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McGuirt JT, Anderson Steeves E, Labban JD, Pfammatter AF, Allen K, Kopper R, Sun Y, Gustafson A. Multi-Method Formative Evaluation of a Digital Online Grocery Shopping Assistant Among Special Supplemental Nutrition Program for Women, Infants, and Children Participants. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:556-568. [PMID: 38775762 DOI: 10.1016/j.jneb.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE Assess the acceptability of a digital grocery shopping assistant among rural women with low income. DESIGN Simulated shopping experience, semistructured interviews, and a choice experiment. SETTING Rural central North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PARTICIPANTS Thirty adults (aged ≥18 years) recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PHENOMENON OF INTEREST A simulated grocery shopping experience with the Retail Online Shopping Assistant (ROSA) and mixed-methods feedback on the experience. ANALYSIS Deductive and inductive qualitative content analysis to independently code and identify themes and patterns among interview responses and quantitative analysis of simulated shopping experience and choice experiment. RESULTS Most participants liked ROSA (28/30, 93%) and found it helpful and likely to change their purchase across various food categories and at checkout. Retail Online Shopping Assistant's reminders and suggestions could reduce less healthy shopping habits and diversify food options. Participants desired dynamic suggestions and help with various health conditions. Participants preferred a racially inclusive, approachable, cartoon-like, and clinically dressed character. CONCLUSIONS AND IMPLICATIONS This formative study suggests ROSA could be a beneficial tool for facilitating healthy online grocery shopping among rural shoppers. Future research should investigate the impact of ROSA on dietary behaviors further.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC.
| | | | - Jeffrey D Labban
- Office of Research, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC
| | - Angela F Pfammatter
- College of Education, Health, and Human Sciences, Department of Public Health, The University of Tennessee Knoxville, Knoxville, TN
| | - Kendall Allen
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC
| | - Regis Kopper
- Department of Computer Science, University of North Carolina Greensboro, Greensboro, NC
| | - Yingcheng Sun
- Department of Computer Science, University of North Carolina Greensboro, Greensboro, NC
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY
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Zoellner JM, You W, Porter K, Kirkpatrick B, Reid A, Brock D, Chow P, Ritterband L. Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:46. [PMID: 38664715 PMCID: PMC11046896 DOI: 10.1186/s12966-024-01594-7] [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: 04/20/2023] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)]. METHODS This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors. RESULTS Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001). CONCLUSIONS Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline. TRIAL REGISTRATION Clincialtrials.gov: NCT03740113. Registered 14 November 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113 .
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA.
| | - Wen You
- Department of Public Health Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Brittany Kirkpatrick
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Annie Reid
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Donna Brock
- Department of Public Health Sciences, University of Virginia, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Phillip Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
| | - Lee Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA, 22908, USA
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Azhar Hilmy SH, Nordin N, Yusof MYPM, Soh TYT, Yusof N. Components in downstream health promotions to reduce sugar intake among adults: a systematic review. Nutr J 2024; 23:11. [PMID: 38233923 PMCID: PMC10792802 DOI: 10.1186/s12937-023-00884-3] [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: 01/16/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.
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Affiliation(s)
- Syathirah Hanim Azhar Hilmy
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
- Department of Periodontology & Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, 57000, Malaysia
| | - Norhasnida Nordin
- Centre of Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Tuan Yuswana Tuan Soh
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia.
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Ricciuto L, Fulgoni VL, Gaine PC, Scott MO, DiFrancesco L. Intakes of Added Sugars, with a Focus on Beverages and the Associations with Nutrient Adequacy in US Adults (NHANES 2003-2018). Nutrients 2023; 15:3916. [PMID: 37764700 PMCID: PMC10537713 DOI: 10.3390/nu15183916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The Dietary Guidelines for Americans recommend adults increase their intake of nutrients that are under-consumed while limiting their intake of added sugars, sodium, and saturated fats. The purpose of this study was to examine the relationship between added sugars intake from specific types of beverages with added sugars (soft drinks, fruit drinks, sports and energy drinks, coffee and tea, and flavored milk) and nutrient adequacy among US adults (19+ y). Data from eight consecutive 2-y cycles of NHANES were combined (2003-2004 through 2017-2018), and regression analysis was conducted to test for trends in quantiles of added sugars intake from each beverage source and the rest of the diet (excluding those beverages) and nutrient adequacy. Results revealed significant associations that varied in direction according to the added sugars source, negative for some (i.e., soft drinks) in terms of greater percentages of adults not meeting a defined threshold of nutrient adequacy with higher added sugars intakes, and positive for others (i.e., fruit drinks, flavored milk, the rest of the diet) in terms of lower percentages of adults not meeting nutrient thresholds. In conclusion, the contribution of different added sugars sources to nutrient intakes is a critical consideration in developing population-based dietary recommendations.
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Affiliation(s)
- Laurie Ricciuto
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A1, Canada
| | | | | | - Maria O Scott
- The Sugar Association, Inc., Washington, DC 20005, USA
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Campbell BK, Le T, Pagano A, McCuistian C, Woodward-Lopez G, Bonniot C, Guydish J. Addressing nutrition and physical activity in substance use disorder treatment: Client reports from a wellness-oriented, tobacco-free policy intervention. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100165. [PMID: 37234703 PMCID: PMC10206429 DOI: 10.1016/j.dadr.2023.100165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
Introduction Interest in wellness interventions in substance use disorder (SUD) treatment is growing although evidence remains limited. This study evaluated nutrition, physical activity, nutrition and physical activity counseling, and relationships of counseling with wellness behavior before and after a wellness-oriented, tobacco-free policy intervention in 17 residential SUD programs. Methods Clients completed cross-sectional surveys reporting sugar-sweetened beverage consumption, physical activity, and receipt of nutrition and physical activity counseling before (n= 434) and after (n = 422) an 18-month intervention. Multivariable regression models assessed pre-post-intervention differences in these variables and examined associations of nutrition counseling with sugar-sweetened beverage consumption and physical activity counseling with physical activity. Results Post-intervention clients were 83% more likely than pre-intervention clients to report nutrition counseling (p = 0.024). There were no pre-post- differences for other variables. Past week sugar-sweetened beverage consumption was 22% lower among clients reporting nutrition counseling than for those who did not (p = 0.008) and this association did not vary by time (pre/post). There was a significant interaction of physical activity counseling receipt by time on past week physical activity (p = 0.008). Pre-intervention clients reporting physical activity counseling had 22% higher physical activity than those who did not; post-intervention clients reporting physical activity counseling had 47% higher physical activity. Conclusion A wellness policy intervention was associated with increased nutrition counseling. Nutrition counseling predicted lower sugar-sweetened beverage consumption. Physical activity counseling predicted higher physical activity, an association that was greater post-intervention. Adding wellness components to tobacco-related interventions may promote health among SUD clients.
