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AlTamimi JZ, Alshwaiyat NM, Alkhalidy H, AlKehayez NM, Alagal RI, Alsaikan RA, Alsemari MA, BinMowyna MN, AlFaris NA. Sugar-Sweetened Beverages Consumption in a Multi-Ethnic Population of Young Men and Association with Sociodemographic Characteristics and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4861. [PMID: 36981770 PMCID: PMC10049135 DOI: 10.3390/ijerph20064861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Sugar-sweetened beverages are frequently consumed among adults and are linked with the incidence of obesity. We aimed to determine rates of weekly and daily sugar-sweetened beverage intake in a multi-ethnic population of young men and their association with sociodemographic characteristics and obesity. This cross-sectional study included 3600 young men who lived in Riyadh, KSA. Participants' sociodemographic characteristics and frequency of sugar-sweetened beverage consumption were gathered through personal interviews. The outcome variables in this study are based on the weekly and daily consumption of sugar-sweetened beverages. Weight and height were measured following standard protocols. The rates of weekly and daily sugar-sweetened beverage intake by participants were 93.6% and 40.8%, respectively. Nationality was a predictor of weekly and daily consumption of sugar-sweetened beverages. The highest rates of weekly (99.5%) and daily (63.9%) consumption were observed in subjects from the Philippines and Yemen, respectively, while Bangladeshi subjects had the lowest rates of weekly (76.9%) and daily (6.9%) consumption. Obesity was another predictor of sugar-sweetened beverage consumption. Obese participants had a significantly higher odds ratio of weekly sugar-sweetened beverage consumption than non-obese subjects (OR = 4.53, p = 0.037). In conclusion, sugar-sweetened beverage consumption was relatively high and our results support an association between the consumption of sugar-sweetened beverages and certain sociodemographic variables and obesity.
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Affiliation(s)
- Jozaa Z. AlTamimi
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (J.Z.A.); (N.M.A.)
| | - Naseem M. Alshwaiyat
- School of Nutrition and Dietetics, Faculty of Health Sciences, Gong Badak Campus, Universiti Sultan Zainal Abidin, Kuala Nerus 21300, Terengganu, Malaysia;
| | - Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Nora M. AlKehayez
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (J.Z.A.); (N.M.A.)
| | - Reham I. Alagal
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (R.I.A.); (R.A.A.)
| | - Reem A. Alsaikan
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (R.I.A.); (R.A.A.)
| | - Malak A. Alsemari
- Department of Medical Imaging—MRI, King Abdullah bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Mona N. BinMowyna
- College of Science and Humanities, Shaqra University, Shaqra 11911, Saudi Arabia;
| | - Nora A. AlFaris
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (J.Z.A.); (N.M.A.)
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AlFaris NA, Alshwaiyat NM, Alkhalidy H, AlTamimi JZ, Alagal RI, Alsaikan RA, Alsemari MA, BinMowyna MN, AlKehayez NM. Sugar-sweetened beverages consumption in a multi-ethnic population of middle-aged men and association with sociodemographic variables and obesity. Front Nutr 2022; 9:987048. [PMID: 36110403 PMCID: PMC9468762 DOI: 10.3389/fnut.2022.987048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adults frequently consume sugar-sweetened beverages. These products are linked to negative health effects such as obesity. Our study was carried out to assess rates of weekly and daily sugar-sweetened beverages consumption in a multi-ethnic population of middle-aged men and association with sociodemographic variables and obesity. Methods A sum of 1,800 middle-aged men (36–59 years) living in Riyadh, KSA, participated in this cross-sectional study. Sociodemographic variables and the frequency of sugar-sweetened beverages consumption were gathered from participants using face to face interviews. Weekly and daily consumption of sugar-sweetened beverages were the two binary outcome variables applied in this research. Weight and height were measured following standard procedures. Results In this study, 93.8 and 32.6% of participants consumed sugar-sweetened beverages weekly and daily, respectively. The weekly and daily sugar-sweetened beverages consumption was predicted by nationality. Subjects from Pakistan (99.3%) and Yemen (60.0%) reported the greatest rates of weekly and daily consumption, respectively, while Bangladeshi and Sudanese subjects reported the lowest rates of weekly (87%) and daily (2.9%) consumption, respectively. Another factor that predicted weekly sugar-sweetened beverages consumption was obesity. Obese subjects had a significantly greater odds ratio of weekly sugar-sweetened beverages intake than non-obese individuals (OR = 3.80, P = 0.003). Conclusion Consumption of sugar-sweetened beverages is common among middle-aged men who live in KSA. Results show connecting sugar-sweetened beverages intake with specific sociodemographic variables and obesity.
