estimating sugar intake. To provide an overview of the epidemiological studies on sugar intake in Asian countries, with a primary focus on dietary assessment methodology for estimating sugar intake, we conducted a scoping review of the epidemiological studies estimating sugar intake in Asian countries (the United Nations' definition) and Taiwan using PubMed and Web of Science. Study quality was evaluated based on its assessment of sugar intake in the whole diet, dietary assessment methods, and data sources used for estimating sugar content. We identified 143 studies from 136 publications from Eastern (n = 63), Southern (n = 30), South-Eastern (n = 26), and Western (n = 24) Asia. Total sugars were investigated in 95 studies, while 23-30 studies investigated sucrose, fructose, added sugars, and free sugars. The main aim of the selected studies was assessment of diet-disease relations (n = 85) and estimation of dietary intake (n = 40), and 62 studies assessed sugars as the primary exposure/outcome. A total of 120 studies assessed sugar intake in the whole diet, and 62 studies used validated FFQs or multiple-day dietary assessment methods. Only 41 studies used country-specific comprehensive food-composition databases or directly measured sugar content. Only 17 studies reported high-quality data. This review elucidated a sufficient number of epidemiological studies estimating sugar intake across Asian countries; however, most studies reported low-quality data. The results from our review showed that both feasible and validated dietary assessment methods, as well as comprehensive country-specific sugar-composition databases, are essential for producing high-quality studies with accurate sugar intake to examine its association with health outcomes.
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Affiliation(s)
- Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan,Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Yuka Omura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumi Oono
- Department of Social and Preventive Epidemiology, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Minami Sugimoto
- Institute for Future Initiatives, University of Tokyo, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch‐Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Siani A, Thies F, Tsabouri S, Adan R, Emmett P, Galli C, Kersting M, Moynihan P, Tappy L, Ciccolallo L, de Sesmaisons‐Lecarré A, Fabiani L, Horvath Z, Martino L, Muñoz Guajardo I, Valtueña Martínez S, Vinceti M. Tolerable upper intake level for dietary sugars. EFSA J 2022; 20:e07074. [PMID: 35251356 PMCID: PMC8884083 DOI: 10.2903/j.efsa.2022.7074] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50-75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (> 15-50% probability) and very low for hypertension (0-15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.
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Lim CGY, Whitton C, Rebello SA, van Dam RM. Diet Quality and Lower Refined Grain Consumption are Associated With Less Weight Gain in a Multi-Ethnic Asian Adult Population. J Nutr 2021; 151:2372-2382. [PMID: 33978192 DOI: 10.1093/jn/nxab110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of obesity is increasing in many Asian countries. However, longitudinal data on the impacts of dietary factors on weight gain in Asian populations are sparse. OBJECTIVES We evaluated the relationship between changes in intakes of nutrients, foods, and beverages and diet quality and long-term changes in body weight. METHODS We used data (n = 3064) from the Singapore Multi-Ethnic Cohort, a prospective cohort including Chinese, Indian, and Malay residents aged 21-65 years. Dietary intakes were assessed using an FFQ, and body weight and waist circumference were measured during health examinations. Diet quality was evaluated using the Dietary Approaches to Stop Hypertension (DASH) and Alternative Healthy Eating Index (AHEI-2010) scores. Data were collected at baseline (2004-2010) and follow-up (2011-2016), with a mean follow-up of 6.0 years. Linear regression was used to assess the associations between dietary changes and weight change, adjusted for socio-demographic and lifestyle variables. RESULTS Improvements in dietary quality scores (DASH, -0.34 kg per 5 points; AHEI-2010, -0.35 kg per 10 points) and replacement of carbohydrates with protein (-0.44 kg per 5% of energy) were significantly associated with less weight gain. Increased intakes of white rice (+0.25 kg per serving/d), soft drinks (+0.69 kg), red meat (+0.58 kg), and poultry with skin (+0.74 kg) were directly associated with weight gain. The replacement of 1 serving per day of white rice with whole grains (-0.68 kg), vegetables (-0.33 kg), poultry without skin (-0.79 kg), and eggs (-0.87 kg) was associated with less weight gain. Similar associations were observed between changes in dietary factors and changes in waist circumference. CONCLUSIONS Among Asian adults, increasing dietary quality, reducing soft drink consumption, and replacing white rice with whole grains, vegetables, and selected high-protein foods was associated with less weight gain.