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Affiliation(s)
- Barbara K. Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Anna Pagano
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Gail Woodward-Lopez
- University of California Nutrition Policy Institute, 1111 Franklin St, Fifth Floor, Oakland, CA 94607, USA
| | - Catherine Bonniot
- Smoking Cessation Leadership Center, Division of General Internal Medicine, University of California, San Francisco, 490 Illinois Street I San Francisco, CA 94143, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
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Čad EM, Tang CS, de Jong HBT, Mars M, Appleton KM, de Graaf K. Study protocol of the sweet tooth study, randomized controlled trial with partial food provision on the effect of low, regular and high dietary sweetness exposure on sweetness preferences in Dutch adults. BMC Public Health 2023; 23:77. [PMID: 36627602 PMCID: PMC9831892 DOI: 10.1186/s12889-022-14946-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/24/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Several health organizations recommend lowering the consumption of sweet-tasting foods. The rationale behind this recommendation is that a lower exposure to sweet foods may reduce preferences for sweet tasting foods, thus lowering sugar and energy intake, and in turn aiding in obesity prevention. However, empirical data supporting this narrative are lacking. In fact, relatively little is known about the contribution of long-term sweet taste exposure on one's sweetness preferences. METHODS The primary objective of this randomized controlled trial is to assess the effect of low, regular and high dietary sweetness exposure on preference for sweet foods and beverages, and to compare these effects between intervention groups. One hundred and eighty adults aged 18-65 years with a BMI of 18.5-30.0 kg/m2 will be recruited and randomly allocated to either: low dietary sweetness exposure (LSE) (10-15% daily energy from sweet tasting foods), regular dietary sweetness exposure (RSE) (25-30% daily energy from sweet tasting foods), or high dietary sweetness exposure (HSE) (40-45% daily energy from sweet tasting foods), for 6 months, followed by a 4-month follow up. Intervention foods are provided ad libitum, covering approximately 50% of the daily number of food items, to include sugar-sweetened, low-calorie-sweetener-sweetened and non-sweet foods. The primary outcome measure is the difference in change in sweetness preference from baseline to 6 months between intervention groups. Secondary outcomes include: change in sweet taste preferences at different time-points; taste intensity perception; behavioral outcomes: food choice and intake, sweet-liker type, food cravings, dietary taste preferences and dietary taste patterns; anthropometric outcomes: body composition, waist-hip circumference, body weight; and biochemical outcomes: glucose variability and biomarkers related to CVD and diabetes. DISCUSSION This study will generate important data on the effect of dietary sweetness exposure on sweetness preferences in terms of effect size and change, duration of change and its impact on food intake, body weight status and associated health outcomes. TRIAL REGISTRATION The study protocol has been registered on ClinicalTrials.gov (ID no. NCT04497974, Registered 4 August 2020, https://clinicaltrials.gov/ct2/show/NCT04497974 ) and approved by Wageningen's Medical Ethical Committee (ABR no. NL72134).
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Affiliation(s)
- Eva M. Čad
- grid.4818.50000 0001 0791 5666Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Claudia S. Tang
- grid.17236.310000 0001 0728 4630Department of Psychology, Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Hanne B. T. de Jong
- grid.4818.50000 0001 0791 5666Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Monica Mars
- grid.4818.50000 0001 0791 5666Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Katherine M. Appleton
- grid.17236.310000 0001 0728 4630Department of Psychology, Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Kees de Graaf
- grid.4818.50000 0001 0791 5666Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Mastrangelo MEDMT, Araujo MC, Castro MBTD. Association between the consumption of sugar-sweetened beverages and food markers: National Dietary Survey 2008-2009. CIENCIA & SAUDE COLETIVA 2022; 27:3117-3128. [PMID: 35894323 DOI: 10.1590/1413-81232022278.00022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
We aimed to analyze the association between sugar-sweetened beverage (SSB) consumption with healthy food markers (HFM) and unhealthy food markers (UFM) as well as their impact on these markers in the Brazilian population's diet. Food consumption during two nonconsecutive days of food records of individuals aged ten years or over were investigated in the National Dietary Survey 2008-2009 (n = 32,900) and the caloric contributions of HFM and UFM were distributed according to the categories of SSB consumption. Multiple linear regression was applied to analyze the associations between the consumption of SSB and the impact of a 50% reduction in portion size and dietary markers. The contribution of energy from HFM was higher among individuals who did not consume SSB. A 50% reduction in the average portion of SSB in the population would imply a 6% decrease in energy contribution to the diet and 12% decrease in total energy from added sugar. It would increase the consumption of HFM and dietary fiber by 7g and 4g, respectively. A 50% reduction in SSB serving size is a strategy that could improve the quality of the diet, increase the consumption of HFM and fiber and reduce the consumption of sugar and UFM.
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Affiliation(s)
- Maria Eliza de Mattos Tobler Mastrangelo
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Bloco J, 2º andar, Ilha do Governador. 21941-590 Rio de Janeiro RJ Brasil.
| | - Marina Campos Araujo
- Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Maria Beatriz Trindade de Castro
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Bloco J, 2º andar, Ilha do Governador. 21941-590 Rio de Janeiro RJ Brasil.
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Thompson IJB, Ritchie LD, Bradshaw PT, Mujahid MS, Au LE. Earlier Introduction to Sugar-Sweetened Beverages Associated With Lower Diet Quality Among WIC Children at Age 3 Years. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:912-920. [PMID: 34229969 DOI: 10.1016/j.jneb.2021.04.468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Examine the association between the timing of sugar-sweetened beverages (SSBs) and 100% juice introduction with subsequent diet quality at age 3 years. DESIGN Secondary analysis of a publicly available, national longitudinal dataset. PARTICIPANTS A total of 2,218 children from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). MAIN OUTCOME MEASURE Dietary intakes were assessed using a 24-hour dietary recall completed by caregivers of children aged 3 years. Diet quality was assessed using the Healthy Eating Index Score-2015 (HEI-2015). ANALYSIS Linear regression was used to assess the relationship between the timing of introduction to 100% juice and SSBs with HEI-2015. Adjustments were made for child- and maternal-related factors. RESULTS Delayed introduction of SSBs during the first 2 years of life was associated with an increased HEI-2015 score. In adjusted analyses, for every 1-month delay in the introduction, there was a 0.09-point increase (95% confidence interval, 0.04-0.13) in the HEI-2015 score at 3 years. CONCLUSIONS AND IMPLICATIONS Earlier introduction to SSBs may be associated with subsequent lower diet quality in WIC participants. This association may be driven by total fruit, whole grains, and added sugars HEI component scores. Further research is needed to support changes to existing WIC nutrition practices regarding SSBs and 100% juice.
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Affiliation(s)
- Isabel J B Thompson
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA
| | - Patrick T Bradshaw
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Mahasin S Mujahid
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Lauren E Au
- Department of Nutrition, University of California Davis, Davis, CA.