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Affiliation(s)
- Nora A. AlFaris
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Naseem M. Alshwaiyat
- School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu, Malaysia
| | - Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Jozaa Z. AlTamimi
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reham I. Alagal
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem A. Alsaikan
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Malak A. Alsemari
- Department of Medical Imaging – MRI, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mona N. BinMowyna
- College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Nora M. AlKehayez
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- *Correspondence: Nora M. AlKehayez
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Mahmoud SA, El Moshy S, Rady D, Radwan IA, Abbass MMS, Al Jawaldeh A. The effect of unhealthy dietary habits on the incidence of dental caries and overweight/obesity among Egyptian school children (A cross-sectional study). Front Public Health 2022; 10:953545. [PMID: 36052005 PMCID: PMC9424618 DOI: 10.3389/fpubh.2022.953545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 01/24/2023] Open
Abstract
Background Obesity and dental caries are public health problems in Egypt. Factors such as unhealthy diet, poor oral hygiene, and physical inactivity can play a major role in both problems. This study was carried out to illuminate the mutual unhealthy dietary risk factors associated with the incidence of both health conditions. Methods Between 1 October 2020 and 1 July 2021, 369 Egyptian children (5-10 years) were examined. Dental status was assessed using decayed, missing/extracted, and filled tooth indices (dmft, deft, and DMFT) for deciduous, mixed, and permanent dentitions, respectively. Moreover, the lifestyle, food habits, and body mass index (BMI) were recorded. Results A total of 342 (93.7%) of the included subjects suffered from caries, and only 27(7.3%) were caries-free. Based on BMI percentiles, 247 (66.9%) of the youngsters were overweight/obese, while 122 (33.1%) had normal weight. The mean dmft was 6.9 (±4.6), deft 4.2 (±3.3), and DMFT 0.1 (±1.7). In the primary dentition, a significant positive correlation was detected between dmft and BMI, legumes, sweetened milk and juice, soft drinks, and desserts, while a significant negative correlation was detected between dmft/deft, meat/poultry/fish, fresh fruits, and vegetables. A significant positive correlation was detected between deft and BMI, sweetened milk and juice, ice cream, candies, and crackers. In the permanent dentition, a significant positive correlation was detected between age, soft drinks, sweetened juice, desserts, and DMFT, while a significant negative correlation was detected with fresh fruits and vegetables. BMI was significantly negatively correlated with a healthy lifestyle, meat/poultry/fish consumption, and fresh fruits and vegetables while positively correlated with legumes, ice cream, soft drinks, granulated sugars, desserts, fast food, and caffeinated drinks. Conclusion Overweight/obesity was positively correlated with primary dentition dental caries. Desserts (sweetened snacks) and soft drinks could be the common risk factors associated with high caries and overweight/obesity incidence among Egyptian school children; conversely, consumption of fruits and vegetables could hinder both health conditions. Moreover, sweetened juices were associated with primary and permanent dental caries.
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Affiliation(s)
- Sara Ahmed Mahmoud
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Sara El Moshy
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Dina Rady
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Israa Ahmed Radwan
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Marwa M. S. Abbass
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt,*Correspondence: Marwa M. S. Abbass
| | - Ayoub Al Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), Cairo, Egypt
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Giussani M, Lieti G, Orlando A, Parati G, Genovesi S. Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review. Front Med (Lausanne) 2022; 9:792949. [PMID: 35492316 PMCID: PMC9039289 DOI: 10.3389/fmed.2022.792949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023] Open
Abstract
Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.