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Affiliation(s)
- Charlie G Y Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,School of Public Health, Curtin University, Perth, Australia
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Neelakantan N, Park SH, Chen GC, van Dam RM. Sugar-sweetened beverage consumption, weight gain, and risk of type 2 diabetes and cardiovascular diseases in Asia: a systematic review. Nutr Rev 2021; 80:50-67. [PMID: 33855443 DOI: 10.1093/nutrit/nuab010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 11/12/2022] Open
Abstract
CONTEXT The prevalence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs) is increasing in Asia and several countries are adopting preventive policies to reduce consumption of sugar-sweetened beverages (SSBs). However, evidence on the relation between SSB consumption and cardiometabolic health in Asian populations has not been summarized. OBJECTIVE In this systematic review, the associations between consumption of SSBs and cardiometabolic outcomes, including obesity, T2DM, and CVD, are examined in Asian populations. DATA SOURCES The PubMed, Scopus, and Web of Science databases, and gray literature were searched up to October, 2020 to identify relevant articles. DATA EXTRACTION Two investigators independently extracted data from included studies. DATA ANALYSIS When sufficient studies were available, a random-effects meta-analysis was used to calculate the pooled estimates (expressed as risk ratio [RR] and 95% confidence interval [CI]). Heterogeneity was tested and quantified using the Cochrane Q test and I2 statistic, respectively. RESULTS Of the 17 studies included, 8 provided results about measures of adiposity (3 on weight change, 4 on body mass index (BMI), 2 on percent body fat, and 1 on abdominal obesity), 6 reported results about T2DM, and 3 reported on different CVD outcomes. High SSB consumption was significantly associated with greater weight gain and with a higher risk of selected CVD outcomes as compared with low consumption. In the meta-analysis, high SSB consumption was associated with greater T2DM risk before (RR, 1.51; 95%CI, 1.15-1.98 for highest vs lowest category; I2 = 76%) and after (RR, 1.38; 95%CI, 1.09-1.73; I2 = 56%) adjustment for BMI. CONCLUSIONS These findings suggest that high SSB consumption is directly associated with weight gain, risk of T2DM, and, possibly, selected CVD outcomes in Asian populations. Public health strategies to reduce SSB consumption in Asian countries are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42019129456.Keywords: adiposity. cardiovascular disease, Asia, sugar-sweetened beverages, type 2 diabetes.
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Affiliation(s)
- Nithya Neelakantan
- N. Neelakantan, S.H. Park, G.-C. Chen, and R.M van Dam are with the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. G.-C. Chen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, New York, USA. R.M van Dam is with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Su Hyun Park
- N. Neelakantan, S.H. Park, G.-C. Chen, and R.M van Dam are with the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. G.-C. Chen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, New York, USA. R.M van Dam is with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Guo-Chong Chen
- N. Neelakantan, S.H. Park, G.-C. Chen, and R.M van Dam are with the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. G.-C. Chen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, New York, USA. R.M van Dam is with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rob M van Dam
- N. Neelakantan, S.H. Park, G.-C. Chen, and R.M van Dam are with the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. G.-C. Chen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, New York, USA. R.M van Dam is with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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12
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Bergeron A, Labonté MÈ, Brassard D, Laramée C, Robitaille J, Desroches S, Provencher V, Couillard C, Vohl MC, Bélanger M, Lamarche B, Lemieux S. Associations of Intake of Free and Naturally Occurring Sugars from Solid Foods and Drinks with Cardiometabolic Risk Factors in a Quebec Adult Population: The PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) Study. J Nutr 2021; 151:1561-1571. [PMID: 33758943 PMCID: PMC8243855 DOI: 10.1093/jn/nxab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented. OBJECTIVE The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada. METHODS Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates. RESULTS In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models. CONCLUSIONS Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.
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Affiliation(s)
- Amélie Bergeron
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Didier Brassard
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Catherine Laramée
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada
| | - Julie Robitaille
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Sophie Desroches
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Véronique Provencher
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Charles Couillard
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Marie-Claude Vohl
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
| | - Mathieu Bélanger
- Department of Family Medicine, Université de
Sherbrooke, Moncton, Canada
| | - Benoît Lamarche
- Centre Nutrition, Santé et Société
(NUTRISS), Institute of Nutrition and Functional Foods,
Université Laval, Quebec, Canada,School of Nutrition, Université Laval,
Quebec, Canada
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13
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Zhang Y, Wu X, Wang Q, Zong Q, Wang R, Li T, Tao S, Tao F. The Relationship Between Sugar-Sweetened Beverages, Takeaway Dietary Pattern, and Psychological and Behavioral Problems Among Children and Adolescents in China. Front Psychiatry 2021; 12:573168. [PMID: 34456758 PMCID: PMC8387797 DOI: 10.3389/fpsyt.2021.573168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: The association of sugar-sweetened beverage (SSB) consumption and takeaway dietary pattern with psychological problems in Chinese children and adolescents has not been concretely reported. Our study aimed to investigate the association between SSB consumption, takeaway dietary pattern, and psychological and behavioral problems (PBPs). Methods: Cluster sampling method has been adopted from April to May 2019 to conduct a questionnaire survey among 30,188 children and adolescents in grades 1 to 12 from 14 schools in six streets in Bao'an District of Shenzhen. This cross-sectional study investigated the association of consumption of SSBs and takeaway patterns with PBPs, and PBPs were measured by the Strengths and Difficulties Questionnaire (SDQ) in primary, junior, and senior high school students. Results: A total of 33,801 primary, junior, and senior high school students (mean age = 12.44, SD = 3.47) ranging from 6 to 18 years old were recruited in this study using a health survey of children and adolescents in junior and senior high schools (grades 1-12), and 30,188 students with no missing data were finally analyzed (questionnaires with missing value >5% were excluded). The top three SSBs in the intake frequency were milk beverage drinks (not milk), vegetable protein drinks, and fruit and vegetable juice drinks. Adjusted for demographic factors, the higher the frequency of students consuming SSBs who have significantly higher PBPs, the higher the frequency of students with takeaway dietary patterns who also have significantly higher PBPs. More frequent intake of SSBs [odds ratio (OR) = 2.23, 95%CI = 2.0-2.47, p < 0.01] and higher takeaway dietary patterns (OR = 2.34, 95%CI = 1.81-3.03, p < 0.01) were associated with higher SDQ total difficulties scores. When low and medium consumption of SSB was compared, children and adolescents who have high SSB intake were more associated with total difficulties score (OR = 3.10, 95%CI = 2.67-3.59, p < 0.01), and when low and medium takeaway dietary patterns were compared, children and adolescents who have high takeaway dietary patterns were more associated with total difficulties score. The joint associations of SSBs and takeaway pattern with SDQ were stronger than the associations individually. Conclusions: Students consuming higher SSBs and having takeaway dietary pattern are associated with increased levels of PBPs individually and interactively. These results may have implications for mental health prevention in adolescents.