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Zoellner JM, Porter KJ, You W, Reid AL, Frederick C, Hilgart M, Brock DJP, Tate DF, Ritterband LM. Study protocol for iSIPsmarter: A randomized-controlled trial to evaluate the efficacy, reach, and engagement of a technology-based behavioral intervention to reduce sugary beverages among rural Appalachian adults. Contemp Clin Trials 2021; 110:106566. [PMID: 34492306 PMCID: PMC8595813 DOI: 10.1016/j.cct.2021.106566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 01/09/2023]
Abstract
Sugar-sweetened beverage (SSB) consumption is disproportionately high among rural Appalachian adults, with intakes double the national average and nearly four times the recommended amount. This trial targets this major dietary risk factor and addresses notable gaps in the rural digital health intervention literature. iSIPsmarter is a technology-based behavior and health literacy intervention aimed at improving SSB behaviors. It is comprised of six Internet-delivered, interactive Cores delivered weekly, an integrated short message service (SMS) strategy to engage users in tracking and reporting SSB behaviors, and a cellular-enabled scale for in-home weighing. iSIPsmarter is adapted from an evidence-based intervention and is grounded by the Theory of Planned Behavior and health literacy, numeracy, and media literacy concepts. The RCT is guided by the RE-AIM framework and targets 244 rural Appalachian adults. The goal is to examine the efficacy of iSIPsmarter to reduce SSB in a two-group design [iSIPsmarter vs. static Participant Education website] with four assessment points. Changes in secondary outcomes (e.g., diet quality, weight, quality of life) and maintenance of outcomes will also be evaluated. Additional secondary aims are to examine reach and representativeness, patterns of user engagement, and cost. Two tertiary aims are exploratory mediation analyses and a systems-level, participatory evaluation to understand context for future organizational-level adoption of iSIPsmarter. The long-term goal is to sustain an effective, scalable, and high reach behavioral intervention to reduce SSB-related health inequities and related chronic conditions (i.e., obesity, diabetes, some obesity-related cancers, heart disease, hypertension, dental decay) in rural Appalachia and beyond. ClinicalTrial registry: NCT05030753.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, School of Medicine, Department of Public Health Sciences, Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, School of Medicine, Department of Public Health Sciences, Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- University of Virginia, School of Medicine, Department of Public Health Sciences, 560 Ray C Hunt Drive, Charlottesville, VA 22908, USA
| | - Annie L Reid
- University of Virginia, School of Medicine, Department of Public Health Sciences, Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Christina Frederick
- University of Virginia, School of Medicine, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, VA 22908, USA
| | - Michelle Hilgart
- University of Virginia, School of Medicine, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, VA 22908, USA
| | - Donna-Jean P Brock
- University of Virginia, School of Medicine, Department of Public Health Sciences, Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Deborah F Tate
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC 27599, USA
| | - Lee M Ritterband
- University of Virginia, School of Medicine, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, VA 22908, USA
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Brauer P, Royall D, Rodrigues A. Use of the Healthy Eating Index in Intervention Studies for Cardiometabolic Risk Conditions: A Systematic Review. Adv Nutr 2021; 12:1317-1331. [PMID: 33460430 PMCID: PMC8321868 DOI: 10.1093/advances/nmaa167] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/17/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022] Open
Abstract
Researchers and counselors need diet-assessment tools that characterize diet at baseline and over time in diet counseling and coaching interventions. Among possible tools, the Healthy Eating Index (HEI) is of interest in cardiometabolic treatment as it has undergone significant validation and development. The objective of this study was to systematically review relevant intervention studies using the HEI and its adaptations to examine whether diet interventions improve diet quality as measured by the HEI and the magnitude of change in included diet-quality scores following dietary intervention. Two databases [Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed] were searched for articles published from January 1995 to December 2019. The review included intervention studies in adults presenting with overweight/obesity and obesity-related chronic disease (metabolic syndrome, diabetes, prediabetes, hypertension, dyslipidemia) who received education or counseling, and the HEI was evaluated from baseline to follow-up (US or Canadian version) or Alternate HEI. Study quality was assessed using Cochrane risk of bias for randomized controlled trials (RCTs) or Cochrane Risk of Bias for Nonrandomized interventions (ROBINS-I). A total of 25 studies were included: 15 RCTs, 3 quasi-experimental studies, and 7 pre-post studies. Eight different versions of the HEI were used. Results demonstrated that diet quality assessed by HEI and its adaptations improved to a clinically relevant degree, especially in studies where multiple food behaviors/food-behavior goals were the focus and where an intensive, long-term intervention was compared with a no-treatment control group. There was wide variation in magnitude of change in included diet-quality indicators. Use of the HEI and its adaptations and other diet-quality tools is promising for better characterization of diet-counseling interventions and results when multiple food behaviors are a focus. Additional development is encouraged.
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Affiliation(s)
- Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Dawna Royall
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Ariellia Rodrigues
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
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Woo JG, Reynolds K, Summer S, Khoury PR, Daniels SR, Kalkwarf HJ. Longitudinal Diet Quality Trajectories Suggest Targets for Diet Improvement in Early Childhood. J Acad Nutr Diet 2021; 121:1273-1283. [PMID: 33109501 PMCID: PMC8065066 DOI: 10.1016/j.jand.2020.08.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is little information about how diet quality evolves in early childhood, whether children exhibit varying diet quality trajectories, or which components of diet quality should be targeted for intervention. OBJECTIVE The goal of this study was to identify and evaluate trajectories of dietary quality in young children. DESIGN This was a secondary analysis of an observational, longitudinal cohort study of non-Hispanic African American or White children and their parents from racially concordant households with 4 years of follow-up (up to 13 study visits). Data on mother, infant feeding, and body mass index were assessed at baseline. Diet was evaluated using 3-day diaries at each visit. PARTICIPANTS/SETTING Of 372 children enrolled, 349 children had at least 3 study visits with dietary data for this analysis. Participants were enrolled at age 3 years between March 2001 and August 2002 in Cincinnati, OH. Final study visits were conducted between February 2005 and June 2006. MAIN OUTCOME MEASURE The main outcome measure was the total Healthy Eating Index 2005 (HEI-2005) score and HEI-2005 component scores. STATISTICAL ANALYSES Diet quality trajectories were modeled using group-based modeling techniques. RESULTS The total HEI-2005 score was low at age 3 years (mean ± standard error = 55.1 ± 0.4 of maximum 100 points) and remained stable to age 7 years (mean ± standard error = 54.0 ± 0.6; P = 0.08 for trend). Five HEI-2005 trajectory groups were identified, of which 1 declined and 1 improved over time. HEI-2005 component scores, except milk intake and meat/beans scores, differed significantly (all, P ≤ 0.02) among trajectory groups at age 3 years, and most differences were maintained at age 7 years. Total vegetables, dark green and orange vegetables and legumes, and whole grains component scores were low for all trajectory groups. Whole fruit; total fruit; saturated fat; and calories from solid fats, alcoholic beverages, and added sugars (SoFAAS) were highly variable among trajectory groups. Children in the lowest diet quality trajectory group were less likely to be breastfed and more likely to have been regular consumers of soft drinks (e.g., powdered drink mixes, sport drinks, or soda pop) before age 3 years. CONCLUSIONS Young childhood diet quality was low at age 3 years and remained stable to age 7 years. Improving intake of vegetables and whole grains is needed for all children. Focused attention regarding increasing fruit intake and reducing SoFAAS may be needed for families at increased risk for low overall diet quality.
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Affiliation(s)
- Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Kelly Reynolds
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Suzanne Summer
- Clinical Translational Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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12
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Appleton KM. Repeated exposure to and subsequent consumption of sweet taste: Reanalysis of test meal intake data following the repeated consumption of sweet vs non-sweet beverages. Physiol Behav 2021; 229:113221. [DOI: 10.1016/j.physbeh.2020.113221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 01/10/2023]
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Wang ML, Minyé HM, Egan KA, Heaton B. Community-based sugar-sweetened beverage intervention associated with short-term improvements in self-rated oral health. Community Dent Oral Epidemiol 2021; 49:362-368. [PMID: 33389770 DOI: 10.1111/cdoe.12610] [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: 07/31/2020] [Revised: 10/07/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the efficacy of a community-based childhood obesity prevention intervention targeting Sugar-sweetened beverage (SSB) consumption on self-rated oral health among children and their parents/caregivers. METHODS This study is a secondary analysis of data from a pilot site-randomized intervention (H2 GO!) targeting SSB consumption and obesity risk among children. The 6-week SSB behavioural intervention was implemented in two Massachusetts Boys and Girls Club sites that were matched for size and racial/ethnic composition. Children ages 9-12 years and their parents/caregivers were eligible to participate. Data on self-rated oral health and sociodemographics were obtained via self-report surveys at baseline, 2 and 6 months. Generalized linear mixed regression models were used to estimate 2- and 6-month change in oral health associated with the intervention. RESULTS Data are from 100 child participants (46% female; 38% Black, 20% Hispanic, 13% White, 12% Multiracial, 11% Asian) and 87 parent participants (78.2% female; 37.9% Hispanic, 29.9% Black, 14.9% Asian, 10.3% White). At baseline, 47% of child participants rated their oral health as good, followed by very good (32%), fair (11%) and excellent (10%). Among parents, 46.3% rated their oral health as good, followed by very good (29.3%), excellent (9.8%), fair (9.7%) and poor (4.9%). The intervention was associated with 2- and 6-month improvements in child participants' mean self-rated oral health scores (β = 0.78; 95% CI: 0.48, 1.087; P < .001; β = 0.98; 95% CI: 0.61, 1.34; P < .001, respectively) and with 2-month improvements in parent participants' mean self-rated oral health (β = 0.42; 95% CI: 0.016, 0.82; P = .042). CONCLUSION Short-term improvements in oral health among children and their parents/caregivers were observed among those participating in a SSB behavioural intervention. Community-based behavioural programmes targeting SSB consumption may be a promising approach to promote oral health as well as prevent childhood obesity.