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Affiliation(s)
- Marco Giussani
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonina Orlando
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy
| | - Gianfranco Parati
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Kraak VI, Consavage Stanley K, Harrigan PB, Zhou M. How have media campaigns been used to promote and discourage healthy and unhealthy beverages in the United States? A systematic scoping review to inform future research to reduce sugary beverage health risks. Obes Rev 2022; 23:e13425. [PMID: 35142020 PMCID: PMC9286342 DOI: 10.1111/obr.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/29/2022]
Abstract
Sugary beverage consumption is associated with many health risks. This study used a proof-of-concept media campaign typology to examine U.S. beverage campaigns that promoted healthy beverages and encouraged or discouraged sugary beverages. We used a three-step systematic scoping review to identify, organize, analyze, and synthesize evidence. Step 1 used Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines to search four electronic databases and gray literature through 2021. Step 2 categorized relevant media campaigns using a media campaign typology. Step 3 examined campaign evaluation outcomes. We identified 280 campaigns organized into six campaign typology categories. The media landscape was dominated by corporate marketing campaigns for branded sugary beverages (65.8%; n = 184) followed by public awareness (9.6%; n = 27), public policy (8.2%; n = 23), social marketing (7.1%; n = 20), corporate social responsibility (5.7%; n = 16), and countermarketing (3.6%; n = 10) campaigns. Evaluations for 20 unique campaigns implemented over 30 years (1992-2021) across 14 states showed reduced sugary beverage or juice and increased water or low-fat milk sales and intake. Positive short-term cognitive and mid-term retail and behavioral changes were reported. There was limited evidence for long-term policy, social norm, and population health outcomes. Future research is needed to use media campaigns in strategic communications to reduce sugary beverage health risks for Americans.
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Affiliation(s)
- Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | | | - Paige B Harrigan
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Mi Zhou
- Department of Public Health, University of California Merced, Merced, California, USA
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Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents. Nutrients 2022; 14:nu14050959. [PMID: 35267934 PMCID: PMC8912352 DOI: 10.3390/nu14050959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.
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Bucher Della Torre S, Moullet C, Jotterand Chaparro C. Impact of Measures Aiming to Reduce Sugars Intake in the General Population and Their Implementation in Europe: A Scoping Review. Int J Public Health 2022; 66:1604108. [PMID: 35095383 PMCID: PMC8791851 DOI: 10.3389/ijph.2021.1604108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/30/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: Implementing public health measures is necessary to decrease sugars intake, which is associated with increased risk of noncommunicable diseases. Our scoping review aimed to identify the types of measures implemented and evaluated to decrease sugars intake in the population and to assess their impact. Methods: Following a review of systematic reviews (SRs) published in 2018, we systematically searched new SR (May 2017–October 2020) in electronic databases. We also searched the measures implemented in Europe in the NOURISHING database. Two researchers selected the reviews, extracted and analysed the data. Results: We included 15 SRs assessing economic tools (n = 5), product reformulation and labels/claims (n = 5), and educational/environmental interventions (n = 7). Economic tools, product reformulation and environmental measures were effective to reduce sugar intake or weight outcomes, while labels, education and interventions combining educational and environmental measures found mixed effects. The most frequently implemented measures in Europe were public awareness, nutritional education, and labels. Conclusion: Among measures to reduce sugar intake in the population, economic tools, product reformulation, and environmental interventions were the most effective, but not the more frequently implemented in Europe.
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Sundborn G, Thornley S, Grey C, Gentles D, Jackson RT, Swinburn B, Veatupu L, Lang B. Gamification and Sugar: A School-Based Pilot Study of Social Marketing and Gamification Approaches to Reduce Sugary Drink Intake in Pasifika School Students. Asia Pac J Public Health 2021; 33:727-733. [PMID: 34218679 DOI: 10.1177/10105395211030133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate a social marketing-gamification intervention to reduce sugary drink intake drawing on popular culture of Pasifika secondary school students in Auckland, New Zealand. Students aged 11 to 14 years from one coeducational high school participated in the 11-week pilot study. The 9-week intervention was undertaken in assemblies and classrooms. Baseline and follow-up measures were completed by 227 and 220 students, respectively, of 298 enrolled students. Retention of the "3-6-9" teaching related to maximum daily sugar intake increased from 9% at baseline to 97% at follow-up (P < .0001). Significant increases were observed of students who correctly answered sugar content of drinks. Overall consumption of sugary drink decreased at follow-up by 0.46 glasses per day. The main conclusion from this study was that this school-based gamification educational package to convey messages about sugar content of drinks using popular modes of engagement is a promising intervention that was acceptable and well supported by school staff and students.