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Affiliation(s)
- Yi Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Qianling Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Qiao Zong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Renjie Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Tingting Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Shuman Tao
- Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Hefei, China.,National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
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14
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Okuda M, Fujiwara A, Sasaki S. Added and Free Sugars Intake and Metabolic Biomarkers in Japanese Adolescents. Nutrients 2020; 12:nu12072046. [PMID: 32660122 PMCID: PMC7400823 DOI: 10.3390/nu12072046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
Reduction in the intakes of added and free sugars is a recommendation to lower cardiometabolic risks. Sugars intake is considered lowest in the Asian-Pacific region, particularly Japan. We examined the association between sugars intake and cardiometabolic risks in Japanese adolescents. We included 3242 students (mean age, 13.56 years) living in Shunan City, Japan, between 2006 and 2010. Sugars intake was estimated using the brief-type self-administered diet history questionnaire. Anthropometrics, serum lipids, fasting plasma glucose, and blood pressure were measured. Metabolic syndrome was determined by the combination of overweight and other risks. Intakes of added and free sugars were 7.6–7.9%E and 8.4–8.8%E of the total energy intake (%E), respectively. Categories based on quintiles of added or free sugars intakes were associated with fasting glucose, systolic blood pressure, and the z-score of metabolic syndrome (Ptrend ≤ 0.025). Other than the association between added sugars ≥10%E and high glucose (odds ratio 1.51, 95% confidence interval 1.04–2.19, p = 0.031), non-significantly high intakes of added or free sugars for risks occurred. Association was observed between added or free sugars intake and cardiometabolic biomarkers in Japanese adolescents, and added sugars intake <10%E could prevent glucose intolerance but not metabolic syndrome.
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Affiliation(s)
- Masayuki Okuda
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2231
| | - Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
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15
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Semnani-Azad Z, Khan TA, Blanco Mejia S, de Souza RJ, Leiter LA, Kendall CWC, Hanley AJ, Sievenpiper JL. Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e209993. [PMID: 32644139 PMCID: PMC7348689 DOI: 10.1001/jamanetworkopen.2020.9993] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Sugar-sweetened beverages (SSBs) are associated with increased risk of metabolic syndrome (MetS). However, the role of other important food sources of fructose-containing sugars in the development of MetS remains unclear. OBJECTIVE To examine the association of major food sources of fructose-containing sugars with incident MetS. DATA SOURCES MEDLINE, Embase, and Cochrane Library were searched from database inception to March 24, 2020, in addition to manual searches of reference lists from included studies using the following search terms: sugar-sweetened beverages, fruit drink, yogurt, metabolic syndrome, and prospective study. STUDY SELECTION Inclusion criteria included prospective cohort studies of 1 year or longer that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study. DATA EXTRACTION AND SYNTHESIS Study quality was assessed using the Newcastle-Ottawa Scale. Extreme quantile risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Dose-response analyses were performed using a 1-stage linear mixed-effects model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results were reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. MAIN OUTCOMES AND MEASURES Pooled risk ratio (RR) of incident MetS (pairwise and dose response). RESULTS Thirteen prospective cohort studies (49 591 participants [median age, 51 years; range, 6-90 years]; 14 205 with MetS) that assessed 8 fructose-containing foods and MetS were included. An adverse linear dose-response association for SSBs (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86) was found. Fruit juices (mixed and 100%) had a U-shaped dose-response association with protection at moderate doses (mixed fruit juice: RR for 125 mL/d, 0.58; 95% CI, 0.42-0.79; 100% fruit juice: RR for 125 mL/d, 0.77; 95% CI, 0.61-0.97). Honey, ice cream, and confectionary had no association with MetS incidence. The certainty of the evidence was moderate for SSBs, yogurt, fruit, mixed fruit juice, and 100% fruit juice and very low for all other food sources. CONCLUSIONS AND RELEVANCE The findings of this meta-analysis suggest that the adverse association of SSBs with MetS does not extend to other food sources of fructose-containing sugars, with a protective association for yogurt and fruit throughout the dose range and for 100% fruit juice and mixed fruit juices at moderate doses. Therefore, current policies and guidelines on the need to limit sources of free sugars may need to be reexamined.