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Affiliation(s)
- Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Boston University Center for Antiracist Research, Boston, MA, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, OH, USA
| | - Helena M Minyé
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, OH, USA.,Center for Reconstructive Dentistry & Oral Surgery, P.C., Dallas, TX, USA
| | - Kelsey A Egan
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Brenda Heaton
- Department of Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston, MA, USA
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Zoellner JM, Porter KJ, You W, Estabrooks PA, Perzynski K, Ray PA, Cantrell ES. The reach and effectiveness of SIPsmartER when implemented by rural public health departments: a pilot dissemination and implementation trial to reduce sugar-sweetened beverages. Transl Behav Med 2020; 10:676-684. [PMID: 30690550 DOI: 10.1093/tbm/ibz003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
SIPsmartER is a theory-based, 6-month, multi-component health literacy intervention shown to improve sugar-sweetened beverages (SSB) behaviors among adults in rural, southwest Virginia. The objective of this pilot trial was to understand the reach and effectiveness of SIPsmartER when delivered by existing staff in public health practice settings. This pre-post research design was conducted in partnership with four medically underserved southwest Virginia Department of Health (VDH) districts. Validated measures and standardized data collection techniques were used. Analyses included descriptive statistics and multilevel mixed-effects linear regressions models. Of 928 individuals screened, 586 (63%) were eligible and 117 (20% of eligible) enrolled in SIPsmartER (79% retained). The sample was majority female (71%) and white (94%) and had ≤high school education (59%) and an annual income of approximately $12,500. Relative to the county population, the enrolled study sample was representative for age and race, yet underrepresented for men and overrepresented for low income and low educational attainment. Significant improvements from baseline to 6 months were observed for the primary SSB outcome (-403 [confidence interval [CI] = -528, -278] SSB kcals/day) (p < .001). SSB-related attitudes, perceived behavioral control, behavioral intentions, and media literacy also significantly improved (all p < .05). SIPsmartER appears to be promising for VDH and potentially other health departments in medically underserved areas. When compared to the previous effectiveness trial, existing VDH staff achieved similar reach and effectiveness for some, but not all, outcomes. Future work is needed on methods to support health departments in developing strategies to reach new participants and to integrate SIPsmartER into sustained practice.
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Katelynn Perzynski
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Pamela A Ray
- New River Health District, Virginia Department of Health, Christiansburg, VA, USA
| | - Eleanor S Cantrell
- LENOWISCO and Cumberland Plateau Health District, Virginia Department of Health, Wise, VA, USA
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15
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Ebbeling CB, Feldman HA, Steltz SK, Quinn NL, Robinson LM, Ludwig DS. Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e015668. [PMID: 32696704 PMCID: PMC7792240 DOI: 10.1161/jaha.119.015668] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background A 2018 American Heart Association science advisory indicated that, pending further research, artificially sweetened beverages (ASBs) may be an appropriate initial replacement for sugar‐sweetened beverages (SSBs) during transition to unsweetened beverages (USBs). Methods and Results We randomly assigned 203 adults (121 males, 82 females; 91.6% retention), who habitually consumed SSBs, to 3 groups and delivered free SSBs, ASBs, or USBs to their homes for 12 months. Outcomes included serum triglyceride to high‐density lipoprotein cholesterol ratio (primary), body weight, and sweet taste preference (experimental assessment, 0%–18% sucrose solutions). Change in serum triglyceride to high‐density lipoprotein cholesterol ratio was not different between groups. Although overall change in weight also was not different between groups, we found effect modification (P=0.006) by central adiposity. Among participants in the highest tertile of baseline trunk fat but not other tertiles, weight gain was greater (P=0.002) for the SSB (4.4±1.0 kg, estimate±SE) compared with ASB (0.5±0.9 kg) or USB (−0.2±0.9 kg) group. Both sweetness threshold (–1.0±0.2% m/v; P=0.005) and favorite concentration (–2.3±0.4% m/v; P<0.0001) decreased in the USB group; neither changed in the SSB group. In the ASB group, sweetness threshold did not change, and favorite concentration decreased (–1.1±0.5% m/v; P=0.02). Pairwise comparison between the ASB and USB groups indicated a difference in sweetness threshold (P=0.015). Conclusions Replacing SSBs with noncaloric beverages for 12 months did not affect serum triglyceride to high‐density lipoprotein cholesterol ratio. Among individuals with central adiposity, replacing SSBs with either ASBs or USBs lowered body weight. However, USBs may have the most favorable effect on sweet taste preference. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01295671.
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Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston MA
| | - Sarah K Steltz
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
| | - Nicolle L Quinn
- Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston MA
| | | | - David S Ludwig
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
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Yuhas M, Hedrick V, Zoellner J. Consumption of Added Sugars by Rural Residents of Southwest Virginia. JOURNAL OF APPALACHIAN HEALTH 2020; 2:53-68. [PMID: 35770211 PMCID: PMC9138752 DOI: 10.13023/jah.0203.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Nationally, rural residents have high consumption of added sugars, yet the top sources have not been explored. Characterizing added-sugar intake in high sugar-sweetened beverage (SSB) consumers in rural areas is an important step to help inform interventions and policies. Purpose The objective of this study was to explore the top food and beverage sources of added sugar and to examine variations by sociodemographic characteristics. Methods This cross-sectional study analyzed data from a randomized-controlled trial to reduce SSB in eight rural Appalachian counties. Data were obtained from baseline demographic surveys and three 24-hour dietary recalls. Dietary analyses included deriving AS grams and percentage of total energy intake from added sugar from individual food categories. Results This study had 301 participants, of which 93% were White (non-Hispanic), 81% were female, 49% were aged 35 to 54 years, 43% had an income of ≤$14,000, 33% had low health literacy, and 32% had < college education. Males and those with an income of ≤$14,000 had significantly higher consumption of added sugar. Added sugar contributed to 21% of total energy intake. The top source of added sugar was soda. SSB contributed to 66% of added sugar and 14% of total energy intake. Within SSB, soda contributed to 40% of added sugar, and 8% of total energy intake. Cola and citrus flavored drinks were the main varieties consumed. Implications Study findings can be used to adapt evidence-based interventions to reflect commonly consumed food and beverages and help inform food- and beverage-based dietary guidelines and policies specific to rural populations.
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17
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Fausnacht AG, Myers EA, Hess EL, Davy BM, Hedrick VE. Update of the BEVQ-15, a beverage intake questionnaire for habitual beverage intake for adults: determining comparative validity and reproducibility. J Hum Nutr Diet 2020; 33:729-737. [PMID: 32283572 DOI: 10.1111/jhn.12749] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The BEVQ-15 is a beverage intake questionnaire that estimates the habitual average daily intake of 15 beverage categories (kcal and fl oz), as well as total sugar-sweetened beverages (SSB) and total beverages. However, subsequent to its initial validation in 2010, it has not been updated. The present study aimed to assess the convergent validity and reproducibility of the updated form of the BEVQ-15 to better reflect current beverage consumption trends. METHODS The study population included adults (n = 50) aged ≥18 years, recruited from a local university community. Participation consisted of three laboratory visits within a 4-week period in which the updated BEVQ-15 was administered during the first and last visit and four 24-h dietary recalls were collected. BEVQ-15 modifications included removing limits of 60 fl oz per beverage, adding a nut milk category, and providing creamer and sweetener preferences for coffee/tea categories. Convergent validity was assessed by comparing reported beverage intake between the BEVQ-15 and dietary recalls. Reproducibility was assessed by comparing both BEVQ-15 administrations. Analyses included descriptive statistics, Wilcoxon signed rank tests, Bland-Altman plots and Spearman's correlations. RESULTS For validity, Bland-Altman plot agreement between the BEVQ-15 and recalls was in the range 92-96% for total SSB and total beverage intake. For reproducibility, all beverage categories, total SSB, and total beverage intake were significantly correlated between the two BEVQ-15 administrations (r = 0.41-0.85; P ≤ 0.01). CONCLUSIONS This updated version of the BEVQ-15 demonstrated moderate convergent validity and reproducibility for total beverage consumption among well-educated southwest Virginia adults.