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Affiliation(s)
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | | | - Bodo Lang
- University of Auckland, Auckland, New Zealand
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The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
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Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, Jago R, Toumpakari Z, Majid HA. School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol. Front Public Health 2020; 8:549637. [PMID: 33072694 PMCID: PMC7536333 DOI: 10.3389/fpubh.2020.549637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
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Affiliation(s)
- Shooka Mohammadi
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Hazreen A. Majid
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Distributional Changes in U.S. Sugar-Sweetened Beverage Purchases, 2002-2014. Am J Prev Med 2020; 59:260-269. [PMID: 32362508 PMCID: PMC7375910 DOI: 10.1016/j.amepre.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION U.S. policy actions focus on reducing sugar-sweetened beverage purchases. Yet, there are no studies on trends in overall purchase distribution and how it has changed by key subpopulations. This study examined changes in distributions of total sugar-sweetened beverage purchases and its major subtypes (regular carbonated soft drinks and fruit/sports/energy drinks) in 2002-2014 and distinguished among low, moderate, and high purchasers. METHODS Longitudinal data on sugar-sweetened beverage purchases of U.S. households from the 2002-2014 Nielsen Homescan Panel were used. Sugar-sweetened beverages were defined as all caloric non-alcoholic beverages containing added sugars. Longitudinal quantile regression model examined trends across distributions (from quantile 25 to 95) of purchases (measured in kcal/day/capita), while accounting for households' unobserved differences. All statistical analyses were conducted in 2019. RESULTS All households across the total purchase distribution significantly reduced their purchases. High purchasers made less proportional reductions than low purchasers (e.g., 35% at 95th quantile vs 62% at 25th quantile). However, the smaller relative reductions among higher purchasers translated into larger absolute decreases (e.g., 134 kcal/day/capita at 95th quantile vs 23 kcal/day/capita at 25th quantile). Similar patterns in heterogeneity were observed across sugar-sweetened beverage subtype distributions and among racial/ethnic and income groups. In addition, there were significant racial/ethnic and income disparities in total sugar-sweetened beverage purchases in 2002-2003. Although racial/ethnic disparities among higher purchasers improved, income disparity patterns at all purchase levels persisted into 2013-2014. CONCLUSIONS From 2002‒2003 to 2013-2014, U.S. households at all purchase levels made meaningful reductions in sugar-sweetened beverage purchases in both absolute and relative terms. Furthermore, racial/ethnic disparities in total sugar-sweetened beverage purchases narrowed, but income disparity patterns persisted.
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Sharma A, Jain M, Nahar VK, Sharma M. Determining predictors of change in sugar sweetened beverage consumption behaviour among university students in India. Int J Adolesc Med Health 2020; 34:ijamh-2019-0078. [PMID: 31981451 DOI: 10.1515/ijamh-2019-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 01/09/2023]
Abstract
Background Consumption of sugar sweetened beverages (SSBs) is a significant risk behaviour that leads to the development of several chronic diseases. The present study aimed to predict the SSB consumption behaviour among Indian university students by utilising a multi theory model (MTM) of health behaviour change. Methods In a cross-sectional design, a validated 37-item self-report questionnaire was administered to 267 participants from a mid-size university in the National Capital Region (NCR) of India. Stepwise multiple regressions were used to determine predictors of change in initiation and sustenance of SSB consumption behaviour. For stepwise multiple regression, the a priori criteria of probability of F to enter the predictor in the model was set as less than or equal to 0.05 and for removing the predictor as greater than or equal to 0.10. Results The model was able to predict 16.7% variance in behavioural initiation through the constructs of participatory dialogue and behavioural confidence, and 30.2% variance in sustenance through emotional transformation and change in social environment. Participatory dialogue and behavioural confidence were predictors of behaviour initiation; and emotional transformation, and change in social environment were predictors of behaviour sustenance for SSB consumption behaviour change. Conclusion The study provided a pathway for design of interventions for SSB intake reduction in Indian university students. Interventions should be designed using participatory dialogue and behavioural confidence initiation, and emotional transformation and change in social environment for sustenance of change in SSB consumption in this population.