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Affiliation(s)
- Zhila Semnani-Azad
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Nutrition and Dietetics, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
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Ryuk JA, Kang S, Daily JW, Ko BS, Park S. Moderate intake of aspartame and sucralose with meals, but not fructose, does not exacerbate energy and glucose metabolism in estrogen-deficient rats. J Clin Biochem Nutr 2019; 65:223-231. [PMID: 31777424 PMCID: PMC6877401 DOI: 10.3164/jcbn.19-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
Both nutritive and non-nutritive sweeteners may influence energy and glucose metabolism differently. The hypothesis that sucrose, fructose, aspartame, and sucralose intake differently modulate energy and glucose metabolism was tested in an estrogen-deficient animal model. At 30 min after giving aspartame and sucralose (10 mg/kg body weight), an oral glucose tolerance test (OGTT) was conducted with glucose, sucrose, and fructose in ovariectomized (OVX) rats. After OGTT, they were continuously fed high fat diets including either 10% corn starch (Control), 10% sucrose (Sucrose), 10% fructose (Fructose), 0.05% aspartame + 9.95% starch (Aspartame) or 0.05% sucralose + 9.95% starch (Sucralose) for 8 week. During 30 min after acute administration of aspartame and sucralose, serum glucose concentrations increased despite slightly increased serum insulin levels before glucose infusion. However, glucose tolerance was not significantly different among the groups. In chronic study, serum glucose concentrations were lowest and insulin highest at the overnight-fasted state in Aspartame and Sucralose. Postprandial serum glucagon-like peptide-1 (GLP-1) and insulin levels were higher in Aspartame and Sucralose than Control. Hepatic insulin signaling (pAkt → pGSK-3β) and phosphoenolpyruvate carboxykinase (PEPCK) expression were lower in Sucralose and Aspartame than the Fructose. Serum acetate levels produced by gut microbiota were higher were lower in the fructose group than Aspartame and Sucralose groups. In conclusion, aspartame and sucralose with a meal might be preferable sweeteners to fructose and sucrose in estrogen deficient rats, and possibly post-menopausal women; however, this needs to be confirmed in human studies.
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Affiliation(s)
- Jin Ah Ryuk
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Suna Kang
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, 336-795, South Korea
| | - James W Daily
- Department of R&D, Daily Manufacturing Inc., Rockwell, NC, USA
| | - Byoung-Seob Ko
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, 336-795, South Korea
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Guyenet SJ. Impact of Whole, Fresh Fruit Consumption on Energy Intake and Adiposity: A Systematic Review. Front Nutr 2019; 6:66. [PMID: 31139631 PMCID: PMC6518666 DOI: 10.3389/fnut.2019.00066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The energy content of whole, fresh fruit derives primarily from simple sugars, which are currently under heightened scrutiny for their potential contribution to obesity and chronic disease risk. Yet fruit also has a relatively low energy density, moderate palatability/reward value, and high fiber content, which together may limit energy intake. Although reasoned arguments can be made that fruit is fattening or slimming, the question is best resolved empirically. Methods: Methods were preregistered with PROSPERO (CRD42018111830). The primary outcome is the impact of whole, fresh fruit consumption on measures of adiposity including body weight in randomized controlled trials (RCTs). Secondary outcomes are the impact of whole, fresh fruit consumption on energy intake in RCTs, and the association between whole, fresh fruit consumption and changes in measures of adiposity in prospective observational studies. CENTRAL and PubMed databases were searched through October 2018. Cochrane risk of bias tool was used to assess risk of bias in RCTs, and the GRADE method was used to judge and convey the certainty of conclusions. Reporting follows PRISMA guidelines. Results: RCTs, and particularly those of higher quality, suggest that increasing whole, fresh fruit consumption promotes weight maintenance or modest weight loss over periods of 3-24 weeks (moderate certainty), with limited evidence suggesting that a high intake of fruit favors weight loss among people with overweight or obesity. Consistent with this, single-meal RCTs suggest that consuming whole, fresh fruit tends to decrease energy intake, particularly when consumed prior to a meal or when displacing more energy-dense foods (moderate certainty). Prospective observational studies suggest that habitually higher fruit intake is not associated with weight change, or is associated with modest protection against weight gain, over five or more years. Conclusions: Current evidence suggests that whole, fresh fruit consumption is unlikely to contribute to excess energy intake and adiposity, but rather has little effect on these outcomes or constrains them modestly. Single-meal RCTs, RCTs lasting 3-24 weeks, and long-term observational studies are relatively consistent in supporting this conclusion. Whole, fresh fruit probably does not contribute to obesity and may have a place in the prevention and management of excess adiposity.