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Affiliation(s)
- A G Fausnacht
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - E A Myers
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - E L Hess
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - B M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - V E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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18
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Fulgoni VL, Gaine PC, Scott MO, Ricciuto L, DiFrancesco L. Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009-2014. Nutrients 2020; 12:nu12040985. [PMID: 32252302 PMCID: PMC7230951 DOI: 10.3390/nu12040985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
There is inconsistent evidence regarding the impact of added sugars consumption on micronutrient dilution of the diet. We examined the associations between added sugars intake deciles and nutrient adequacy for 17 micronutrients in U.S. adults 19+ (n = 13,949), 19–50 (n = 7424), and 51+ y (n = 6525) using two days of 24 hour dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 and regression analysis. Added sugars intake deciles ranged from <3.8 to >23.3% of calories among adults 19+ y, with a median intake of 11.0% of calories. Significant associations (p ≤ 0.01) between added sugars intake deciles and percentage of the population below the Estimated Average Requirement (EAR) were found for magnesium, vitamin C, vitamin D, and vitamin E; only the association with magnesium remained significant after dropping the two highest and lowest deciles of intake, suggesting a threshold effect. Intakes below approximately 18% of calories from added sugars were generally not associated with micronutrient inadequacy. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these four micronutrients, suggesting that adequate intakes are difficult to achieve regardless of added sugars intake.
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Affiliation(s)
- Victor L. Fulgoni
- Nutrition Impact, LLC, Battle Creek, MI 49014, USA
- Correspondence: ; Tel.: +1-269-962-0448
| | - P. Courtney Gaine
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
| | - Maria O. Scott
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
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Duong TV. A workplace sales ban and motivational intervention can reduce sugar-sweetened beverage intake and improve cardiometabolic health. Evid Based Nurs 2020; 24:43. [PMID: 32132123 DOI: 10.1136/ebnurs-2019-103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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Bradbury KM, Turel O, Morrison KM. Electronic device use and beverage related sugar and caffeine intake in US adolescents. PLoS One 2019; 14:e0223912. [PMID: 31639162 PMCID: PMC6805001 DOI: 10.1371/journal.pone.0223912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Despite recent declines in consumption of sugary beverages, energy drinks (ED) and sodas continue to contribute a substantial amount of sugar and caffeine to the diet of youth. Consumption of these beverages has been linked with electronic device use, however in-depth associations between sugar and caffeine intake from energy drinks and sodas with various electronic devices are not clear. Objective Describe the relationship of soda and energy drink consumption and associated added sugar and caffeine intake with electronic device use among adolescents. Methods Secondary data from the 2013–2016 cycles of Monitoring the Future Survey, a national, repeated, cross-sectional study, were analyzed. Information on energy drink and soda consumption by students in grades 8 and 10 (n = 32,418) from 252–263 schools randomly sampled from all US states was used. Results Soda and energy drink consumption decreased each year from 2013–2016 while daily use of electronic devices remained stable. An additional hour/day of TV was linked to a 6.92g (6.31,7.48; p<0.001) increase in sugar intake and a 32% (OR = 1.32; 1.29,1.35; p < .001) higher risk of exceeding World Health Organization (WHO) recommended sugar intakes. Further, each hour/day of TV was linked to a 28% increased risk of exceeding caffeine recommendations (OR = 1.25–1.31; p<0.001). Each hour per day talking on a cellphone was associated with an increased risk of exceeding WHO sugar and caffeine intakes by 14% (OR = 1.11–1.16; p<0.001) and 18% (OR = 1.15–1.21; p<0.001) respectively. Video game use was only weakly linked to caffeine intake. Computer use for school was associated with lower likelihood of exceeding sugar intake cut-offs. Conclusion While a trend towards reduced energy drink and soda intake from 2013–2016 was evident, greater electronic device use, especially TV time, was linked to higher intake of beverage-derived added sugar and caffeine amongst adolescents. Addressing these behaviours through counselling or health promotion could potentially help to reduce excess sugar and caffeine intake from sodas and energy drinks among this population.
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Affiliation(s)
- Kelly M. Bradbury
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Ofir Turel
- Department of Information Systems and Decision Sciences, Mihaylo College of Business and Economics, California State University—Fullerton, Fullerton, California, United States of America
| | - Katherine M. Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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Zoellner JM, Porter KJ, You W, Chow PI, Ritterband LM, Yuhas M, Loyd A, McCormick BA, Brock DJP. Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods. Contemp Clin Trials 2019; 83:64-80. [PMID: 31233859 PMCID: PMC6713199 DOI: 10.1016/j.cct.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
Abstract
The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 321A Hutcheson Hall, 24060, USA
| | - Phillip I Chow
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Lee M Ritterband
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Maryam Yuhas
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Annie Loyd
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Brittany A McCormick
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Donna-Jean P Brock
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
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Wang ML, Otis M, Rosal MC, Griecci CF, Lemon SC. Reducing sugary drink intake through youth empowerment: results from a pilot-site randomized study. Int J Behav Nutr Phys Act 2019; 16:58. [PMID: 31362753 PMCID: PMC6668134 DOI: 10.1186/s12966-019-0819-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/17/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Efficacious strategies to reduce sugar-sweetened beverage (SSB) consumption among youth are needed. This pilot study assessed the feasibility and preliminary efficacy of a community-based youth empowerment intervention to reduce SSB consumption and obesity risk among a low-income, ethnically diverse sample of youth. METHODS The H2GO! intervention was pilot-tested in an afterschool setting (Boys and Girls Clubs (BGC)) in Massachusetts, USA. One site was randomized to receive the intervention; the other site received standard programming. Youth ages 9-12 years and their parents/caregivers were eligible to participate. A total of N = 110 parent-child pairs (N = 55 parent-child pairs per site) were recruited. The 6-week intervention consisted of group-based weekly sessions delivered by trained BGC staff and youth-led activities that engaged parents. Child outcomes included self-reported SSB and water intake and measured body mass index z scores (zBMI). Parent outcomes included self-reported SSB and water intake, SSB purchasing, and availability of SSBs at home. Outcomes were measured at baseline, 2 months, and 6 months. Generalized linear and logistic regression models were used to estimate intervention effects over time. RESULTS The final analytic study sample consisted of 100 child participants (38% Black, 20% Hispanic, 13% White, 12% Multiracial, 11% Asian) and 87 parent participants (78.2% female; 78.2% reporting eligibility for the free-or-reduced price lunch program). 6-month retention rates were ≥ 82%. Intervention attendance rates among intervention child participants (N = 51) averaged 78.1% (SD = 10.3). Over half (56.0%) of child participants were overweight or obese at baseline. Relative to the comparison site, intervention site child participants had decreased SSB intake (β = - 1.64; 95% CI: 2.52, - 0.76), increased water intake (β = 1.31; 95% CI: 0.38, 2.23), and decreased zBMI (- 0.23 units; 95% CI: - 0.31, - 0.14) over 6 months (p < 0.001). Intervention parent participants also reported decreased SSB intake (β = - 1.76; 95% CI: - 2.56, - 0.96) and increased water intake (β = 1.75; 95% CI: 1.11, 2.40) than comparison parent participants at 6 months (p < 0.001). CONCLUSIONS Findings demonstrate the potential of a youth empowerment intervention on reducing SSB intake and zBMI among a diverse sample. Findings will guide a larger cluster-randomized controlled trial to test intervention efficacy on preventing childhood obesity, as well as inform future interventions that aim to target additional diet and physical activity behaviors through youth empowerment. TRIAL REGISTRATION ClinicalTrials.gov NCT02890056 . Registered 31 August 2016.