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Affiliation(s)
- Ankur Sharma
- Department of Public Health Dentistry, Manav Rachna Dental College, Faridabad, India
| | - Meena Jain
- Department of Public Health Dentistry, Manav Rachna Dental College, Delhi-Surajkund Road, Faridabad, India, Phone: +91 74286 72266
| | - Vinayak K Nahar
- School of Medicine, Department of Dermatology, University of Mississippi Medical Center Jackson, Mississippi, United States of America.,School of Medicine/John D. Bower School of Population Health,, Department of Preventive Medicine, University of Mississippi Medical Center, Mississippi, United States of America
| | - Manoj Sharma
- Behavioral and Environmental Health, Jackson State University, Jackson, MS, USA
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Abdel Rahman A, Jomaa L, Kahale LA, Adair P, Pine C. Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis. Nutr Rev 2019; 76:88-107. [PMID: 29281069 PMCID: PMC5939855 DOI: 10.1093/nutrit/nux061] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Context Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking. Objective This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years. Data Sources Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility. Study Selection Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies. Data Extraction Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software. Results Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups. Conclusions The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest. Systematic Review Registration PROSPERO registration number CRD42014004432.
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Affiliation(s)
- Abir Abdel Rahman
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Balamand, Ashrafieh, Beirut, Lebanon
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lara A Kahale
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pauline Adair
- School of Psychology, Queens University Belfast, Belfast, United Kingdom
| | - Cynthia Pine
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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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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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Sugar-Sweetened Beverages Contribute Significantly to College Students' Daily Caloric Intake in Jordan: Soft Drinks Are Not the Major Contributor. Nutrients 2019; 11:nu11051058. [PMID: 31083526 PMCID: PMC6566441 DOI: 10.3390/nu11051058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022] Open
Abstract
Sugar sweetened beverages (SSBs) are caloric-dense and associated with poor diet quality which may result in weight gain and obesity. Obesity is an independent risk factor for several chronic diseases. This study aimed to (1) assess the consumption level of SSBs among college students in Jordan and (2) examine the relationship of consumption level to body weight. The current study is a cross-sectional study conducted on 967 college students (55.3% males and 44.7% females). Consumption of SSBs was assessed using validated questionnaires. SSBs were classified into four major categories (hot drinks, fruit drinks, energy drinks, and soft drinks). Anthropometric measurements of the participants including body weight, height, and waist circumferences were recorded. Male students consumed more calories from SSBs compared to female students (p = 0.016). The mean contribution of SSBs to daily energy intake among college students was 480 kcal with the highest contribution from sugar sweetened hot drinks and fruit drinks. A significant positive relationship was found in BMI (p = 0.006) and waist circumference (p = 0.030) for participants consuming calories from SSBs. In conclusion, beverages with added sugar contribute substantially to the daily energy intake of college students in Jordan.
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A qualitative exploration of parents', youths' and food establishment managers' perceptions of beverage industry self-regulation for obesity prevention. Public Health Nutr 2019; 22:805-813. [PMID: 30755283 DOI: 10.1017/s1368980018003865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to explore the range of stakeholders' perceptions of the Balance Calories Initiative (BCI), under which the American Beverage Association pledged to decrease per capita US consumption of beverage energy by 20 % by 2025. DESIGN Semi-structured cross-sectional interviews were conducted in 2017. SETTING Participants were recruited from communities targeted by the BCI (Montgomery, AL; North Mississippi Delta, MS; Eastern Los Angeles, CA).ParticipantsA total of thirty-three parents and thirty-eight youths aged 10-17 years were recruited through youth-serving organizations, street intercept and snowball sampling; sixteen store/restaurant managers were recruited at businesses. Participants were asked about their awareness of the BCI. Parents and youths were asked to 'think aloud' as they viewed BCI messages (e.g. 'Balance What You Eat, Drink, and Do') and managers were asked about beverage marketing. RESULTS Twelve parents and twenty-four youths had seen BCI messages; only four managers were aware of the BCI. Many parents and youths showed some misunderstanding of BCI messages (e.g. that they should drink more sugar-sweetened beverages (SSB) or they needed to equalize healthy and unhealthy beverage intake). Only one manager had communicated with beverage companies about the BCI. CONCLUSIONS We found mixed comprehension and low awareness of BCI messages in communities targeted by the American Beverage Association for reduced SSB consumption. Industry self-regulation attempts to reduce SSB consumption may have limited effectiveness if stakeholder input is not addressed. Public health practitioners should be aware of the need to address youths' and parents' misunderstandings about SSB consumption, especially in BCI-targeted communities.