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18
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Jardí C, Aranda N, Bedmar C, Ribot B, Elias I, Aparicio E, Arija V. Ingesta de azúcares libres y exceso de peso en edades tempranas. Estudio longitudinal. An Pediatr (Barc) 2019; 90:165-172. [DOI: 10.1016/j.anpedi.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 12/11/2022] Open
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20
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Hao CL, Lin HL, Ke LY, Yen HW, Shen KP. Pre-germinated brown rice extract ameliorates high-fat diet-induced metabolic syndrome. J Food Biochem 2019; 43:e12769. [PMID: 31353547 DOI: 10.1111/jfbc.12769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
This study examined the effect of pre-germinated brown rice extract (PGBRE), containing no dietary fibers, but γ-oryzanol, γ-aminobutyric acid (GABA), flavonoids, and anthocyanidin, on high-fat-diet (HFD)-induced metabolic syndrome. C57BL/6 mice were divided into five groups: regular diet, HFD, HFD with oral PGBRE 30, 300, or 600 mg/kg per day for 18 weeks. In the HFD group, higher body and liver weight gain, hyperglycemia, HbA1c, and insulin; higher TG, TC, LDL-C, non-HDL, atherosclerosis index, lower HDL, adiponectin in blood; higher TG in the liver; higher TG, bile acid in feces; and lower protein levels of AMP-activated protein kinase, insulin receptor, insulin receptor substrate-1, insulin receptor substrate-2, peroxisome proliferator-activated receptor-γ, phosphatidylinositol-3-kinase, Akt/PKB, glucose transporter-1, glucose transporter-4, glucokinase in the skeletal muscle; lower glucagon-like peptide 1 (GLP-1) in the intestine; higher sterol regulatory element-binding protein-1 (SREBP-1), stearoyl-CoA desaturase 1 (SCD-1), fatty acid synthase (FAS), 3-hydroxy-3-methylglutaryl-CoA reductase, proprotein convertase subtilisin/kexin type 9 (PCSK9), and lower PPAR-α, low-density lipoprotein receptor, cholesterol-7α-hydroxylase in the liver; higher SREBP-1, SCD-1, FAS, and lower PPAR-α, adiponectin in the adipose tissue were found. In HFD + PGBRE groups, the above biochemical parameters were improved. PRACTICAL APPLICATIONS: According to the results, we suggested that dietary fibers played a minor role in this study. Extract of PGBR, excluding dietary fiber, showed beneficial activity to ameliorate metabolic syndrome. γ-oryzanol, GABA, flavonoids, and anthocyanidin in PGBRE can inhibit HFD-induced metabolic syndrome and we demonstrated clearly its action mechanisms. This is the first report to examine the relation between PGBRE, GLP-1, and PCSK9. Taken together, PGBRE can potentially be used to develop a good supplement to control metabolic syndrome.
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Affiliation(s)
- Chi-Long Hao
- Division of Cardiology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Hui-Li Lin
- Department of Food Science and Nutrition, Meiho University, Pingtung, Taiwan
| | - Liang-Yin Ke
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuo-Ping Shen
- Department of Nursing, Meiho University, Pingtung, Taiwan
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21
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Kamel M, Smith BT, Wahi G, Carsley S, Birken CS, Anderson LN. Continuous cardiometabolic risk score definitions in early childhood: a scoping review. Obes Rev 2018; 19:1688-1699. [PMID: 30223304 DOI: 10.1111/obr.12748] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiometabolic risk (CMR) in young children has been measured using various approaches, including a continuous summary score that incorporates components such as adiposity, lipids, metabolic factors and blood pressure. OBJECTIVES The objective of this study was to comprehensively review definitions of continuous CMR scores in children <10 years of age. METHODS A scoping review was conducted using a systematic search of four scientific databases up to June 2016. Inclusion criteria were children <10 years of age and report of a continuous CMR score. RESULTS Ninety-one articles were included. Most studies were published from 2007 to 2016 (96%). Nearly all continuous CMR scores (90%) were calculated using the sum or the mean of z-scores, and many articles age-standardized and sex-standardized components within their own population. The mean number of variables included in the risk scores was 5 with a range of 3-11. The most commonly included score components were waist circumference (52%), triglycerides (87%), high-density lipoprotein cholesterol (67%), glucose (43%) and systolic blood pressure (52%). IMPORTANCE Continuous CMR scores are emerging frequently in the child health literature and are calculated using numerous methods with diverse components. This heterogeneity limits comparability across studies. A harmonized definition of CMR in childhood is needed.
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Affiliation(s)
- M Kamel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - B T Smith
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - G Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Carsley
- Public Health Ontario, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - C S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Seo YG, Choi MK, Kang JH, Lee HJ, Jang HB, Park SI, Ju YS, Park KH. Cardiovascular disease risk factor clustering in children and adolescents: a prospective cohort study. Arch Dis Child 2018; 103:968-973. [PMID: 29650509 DOI: 10.1136/archdischild-2017-313226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 03/09/2018] [Accepted: 03/25/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The early identification of predictors related to cardiovascular disease risk factor clustering (CVD-RFC) can help prevent chronic disease. We aimed to identify the risk factors for CVD-RFC in adolescents. METHODS A prospective longitudinal cohort study design was used to obtain data included in these analyses from school-aged children who participated in the Korean Child-Adolescent Study 2008-2014. A total of 1309 children aged 6-15 years were enrolled. We compared the participants based on the presence or absence of CVD-RFC and examined the cumulative incidence of CVD-RFC. RESULTS Of the total 1309 children, 410 (31.32%) had CVD-RFC in adolescence. A higher average household income ≥3 million Korean Republic won (KRW)/month (3-5 million KRW/month: HR 0.75 (95% CI 0.58 to 0.97); ≥5 million KRW/month: HR 0.58 (95% CI 0.44 to 0.77)) was associated with a lower CVD-RFC incidence, while the presence of parental CVD history (HR 1.28 (95% CI 1.04 to 1.57)), overweight or obesity (HR 3.83 (95% CI 3.05 to 4.80)) and shorter sleep duration of 8-9 hour/day (HR 1.80 (95% CI 1.05 to 3.07)) and <8 hour/day (HR 1.93 (95% CI 1.11 to 3.34)) had higher CVD-RFC incidences. CONCLUSIONS Obesity in childhood, short sleep duration and parental factors such as low socioeconomic status and parental history of CVD are significant risk factors for the development of CVD-RFC in adolescents. Efforts to create awareness regarding sufficient sleep duration in children via intervention programmes targeting cardiometabolic health in children and special attention to lifestyle modifications and socioeconomic components of the family should be considered.