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Affiliation(s)
- Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 4th floor, Boston, MA 02118 USA
| | - Marisa Otis
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 4th floor, Boston, MA 02118 USA
| | - Milagros C. Rosal
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 01655 USA
| | - Christina F. Griecci
- Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Stephenie C. Lemon
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 01655 USA
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Sylvetsky AC, Hiedacavage A, Shah N, Pokorney P, Baldauf S, Merrigan K, Smith V, Long MW, Black R, Robien K, Avena N, Gaine C, Greenberg D, Wootan MG, Talegawkar S, Colon‐Ramos U, Leahy M, Ohmes A, Mennella JA, Sacheck J, Dietz WH. From biology to behavior: a cross-disciplinary seminar series surrounding added sugar and low-calorie sweetener consumption. Obes Sci Pract 2019; 5:203-219. [PMID: 31275594 PMCID: PMC6587329 DOI: 10.1002/osp4.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This report presents a synopsis of a three-part, cross-sector, seminar series held at the George Washington University (GWU) in Washington, DC from February-April, 2018. The overarching goal of the seminar series was to provide a neutral forum for diverse stakeholders to discuss and critically evaluate approaches to address added sugar intake, with a key focus on the role of low-calorie sweeteners (LCS). METHODS During three seminars, twelve speakers from academic institutions, federal agencies, non-profit organizations, and the food and beverage industries participated in six interactive panel discussions to address: 1) Do Farm Bill Policies Impact Population Sugar Intake? 2) What is the Impact of Sugar-sweetened Beverage (SSB) Taxes on Health and Business? 3) Is Sugar Addictive? 4) Product Reformulation Efforts: Progress, Challenges, and Concerns? 5) Low-calorie Sweeteners: Helpful or Harmful, and 6) Are Novel Sweeteners a Plausible Solution? Discussion of each topic involved brief 15-minute presentations from the speakers, which were followed by a 25-minute panel discussion moderated by GWU faculty members and addressed questions generated by the audience. Sessions were designed to represent opposing views and stimulate meaningful debate. Given the provocative nature of the seminar series, attendee questions were gathered anonymously using Pigeonhole™, an interactive, online, question and answer platform. RESULTS This report summarizes each presentation and recapitulates key perspectives offered by the speakers and moderators. CONCLUSIONS The seminar series set the foundation for robust cross-sector dialogue necessary to inform meaningful future research, and ultimately, effective policies for lowering added sugar intakes.
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Affiliation(s)
- A. C. Sylvetsky
- Milken Institute School of Public HealthThe George Washington University
| | - A. Hiedacavage
- Milken Institute School of Public HealthThe George Washington University
| | - N. Shah
- Milken Institute School of Public HealthThe George Washington University
| | - P. Pokorney
- Milken Institute School of Public HealthThe George Washington University
| | - S. Baldauf
- Milken Institute School of Public HealthThe George Washington University
| | - K. Merrigan
- Milken Institute School of Public HealthThe George Washington University
- Swette Center for Sustainable Food SystemsArizona State University
| | - V. Smith
- Department of Agricultural EconomicsMontana State University
| | - M. W. Long
- Milken Institute School of Public HealthThe George Washington University
| | - R. Black
- Quadrant D Consulting, LLCTufts University Friedman School of Nutrition Science & Policy
| | - K. Robien
- Milken Institute School of Public HealthThe George Washington University
| | - N. Avena
- Department of NeuroscienceMount Sinai School of Medicine
- Department of PsychologyPrinceton University
| | | | - D. Greenberg
- PepsiCo Inc. (Current affiliation NutriSci Inc.)
| | | | - S. Talegawkar
- Milken Institute School of Public HealthThe George Washington University
| | - U. Colon‐Ramos
- Milken Institute School of Public HealthThe George Washington University
| | - M. Leahy
- Food, Nutrition & Policy Solutions LLC
| | | | | | - J. Sacheck
- Milken Institute School of Public HealthThe George Washington University
| | - W. H. Dietz
- Milken Institute School of Public HealthThe George Washington University
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Abstract
OBJECTIVE To establish high intake of free sugars and its related disease burden as a significant public health challenge in Australia. DESIGN We discuss five key actions to reduce intake of free sugars tailored to the Australian context. These strategies are informed by reviewing the global scientific evidence on the effectiveness of a range of policy responses to reduce intake of free sugars at the population level. SETTING Australia. PARTICIPANTS Australian population. RESULTS The five key actions to reduce population levels for intake of free sugars tailored to the Australian context include prioritising health in trade agreements and policy; introducing a fiscal policy supporting health and promoting food reformulation; regulating advertising and improving labelling; strengthening the current dietary guidelines; and encouraging healthy choices. CONCLUSIONS The adoption and implementation of the strategies discussed in the current commentary would aid in tackling the rising health burden from the intake of free sugars in Australia.
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Galizzi MM, Whitmarsh L. How to Measure Behavioral Spillovers: A Methodological Review and Checklist. Front Psychol 2019; 10:342. [PMID: 31024368 PMCID: PMC6460990 DOI: 10.3389/fpsyg.2019.00342] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
A growing stream of literature at the interface between economics and psychology is currently investigating 'behavioral spillovers' in (and across) different domains, including health, environmental, and pro-social behaviors. A variety of empirical methods have been used to measure behavioral spillovers to date, from qualitative self-reports to statistical/econometric analyses, from online and lab experiments to field experiments. The aim of this paper is to critically review the main experimental and non-experimental methods to measure behavioral spillovers to date, and to discuss their methodological strengths and weaknesses. A consensus mixed-method approach is then discussed which uses between-subjects randomization and behavioral observations together with qualitative self-reports in a longitudinal design in order to follow up subjects over time. In particular, participants to an experiment are randomly assigned to a treatment group where a behavioral intervention takes place to target behavior 1, or to a control group where behavior 1 takes place absent any behavioral intervention. A behavioral spillover is empirically identified as the effect of the behavioral intervention in the treatment group on a subsequent, not targeted, behavior 2, compared to the corresponding change in behavior 2 in the control group. Unexpected spillovers and additional insights (e.g., drivers, barriers, mechanisms) are elicited through analysis of qualitative data. In the spirit of the pre-analysis plan, a systematic checklist is finally proposed to guide researchers and policy-makers through the main stages and features of the study design in order to rigorously test and identify behavioral spillovers, and to favor transparency, replicability, and meta-analysis of studies.
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Affiliation(s)
- Matteo M. Galizzi
- London School of Economics and Political Science, Department of Psychological and Behavioural Science, London, United Kingdom
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Woodruff RC, Haardörfer R, Gazmararian JA, Ballard D, Addison AR, Hotz JA, Tucker RB, Kegler MC. Home Environment-Focused Intervention Improves Dietary Quality: A Secondary Analysis From the Healthy Homes/Healthy Families Randomized Trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:96-100. [PMID: 30241706 DOI: 10.1016/j.jneb.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Estimate Healthy Homes/Healthy Families (HHHF) intervention efficacy for improving dietary quality. METHODS Low-income overweight and obese women (n = 349) recruited from rural community health centers were randomized to receive HHHF, a 16-week home environment-focused coaching intervention or health education materials by mail. Healthy Eating Index-2010 scores were calculated from 2 24-hour dietary recalls collected at baseline and 6- and 12-month follow-up. RESULTS HHHF participants reported greater improvements in Healthy Eating Index-2010 total scores at 6-month follow-up (+3.41 ± 13.43 intervention vs +2.02 ± 12.26 control; P =.009). Subcomponent analysis indicated greater consumption of total vegetables (P = .02) and greens and beans (P = .001), whole grains (P = .02) and reduced consumption of empty calories (P = .03). Standardized intervention effect sizes were 0.16 at 6 months and 0.13 at 12 months of follow-up. CONCLUSIONS AND IMPLICATIONS The HHHF resulted in short-term improvements in dietary quality, although more research is needed to interpret the clinical significance of effect sizes of this magnitude.