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Mendez MA, Miles DR, Poti JM, Sotres-Alvarez D, Popkin BM. Persistent disparities over time in the distribution of sugar-sweetened beverage intake among children in the United States. Am J Clin Nutr 2019; 109:79-89. [PMID: 30535176 PMCID: PMC6698637 DOI: 10.1093/ajcn/nqy123] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/09/2018] [Accepted: 05/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Recent research suggests that sugar-sweetened beverage (SSB) consumption has been declining among US children aged 2-18 y. However, most studies focused on changes in mean intake, ignore high SSB consumers and do not examine intake among vulnerable groups and, including adolescents, low-income households, and several racial/ethnic minorities. Objective The aim was to estimate usual SSB intake from NHANES surveys from 2003-2004 to 2013-2014 to examine shifts at both the median and 90th percentile among US children, evaluating the extent to which intake disparities in total SSBs and subtypes have persisted. Design Children 2-18 y from NHANES 2003, 2005, 2007, 2009, 2011 and 2013. SSBs were all non-diet beverages sweetened with sugars including revising all beverages to as consumed status and excluding soy and dairy based beverages. The NCI usual intake method was used to estimate usual intake from two 24-hour recalls. A 2-part correlated model accounted for nonconsumers. Quantile regression was then used to examine differences in SSB usual intakes at the 50th and 90th percentiles by race-ethnicity, and examine interactions indicating whether racial-ethnic disparities in intake were modified by income. Results Despite considerable declines, children's SSB intake remains high, particularly among heavy consumers. Among adolescents, median SSB intake in 2013-2014 was on the order of 150-200 kcal/d, and heavy intake at the 90th percentile was on the order of 250-300 kcal/d. There were important disparities in intake that persisted over time. Although high household income was associated with lower SSB intake in non-Hispanic white (NHW) children, intakes of non-Hispanic black (NHB) and Mexican-American (MA) children from these households were similar to or higher than those from poor households. There were also large racial/ethnic differences in the types of SSBs consumed. The consumption of regular sodas by NHB children was somewhat lower than among MA and NHW children, whereas fruit drink intake was markedly higher. Conclusions Overall, these findings suggest that, despite recent declines, strategies are needed to further reduce SSB consumption, and particularly heavy intake, especially among NHB children where fruit drinks also are key source of SSBs.
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Affiliation(s)
- Michelle A Mendez
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donna R Miles
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer M Poti
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Godin KM, Hammond D, Chaurasia A, Leatherdale ST. Examining changes in school vending machine beverage availability and sugar-sweetened beverage intake among Canadian adolescents participating in the COMPASS study: a longitudinal assessment of provincial school nutrition policy compliance and effectiveness. Int J Behav Nutr Phys Act 2018; 15:121. [PMID: 30482211 PMCID: PMC6257956 DOI: 10.1186/s12966-018-0754-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students’ SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students’ weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake. Methods This longitudinal study used data from the COMPASS study (2013/14–2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta – voluntary guidelines, Ontario public – mandatory guidelines, and Ontario private schools – no guidelines). We assessed availability of 10 beverage categories in schools’ vending machines via the COMPASS School Environment Application and participants’ intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students’ SSB intake. Results Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants’ overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants’ SSB intake. Conclusions Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake. Electronic supplementary material The online version of this article (10.1186/s12966-018-0754-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katelyn M Godin
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Kirkpatrick SI, Raffoul A, Maynard M, Lee KM, Stapleton J. Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews. Nutrients 2018; 10:nu10081036. [PMID: 30096786 PMCID: PMC6115867 DOI: 10.3390/nu10081036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/06/2023] Open
Abstract
There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences.