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Affiliation(s)
- Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Min-Kyu Choi
- Department of Family Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Han Byul Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Young Soo Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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23
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Moran AJ, Roberto CA. Health Warning Labels Correct Parents' Misperceptions About Sugary Drink Options. Am J Prev Med 2018; 55:e19-e27. [PMID: 29903567 PMCID: PMC6128141 DOI: 10.1016/j.amepre.2018.04.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/15/2018] [Accepted: 04/10/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Noncarbonated sugar-sweetened beverages, such as fruit drinks, sports drinks, and sweetened teas are increasingly promoted to and consumed by youth. These beverages may be perceived as healthier options than soda. To educate consumers about beverages high in added sugar, several cities and states have proposed policies mandating health warning labels on sugar-sweetened beverages. METHODS In 2015, a total of 2,381 parents were randomized to a no label, calorie label, or warning label condition. An online survey asked about the healthfulness of different beverages, and asked parents to select a beverage for their child in a choice task. Regressions compared the warning and calorie label groups to the control group and measured mediating effects of health beliefs on beverage choice. Data were analyzed in 2016. RESULTS Parents viewed fruit drinks, sports drinks, and sweetened teas as healthier and less likely to cause disease than soda. Compared with no label, warning labels significantly increased parents' risk perceptions for all beverages except soda. Warning labels significantly reduced the odds of selecting fruit drinks for the child (OR=0.42, 95% CI=0.32, 0.56), and this effect was mediated by changes in health beliefs and risk perceptions. CONCLUSIONS Fruit drinks, sports drinks, and sweetened teas are increasingly promoted to youth. Parents believe these beverages are healthier and less likely to cause disease than soda, and warning labels may correct these misperceptions.
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Affiliation(s)
- Alyssa J Moran
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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24
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Aldhoon-Hainerová I, Hainer V, Zamrazilová H. Impact of dietary intake, lifestyle and biochemical factors on metabolic health in obese adolescents. Nutr Metab Cardiovasc Dis 2017; 27:703-710. [PMID: 28693964 DOI: 10.1016/j.numecd.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/09/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Obesity devoid of metabolic abnormalities is known as metabolically healthy obesity (MHO). The aim of the study was to examine determinants of MHO during adolescence. METHODS AND RESULTS From among 710 obese adolescents, 43 girls and 57 boys were classified as metabolically unhealthy (abdominal obesity and ≥2 risk components of metabolic syndrome). MHO (absence of any cardiometabolic risk factor) was found in 211 girls and 131 boys (regardless of waist circumference) and in 33 girls and 27 boys (without abdominal obesity). Laboratory and anthropometric parameters, dietary records and various lifestyle factors were compared between MHO vs. those unhealthy. The prevalence of MHO regardless of waist circumference was higher in girls than in boys (53.1 vs. 41.9%) but comparable when abdominal obesity was excluded (8.3 vs. 8.6%). Anthropometric variables, levels of gamma-glutamyl transferase, total and low-density lipoprotein cholesterol in both genders, hs-C-reactive protein in girls and alanine aminotransferase in boys differentiated the two metabolic phenotypes. Uric acid was related to metabolic health only in the analysis of MHO without abdominal obesity. Total hours of sleep, bedtime, time of the last daily meal, regular meal consumption and protein intake in boys and screen time, the score of disinhibition and diet composition in girls were found to impact cardiometabolic health. CONCLUSIONS In obese adolescents, metabolic health was related to anthropometric and biochemical parameters and only weak associations were found with most of the lifestyle factors studied. Uric acid concentration associated with metabolic health when abdominal obesity was excluded.
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Affiliation(s)
- I Aldhoon-Hainerová
- Institute of Endocrinology, Prague, Czech Republic; Department of Pediatrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - V Hainer
- Institute of Endocrinology, Prague, Czech Republic
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25
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Kaar JL, Simon SL, Schmiege SJ, Nadeau KJ, Kelsey MM. Adolescent's Health Behaviors and Risk for Insulin Resistance: A Review of the Literature. Curr Diab Rep 2017; 17:49. [PMID: 28526994 DOI: 10.1007/s11892-017-0881-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW One-third of US adolescents are obese, and related comorbidities exist in this population. Preventing early indicators of these diseases, such as insulin resistance (IR), may impact future morbidity and mortality. Interventions to date have only focused on diet or exercise. Additional targets to prevent disease are needed. This paper reviews the evidence in adolescents examining multiple health behaviors that have been associated with IR. RECENT FINDINGS Health behaviors (i.e., diet, activity, sleep) have been individually examined as possible contributors to disease, but an understanding of the complex interplay between these behaviors is lacking. A better understanding of how multiple health behaviors contribute to IR in adolescents is needed. Future studies using both advanced statistical methodology and robust measures of each health behavior may facilitate better understanding of the impact of lifestyle factors on IR and guide intervention strategies to reduce the risk of disease.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA.