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Affiliation(s)
- Rebecca C Woodruff
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Ann R Addison
- Primary Care of Southwest Georgia, Inc., Blakely, GA
| | | | - R B Tucker
- South Central Primary Care Center, Inc., Ocilla, GA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
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FONTES AS, PALLOTTINI AC, VIEIRA DADS, BATISTA LD, FONTANELLI MDM, FISBERG RM. Increased sugar-sweetened beverage consumption is associated with poorer dietary quality: A cross-sectional population-based study. REV NUTR 2019. [DOI: 10.1590/1678-9865201932e180121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To evaluate the association between sugar-sweetened beverages consumption and dietary quality in adolescents, adults, and older adults living in São Paulo, Brazil. Methods Data were drawn from a cross-sectional population-based study conducted in 2008 in a representative urban city sample involving 1494 consumers of sugar-sweetened beverages. Dietary intake was evaluated through two 24-Hour Dietary Recalls, and the usual sugar-sweetened beverages consumption was estimated using the Multiple Source Method. Dietary quality was evaluated using the Brazilian Healthy Eating Index – Revised. The association between total score of the revised index and components with sugar-sweetened beverages consumption tertiles was assessed using multiple linear regression models for each age group, considering the sample design. Results Regardless of age group, the increase of sugar-sweetened beverages consumption was associated with a decrease in the total Healthy Eating Index – Revised score and in the components “total fruit”; “whole fruit”; “meat, eggs and legumes”, and the “solid fat, alcohol and added sugar”. Conclusion The results of our study suggest that higher sugar-sweetened beverages consumption was associated with poorer dietary quality. Planning public health policies aimed at decreasing sugar-sweetened beverages consumption is essential to increase dietary quality and reduce the incidence of noncommunicable diseases.
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Zoellner JM, You W, Estabrooks PA, Chen Y, Davy BM, Porter KJ, Hedrick VE, Bailey A, Kružliaková N. Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial. Int J Behav Nutr Phys Act 2018; 15:97. [PMID: 30286755 PMCID: PMC6172826 DOI: 10.1186/s12966-018-0728-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/24/2018] [Indexed: 12/30/2022] Open
Abstract
Background Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported. Methods Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures. Results Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ. Conclusion Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption. Trial registry Clinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA. .,Cancer Center without Walls at the UVA Cancer Center, 16 East Main St, Christiansburg, VA, 24073, USA.
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yvonnes Chen
- School of Journalism, University of Kansas, Lawrence, KS, 66045, USA
| | - Brenda M Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Kathleen J Porter
- Cancer Center without Walls at the UVA Cancer Center, 16 East Main St, Christiansburg, VA, 24073, USA
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Angela Bailey
- Department of Movement Arts, Health Promotion & Leisure Studies, Bridgewater State University, Bridgewater, MA, 02325, USA
| | - Natalie Kružliaková
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA
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Bremer MC, Zoellner JM, Misyak SA, Hedrick VE. Dietary Intake Changes in Response to a Sugar-Sweetened Beverage Reduction Trial for Various Supplemental Nutrition Assistance Program (SNAP) Eligibility Groups. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:931-936. [PMID: 30297018 PMCID: PMC10512974 DOI: 10.1016/j.jneb.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/03/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine dietary intake differences resulting from a sugar-sweetened beverage reduction intervention by 3 Supplemental Nutrition Assistance Program (SNAP) participation groups: SNAP participants (n = 56), income-eligible nonparticipants (n = 30), and income-ineligible nonparticipants (n = 60). METHODS Adults in southwest Virginia were enrolled in a 6-month behavioral trial. The researchers collected SNAP enrollment status and 3 24-hour dietary recalls at baseline and 6 months. Repeated-measures ANOVAs were used to assess differences in dietary intake among SNAP participation groups. RESULTS No significant group × time differences were found for energy density, Healthy Eating Index scores, Healthy Beverage Index scores, or intake of total calories, added sugars, and sugar-sweetened beverages. However, several within-group improvements were noted: income-ineligible nonparticipants and SNAP participants improved in more areas compared with income-eligible nonparticipants, including intake of total calories, added sugars, and sugar-sweetened beverages. CONCLUSIONS AND IMPLICATIONS This exploratory analysis suggests that the overall effectiveness of a sugar-sweetened beverage intake reduction intervention was not influenced by SNAP eligibility and participation status, because there were no significant group by time differences over the intervention. It is important to recognize for future programs that different approaches to improving dietary intake may be needed to match the characteristics of this audience better. This may be accomplished by attempting to decrease the disparity gap between income-eligible nonparticipants and those receiving SNAP or who are income ineligible through the use of programs such as SIPsmartER.
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Affiliation(s)
- Molly C Bremer
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Jamie M Zoellner
- Department of Public Health Sciences, Cancer Center Without Walls, University of Virginia, Christiansburg, VA
| | - Sarah A Misyak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA.
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Franken SCM, Smit CR, Buijzen M. Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040713. [PMID: 29642628 PMCID: PMC5923755 DOI: 10.3390/ijerph15040713] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/29/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022]
Abstract
Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.
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Affiliation(s)
- Saskia C M Franken
- Faculty for Accounting, Finance and Marketing, University of Aruba, J.E. Irausquinplein 4, Oranjestad, Aruba.
- Behavioural Science Institute, Radboud University, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Crystal R Smit
- Behavioural Science Institute, Radboud University, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Moniek Buijzen
- Behavioural Science Institute, Radboud University, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
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Kružliaková N, Estabrooks PA, You W, Hedrick V, Porter K, Kiernan M, Zoellner J. The Relationship Between the Stanford Leisure-Time Activity Categorical Item and the Godin Leisure-Time Exercise Questionnaire Among Rural Intervention Participants of Varying Health Literacy Status. J Phys Act Health 2018; 15:269-278. [PMID: 29421974 PMCID: PMC10512970 DOI: 10.1123/jpah.2017-0284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A pragmatic, self-reported physical activity measure is needed for individuals of varying health literacy status. METHODS This study is a secondary analysis of a 6-month behavioral intervention for rural Appalachian adults developed using health literacy strategies. We examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline health literacy status moderates intervention effects. RESULTS Of 301 enrolled participants, 289 completed the L-Cat at baseline and 212 at 6 months. Approximately 33% were low health literate and 43% reported annual income of ≤$14,999. There was high agreement (84.1%) between the L-Cat and adapted GLTEQ for classifying individuals as meeting physical activity recommendations with little differences by health literacy level (low literacy 80.4% and high literacy 85.9%). The primary source of incongruent classification was the adapted GLTEQ classified almost 20% of individuals as meeting recommendations, whereas the L-Cat classified them as not meeting recommendations. There were differences in responsiveness between measures, but baseline health literacy status did not moderate change in any L-Cat or adapted GLTEQ measures. CONCLUSION Implications and recommendations for using the L-Cat 2.3 and GLTEQ among individuals of varying health literacy status are discussed.
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Abstract
This report summarises a workshop convened by ILSI Europe on 3 and 4 April 2017 to discuss the issue of dietary sweetness. The objectives were to understand the roles of sweetness in the diet, establish whether exposure to sweetness affects diet quality and energy intake, and consider whether sweetness per se affects health. Although there may be evidence for tracking of intake of some sweet components of the diet through childhood, evidence for tracking of whole diet sweetness, or through other stages of maturity are lacking. The evidence to date does not support adverse effects of sweetness on diet quality or energy intake, except where sweet food choices increase intake of free sugars. There is some evidence for improvements in diet quality and reduced energy intake where sweetness without calories replaces sweetness with calories. There is a need to understand the physiological and metabolic relevance of sweet taste receptors on the tongue, in the gut and elsewhere in the body, as well as possible differentiation in the effects of sustained consumption of individual sweeteners. Despite a plethora of studies, there is no consistent evidence for an association of sweetness sensitivity/preference with obesity or type 2 diabetes. A multifaceted integrated approach, characterising nutritive and sensory aspects of the whole diet or dietary patterns, may be more valuable in providing contextual insight. The outcomes of the workshop could be used as a scientific basis to inform the expert community and create more useful dialogue among health care professionals.