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Affiliation(s)
- Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
| | - Amanda Raffoul
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
| | - Merryn Maynard
- Meal Exchange, 401 Richmond St. W., Toronto, ON M5V 3A8, Canada.
| | - Kirsten M Lee
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
| | - Jackie Stapleton
- University of Waterloo Library, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
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Rosettie KL, Micha R, Cudhea F, Peñalvo JL, O’Flaherty M, Pearson-Stuttard J, Economos CD, Whitsel LP, Mozaffarian D. Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States. PLoS One 2018; 13:e0200378. [PMID: 29979761 PMCID: PMC6034872 DOI: 10.1371/journal.pone.0200378] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Promising school policies to improve children's diets include providing fresh fruits and vegetables (F&V) and competitive food restrictions on sugar-sweetened beverages (SSBs), yet the impact of national implementation of these policies in US schools on cardiometabolic disease (CMD) risk factors and outcomes is not known. Our objective was to estimate the impact of national implementation of F&V provision and SSB restriction in US elementary, middle, and high schools on dietary intake and body mass index (BMI) in children and future CMD mortality. METHODS We used comparative risk assessment (CRA) frameworks to model the impacts of these policies with input parameters from nationally representative surveys, randomized-controlled trials, and systematic reviews and meta-analyses. For children ages 5-18 years, this incorporated national data on current dietary intakes and BMI, impacts of these policies on diet, and estimated effects of dietary changes on BMI. In adults ages 25 and older, we further incorporated the sustainability of dietary changes to adulthood, effects of dietary changes on CMD, and national CMD death statistics, modeling effects if these policies had been in place when current US adults were children. Uncertainty across inputs was incorporated using 1000 Monte Carlo simulations. RESULTS National F&V provision would increase daily fruit intake in children by as much as 25.0% (95% uncertainty interval (UI): 15.4, 37.7%), and would have small effects on vegetable intake. SSB restriction would decrease daily SSB intake by as much as 26.5% (95% UI: 6.4, 46.4%), and reduce BMI by as much as 0.7% (95% UI: 0.2, 1.2%). If F&V provision and SSB restriction were nationally implemented, an estimated 22,383 CMD deaths/year (95% UI: 18735, 25930) would be averted. CONCLUSION National school F&V provision and SSB restriction policies implemented in elementary, middle, and high schools could improve diet and BMI in children and reduce CMD mortality later in life.
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Affiliation(s)
- Katherine L. Rosettie
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Frederick Cudhea
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Jose L. Peñalvo
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
| | - Christina D. Economos
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Laurie P. Whitsel
- American Heart Association, Arlington, Virginia, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America
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Lane H, Porter KJ, Hecht E, Harris P, Kraak V, Zoellner J. Kids SIP smartER: A Feasibility Study to Reduce Sugar-Sweetened Beverage Consumption Among Middle School Youth in Central Appalachia. Am J Health Promot 2018; 32:1386-1401. [PMID: 28731385 PMCID: PMC5993639 DOI: 10.1177/0890117117715052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs). DESIGN Matched-contact randomized crossover study with mixed-methods analysis. SETTING One middle school in rural, Appalachian Virginia. PARTICIPANTS Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers. INTERVENTION Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity. MEASURES Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance). ANALYSIS Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data. RESULTS During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources. CONCLUSION Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.
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Affiliation(s)
- Hannah Lane
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen J. Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Erin Hecht
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Vivica Kraak
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic and State University, Blacksburg, VA, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Orlando A, Cazzaniga E, Giussani M, Palestini P, Genovesi S. Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid. Front Public Health 2018; 6:129. [PMID: 29774210 PMCID: PMC5943632 DOI: 10.3389/fpubh.2018.00129] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children.