| | - Stacey L Simon
- Department of Pediatrics, Division of Pulmonology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 395, Aurora, CO, 80045, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13120 East 19th Avenue, Mail Stop C288-04, Aurora, CO, 80045, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA
| | - Megan M Kelsey
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA
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Kuzma JN, Schmidt KA, Kratz M. Prevention of metabolic diseases: fruits (including fruit sugars) vs. vegetables. Curr Opin Clin Nutr Metab Care 2017; 20:286-293. [PMID: 28403010 PMCID: PMC5816683 DOI: 10.1097/mco.0000000000000378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW To discuss recent evidence from observational and intervention studies on the relationship between fruit and vegetable (F&V) consumption and metabolic disease. RECENT FINDINGS Observational studies have consistently demonstrated a modest inverse association between the intake of fruit and leafy green vegetables, but not total vegetables, and biomarkers of metabolic disease as well as incident type 2 diabetes mellitus. This is in contrast to limited evidence from recently published randomized controlled dietary intervention trials, which - in sum - suggests little to no impact of increased F&V consumption on biomarkers of metabolic disease. SUMMARY Evidence from observational studies that fruit and leafy green vegetable intake is associated with lower type 2 diabetes risk and better metabolic health could not be confirmed by dietary intervention trials. It is unclear whether this discrepancy is because of limitations inherent in observational studies (e.g., subjective dietary assessment methods, residual confounding) or due to limitations in the few available intervention studies (e.g., short duration of follow-up, interventions combining whole fruit and fruit juice, or lack of compliance). Future studies that attempt to address these limitations are needed to provide more conclusive insight into the impact of F&V consumption on metabolic health.
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Affiliation(s)
- Jessica N. Kuzma
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kelsey A. Schmidt
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mario Kratz
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Epidemiology & Medicine, University of Washington, Seattle, WA
- Correspondence to Dr. Mario Kratz, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop M4-B402, Seattle, WA 98109 USA Tel: +1 *206) 667-7362;
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27
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Frantsve-Hawley J, Bader JD, Welsh JA, Wright JT. A systematic review of the association between consumption of sugar-containing beverages and excess weight gain among children under age 12. J Public Health Dent 2017; 77 Suppl 1:S43-S66. [PMID: 28556932 DOI: 10.1111/jphd.12222] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/12/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A systematic review was conducted to address this clinical question: Does consumption of (non-dairy) sugar-containing beverages (SCBs) among children under age 12 result in excess weight gain? METHODS The authors searched four databases for controlled trials (randomized and non-randomized) and cohort studies published in English through March 29, 2016: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL. Initial and full-text screening, data abstraction, and risk of bias assessment were performed independently and in duplicate. RESULTS Thirty-eight studies met inclusion criteria for this systematic review. One was a randomized controlled trial, and 37 were cohort studies. Though the results of these studies were mixed, the majority demonstrated a statistically significant positive association between SCB consumption in children under age 12 and total adiposity and central adiposity. In contrast, most studies that assessed 100 percent fruit juice consumption only with either total adiposity or central adiposity did not support an association. Among only children under age 5 at baseline, no studies examined central adiposity, but nearly all studies examining SCBs and total adiposity, and a majority examining only fruit juice consumption, demonstrated a statistically significant positive association. CONCLUSION Our results support a statistically significant positive association between SCBs and total and central adiposity among children under age 12. This association is most consistent for total adiposity among children <5. Our results for 100 percent fruit juice only suggest differences by age, as most studies among those < 12 were negative but most among those <5 were positive.
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Affiliation(s)
- Julie Frantsve-Hawley
- American Association of Public Health Dentistry, Springfield, IL, USA; College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - James D Bader
- School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Jean A Welsh
- Department of Pediatrics, Emory University School of Medicine, Wellness Department, Children's Healthcare of Atlanta, Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - J Timothy Wright
- Department of Pediatric Dentistry, UNC School of Dentistry, Chapel Hill, NC, USA
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Ha KH, Kim DJ. Epidemiology of Childhood Obesity in Korea. Endocrinol Metab (Seoul) 2016; 31:510-518. [PMID: 27834078 PMCID: PMC5195826 DOI: 10.3803/enm.2016.31.4.510] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 12/14/2022] Open
Abstract
Over the past several decades, the prevalence of obesity has increased dramatically worldwide and is increasing not only in developed countries, but also in developing countries. This increase may lead to an increase in the incidence of chronic diseases throughout the lifespan. In Korean children and adolescents, the prevalence of obesity increased from 6.8% in 1998 to 10.0% in 2013. Obesity is a state that more commonly influences children and adolescents of lower socioeconomic status (SES) than those with a higher SES. However, the prevalence of metabolic syndrome in a nationally representative sample of Korean adolescents decreased from 1998 to 2012. According to the Diabetes Fact Sheet of the Korean Diabetes Association, the prevalence of type 2 diabetes among children aged 18 years or younger was 153.5 per 100,000 in 2006 and 205.0 per 100,000 in 2013. Obesity is a complex disease influenced by many interacting factors, such as adipocytokines, lipopolysaccharide-binding protein, adenovirus 36 infection, birth weight, lifestyle, and endocrine-disrupting chemicals. Obesity in youth can adversely impact practically every organ system and lead to serious consequences, such as metabolic, gastrointestinal, pulmonary, cardiovascular, and psychosocial complications. Therefore, coordinated efforts by governments, organizations, communities, and individuals are needed to prevent and treat childhood obesity. In particular, a long-term policy to improve the social environment will also be necessary.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.