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Appleton KM, Tuorila H, Bertenshaw EJ, de Graaf C, Mela DJ. Sweet taste exposure and the subsequent acceptance and preference for sweet taste in the diet: systematic review of the published literature. Am J Clin Nutr 2018; 107:405-419. [PMID: 29566187 DOI: 10.1093/ajcn/nqx031] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/12/2022] Open
Abstract
Background There are consistent, evidence-based global public health recommendations to reduce intakes of free sugars. However, the corresponding evidence for recommending reduced exposure to sweetness is less clear. Objective Our aim was to identify and review the published evidence investigating the impact of dietary exposure to sweet-tasting foods or beverages on the subsequent generalized acceptance, preference, or choice of sweet foods and beverages in the diet. Design Systematic searches were conducted to identify all studies testing relations of variation in exposure to sweetness through foods and beverages with subsequent variation in the generalized acceptance, preference, or choice of sweetened foods or beverages, in humans aged >6 mo. Results Twenty-one studies met our inclusion criteria, comprising 7 population cohort studies involving 2320 children and 14 controlled trials involving 1113 individuals. These studies were heterogeneous in study design, population, exposure, and outcomes measured, and few were explicitly designed to address our research question. The findings from these were inconsistent. We found equivocal evidence from population cohort studies. The evidence from controlled studies suggests that a higher sweet taste exposure tends to lead to reduced preferences for sweetness in the shorter term, but very limited effects were found in the longer term. Conclusions A small and heterogeneous body of research currently has considered the impact of varying exposure to sweet taste on subsequent generalized sweet taste preferences, and this evidence is equivocal regarding the presence and possible direction of a relation. Future work should focus on adequately powered studies with well-characterized exposures of sufficient duration. This review was registered with PROSPERO as CRD42016051840, 24 November 2016.
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Affiliation(s)
- K M Appleton
- Department of Psychology, Faculty of Science and Technology, Bournemouth University, Bournemouth, United Kingdom
| | - H Tuorila
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | | | - C de Graaf
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - D J Mela
- Unilever R&D Vlaardingen, Vlaardingen, The Netherlands
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Leung CW, DiMatteo SG, Gosliner WA, Ritchie LD. Sugar-Sweetened Beverage and Water Intake in Relation to Diet Quality in U.S. Children. Am J Prev Med 2018; 54:394-402. [PMID: 29338950 PMCID: PMC5818294 DOI: 10.1016/j.amepre.2017.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/20/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sugar-sweetened beverages (SSBs) are a major contributor to children's added sugar consumption. This study examines whether children's SSB and water intakes are associated with diet quality and total energy intake. METHODS Using data on children aged 2-18 years from the 2009-2014 National Health and Nutrition Examination Survey, linear regression models were used to analyze SSB and water intake in relation to Healthy Eating Index 2010 (HEI-2010) scores and total energy intake. Generalized linear models were used to analyze SSB and water intake in relation to the HEI-2010 scores. Analyses were conducted including and excluding caloric contributions from SSBs and were conducted in 2016-2017. RESULTS SSB intake was inversely associated with the HEI-2010 total scores (9.5-point lower score comparing more than two servings/day with zero servings/day, p-trend<0.0001) and positively associated with total energy intake (394 kcal higher comparing more than two servings/day with zero servings/day, p-trend<0.0001). The associations between SSB and HEI-2010 total scores were similar when SSBs were excluded from HEI-2010 calculations. Water intake was positively associated with HEI-2010 total scores, but not associated with total energy intake. SSB intake was inversely associated with several HEI-2010 component scores, notably vegetables, total fruit, whole fruit, greens and beans, whole grains, dairy, seafood and plant proteins, and empty calories. Water intake was positively associated with most of the same HEI-2010 component scores. CONCLUSIONS Children who consume SSBs have poorer diet quality and higher total energy intake than children who do not consume SSBs. Interventions for obesity and chronic disease should focus on replacing SSBs with water and improving other aspects of diet quality that correlate with SSB consumption.
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Affiliation(s)
- Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - S Gemma DiMatteo
- Department of Epidemiology and Biostatistics, School of Public Health, University of California at Berkeley, Berkeley, California; Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California
| | - Wendi A Gosliner
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California
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Arsenault BJ, Lamarche B, Després JP. Targeting Overconsumption of Sugar-Sweetened Beverages vs. Overall Poor Diet Quality for Cardiometabolic Diseases Risk Prevention: Place Your Bets! Nutrients 2017; 9:nu9060600. [PMID: 28608806 PMCID: PMC5490579 DOI: 10.3390/nu9060600] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 01/08/2023] Open
Abstract
Chronic overconsumption of sugar-sweetened beverages (SSBs) is amongst the dietary factors most consistently found to be associated with obesity, type 2 diabetes (T2D) and cardiovascular disease (CVD) risk in large epidemiological studies. Intervention studies have shown that SSB overconsumption increases intra-abdominal obesity and ectopic lipid deposition in the liver, and also exacerbates cardiometabolic risk. Similar to the prevalence of obesity and T2D, national surveys of food consumption have shown that chronic overconsumption of SSBs is skyrocketing in many parts of the world, yet with marked heterogeneity across countries. SSB overconsumption is also particularly worrisome among children and adolescents. Although the relationships between SSB overconsumption and obesity, T2D, and CVD are rather consistent in epidemiological studies, it has also been shown that SSB overconsumption is part of an overall poor dietary pattern and is particularly prevalent among subgroups of the population with low socioeconomic status, thereby questioning the major focus on SSBs to target/prevent cardiometabolic diseases. Public health initiatives aimed specifically at decreasing SSB overconsumption will most likely be successful in influencing SSB consumption per se. However, comprehensive strategies targeting poor dietary patterns and aiming at improving global dietary quality are likely to have much more impact in addressing the unprecedented public health challenges that we are currently facing.
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Affiliation(s)
- Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Y-2110, Pavillon Marguerite D'Youville, 2725 chemin Ste-Foy, Québec City, QC G1V 4G5, Canada.
- Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada.
| | - Benoît Lamarche
- School of Nutrition, Université Laval, Québec City, QC G1V 0A6, Canada.
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Y-2110, Pavillon Marguerite D'Youville, 2725 chemin Ste-Foy, Québec City, QC G1V 4G5, Canada.
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada.
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Hedrick VE, Davy BM, Myers EA, You W, Zoellner JM. Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial. Nutrients 2015; 7:10168-78. [PMID: 26690208 PMCID: PMC4690077 DOI: 10.3390/nu7125525] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 11/16/2015] [Accepted: 11/30/2015] [Indexed: 01/03/2023] Open
Abstract
The recently developed Healthy Beverage Index (HBI) was designed to evaluate overall beverage intake quality (including total fluid consumption and beverage calories), yet no known intervention studies have assessed longitudinal changes to the HBI. The objective of this investigation was to assess changes in HBI scores in response to a sugar-sweetened beverage (SSB) reduction trial as compared to a physical activity comparison group. Participants were enrolled into a six-month, community-based, controlled behavioral trial and randomized into either a SSB reduction group (SIPsmartER) or a physical activity group (MoveMore). Correlations and multilevel mixed-effects linear regression with intention-to-treat analyses are presented. Total HBI score significantly increased for SIPsmartER (n = 149) (mean increase = 7.5 points (5.4, 9.7), p ≤ 0.001) and MoveMore (n = 143) (mean increase = 3.4 points (1.6, 5.2), p ≤ 0.001) participants, with a significant between group effect (p ≤ 0.05), over the six-month intervention. Other significant changes in HBI components for SIPsmartER included increased SSB and total beverage calorie scores, and decreased low-fat milk and diet soda scores. Changes in total HBI scores were significantly correlated with changes in total Healthy Eating Index-2010 scores (r = 0.15, p ≤ 0.01). Our findings suggest that individual HBI component scores, beyond the SSB component, are influenced by intervention strategies that primarily focus on SSB reduction.
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Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Emily A Myers
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Polytechnic Institute and State University, 250 Drillfield Drive, Blacksburg, VA 24061, USA.
| | - Jamie M Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
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