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29
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Kang YJ, Wang HW, Cheon SY, Lee HJ, Hwang KM, Yoon HS. Associations of Obesity and Dyslipidemia with Intake of Sodium, Fat, and Sugar among Koreans: a Qualitative Systematic Review. Clin Nutr Res 2016; 5:290-304. [PMID: 27812518 PMCID: PMC5093226 DOI: 10.7762/cnr.2016.5.4.290] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 10/20/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Abstract
A qualitative systematic review was performed to identify associations of obesity and dyslipidemia with intake of sodium, fat, and sugar among Koreans. We reviewed 6 Korean research databases (KMbase, KoreaMed, NDSL, DBpia, RISS, KISS) with the keywords “sodium intake,” “fat intake,” and “sugar intake.” Total of 11 studies were investigated in this present study. Of these articles, 7 studies were related to sodium intake, 2 studies had a relation to fat intake, and 2 studies were associated with sugar intake. We indicated general characteristics, concentration of serum lipids, nutrition intake, and statistically significant results. High sodium intake contributed to increased etiology of hypertriglyceridemia, high-density lipoprotein (HDL) hypocholesterolemia, and a risk of being overweight. Fat intake was significantly associated with body fat, low-density lipoprotein (LDL) hypercholesterolemia, and HDL hypocholesterolemia. Sugar intake from coffee drinks and sugar-sweetened beverages contributed to increased HDL hypocholesterolemia and continuous metabolic syndrome score. This qualitative review among Koreans represented that intake of sodium, fat, and sugar has a positive relationship with cause of obesity-related diseases. Especially, this present study has a great significance in terms of considered study that intake of the potentially hazardous nutrients among Koreans has an association with obesity and dyslipidemia. However, further studies such as randomized controlled trials on associations between sodium, fat, and sugar and obesity and dyslipidemia need to be continuously required in order to conduct quantitative systematic reviews and a meta-analysis for Koreans.
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Affiliation(s)
- Yoon Jung Kang
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
| | - Hye Won Wang
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
| | - Se Young Cheon
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
| | - Hwa Jung Lee
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
| | - Kyung Mi Hwang
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
| | - Hae Seong Yoon
- Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation, Cheongju 28159, Korea
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30
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Ha K, Chung S, Joung H, Song Y. Dietary sugar intake and dietary behaviors in Korea: a pooled study of 2,599 children and adolescents aged 9-14 years. Nutr Res Pract 2016; 10:537-545. [PMID: 27698962 PMCID: PMC5037072 DOI: 10.4162/nrp.2016.10.5.537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Dietary sugar intake, particularly added sugar and sugar-sweetened beverages, has received worldwide attention recently. Investigation of dietary behaviors may facilitate understanding of dietary sugar intakes of children and adolescents. However, the relationship between dietary sugar intake and dietary behaviors in the Korean population has not been investigated. Thus, this study aimed to estimate dietary sugar intake and food sources according to sex as well as examine the relationship of dietary sugar intake with frequent snacking and dietary patterns among Korean children and adolescents. SUBJECTS/METHODS We pooled data from five studies involving Korean children and adolescents conducted from 2002 to 2011. A total of 2,599 subjects aged 9-14 years were included in this study. Each subject completed more than 3 days of dietary records. RESULTS Mean daily total sugar intake was 46.6 g for boys and 54.3 g for girls. Compared with boys, girls showed higher sugar intakes from fruits (7.5 g for boys and 8.8 g for girls; P = 0.0081) and processed foods (27.9 g for boys and 34.9 g for girls; P < 0.0001). On average, 95.4% of boys and 98.8% of girls consumed snacks during the study period, and total sugar intake showed a significantly increasing trend with increasing energy intake from snacks (P < 0.0001 for both sexes). Two dietary patterns were identified by cluster analysis: Traditional and Westernized patterns. Total sugar intake was higher in the Westernized pattern (56.2 g for boys and 57.2 g for girls) than in the Traditional pattern (46.5 g for boys and 46.3 g for girls). CONCLUSIONS These results suggest that multilateral and practical development of a nutrition education and intervention program that considers dietary behaviors as well as absolute sugar intake is required to prevent excessive sugar intake in Korean children and adolescents.
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Affiliation(s)
- Kyungho Ha
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - Sangwon Chung
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - Hyojee Joung
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - YoonJu Song
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi 14662, Korea
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31
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Effects of an obesity management mentoring program for Korean children. Appl Nurs Res 2016; 31:160-4. [DOI: 10.1016/j.apnr.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 02/28/2016] [Accepted: 03/05/2016] [Indexed: 11/18/2022]
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