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Affiliation(s)
- Antonina Orlando
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuela Cazzaniga
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Giussani
- Family Pediatrician, Azienda Sanitaria Locale della Provincia di Milano, Milan, Italy
| | - Paola Palestini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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24
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Yoshida Y, Simoes EJ. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep 2018; 18:31. [PMID: 29671076 PMCID: PMC6025796 DOI: 10.1007/s11892-018-1004-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. RECENT FINDINGS Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
- Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - Eduardo J. Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
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25
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Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, Peñalvo JL, Mozaffarian D. Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis. PLoS One 2018; 13:e0194555. [PMID: 29596440 PMCID: PMC5875768 DOI: 10.1371/journal.pone.0194555] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. Objective To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. Methods We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. Results From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Conclusions Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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Affiliation(s)
- Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- * E-mail:
| | - Dimitra Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ioanna Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eirini Trichia
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Laurie P. Whitsel
- Policy Research, American Heart Association, Dallas, TX, United States of America
| | - Mary Story
- Global Health Institute and Community and Family Medicine, Duke University, Durham, NC, United States of America
| | - Jose L. Peñalvo
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
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Bogart LM, Elliott MN, Ober AJ, Klein DJ, Hawes-Dawson J, Cowgill BO, Uyeda K, Schuster MA. Home Sweet Home: Parent and Home Environmental Factors in Adolescent Consumption of Sugar-Sweetened Beverages. Acad Pediatr 2017; 17:529-536. [PMID: 28143794 PMCID: PMC5495605 DOI: 10.1016/j.acap.2017.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSBs) are key contributors to obesity among youth. We investigated associations among parental and home-related factors (parental attitudes and consumption; home availability) regarding 3 types of SSBs-soda, sports drinks, and fruit-flavored drinks-with consumption of each type of SSB in a general school-based sample of adolescents. METHODS Data were collected across 3 school semesters, from 2009 to 2011. A total of 1313 seventh grade student-parent dyads participated. Students completed in-class surveys across 9 schools in a large Los Angeles school district; their parents completed telephone interviews. Youth were asked about their SSB consumption (soda, sports drinks, and fruit-flavored drinks), and parents were asked about their attitudes, consumption, and home availability of SSBs. RESULTS We estimated expected rates of youth SSB consumption for hypothetical parents at very low (5th) and very high (95th) percentiles for home/parental risk factors (ie, they consumed little, had negative attitudes, and did not keep SSBs in the home; or they consumed a lot, had positive attitudes, and did keep SSBs in the home). Youth of lower-risk parents (at the 5th percentile) were estimated to drink substantially less of each type of beverage than did youth of higher-risk parents (at the 95th percentile). For example, youth with higher-risk parents averaged nearly double the SSB consumption of youth of lower-risk parents (2.77 vs 1.37 glasses on the previous day; overall model significance F22,1312 = 3.91, P < .001). CONCLUSIONS Results suggest a need to focus on parental and home environmental factors when intervening to reduce youths' SSB consumption.
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Marc N. Elliott
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - Allison J. Ober
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - David J. Klein
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115
| | | | - Burton O. Cowgill
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, A2-125 CHS, Box 9569000, Los Angeles, CA 90095-6900
| | - Kimberly Uyeda
- Community Partners and Medi-Cal Programs, Student Health and Human Services, Los Angeles Unified School District, 333 South Beaudry Ave, 29th floor, Los Angeles, CA 90017
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
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Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review. Public Health Nutr 2017; 20:2416-2431. [DOI: 10.1017/s1368980017000076] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractObjectiveTo verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions.DesignSystematic review of interventions targeting adolescents and/or the school environment.SettingThe following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials.SubjectsAdolescents were defined as individuals between the ages of 12 and 17 years.ResultsA total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %).ConclusionsSchool-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.
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28
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The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr 2016; 71:694-711. [PMID: 27901036 PMCID: PMC5470099 DOI: 10.1038/ejcn.2016.234] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022]
Abstract
Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer.
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29
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Gebremariam MK, Henjum S, Terragni L, Torheim LE. Correlates of fruit, vegetable, soft drink, and snack intake among adolescents: the ESSENS study. Food Nutr Res 2016; 60:32512. [PMID: 27652684 PMCID: PMC5031794 DOI: 10.3402/fnr.v60.32512] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022] Open
Abstract
Background Identifying modifiable correlates of dietary behaviors is of utmost importance for the promotion of healthy dietary behaviors. Objective This study explores individual, home, and school/neighborhood environmental correlates of dietary behaviors (intake of fruits, vegetables, soft drinks, and unhealthy snacks) among adolescents. Methods In total, 742 adolescents with a mean age of 13.6 (SD=0.3) were included in this cross-sectional study conducted in 11 secondary schools located in the eastern part of Norway. A web-based questionnaire was used to collect data. Univariable and multivariable linear regression analyses were used to explore factors associated with the dietary behaviors included. Results A higher frequency of food/drink purchase in the school canteen was related to a higher consumption of soft drinks and snacks. A higher frequency of food/drink purchase in shops around schools during break or recess was related to a higher consumption of snacks. A higher frequency of food/drink purchase in shops around the neighborhood on the way to and from school was related to a higher consumption of soft drinks. Perceived parental modeling and perceived accessibility at home were found to be positively associated with all dietary behaviors. Perceived parental rules were inversely associated with soft drink and snack consumption; self-efficacy related to healthy eating was positively associated with fruit and vegetable consumption. Other included school and neighborhood environmental correlates were not associated with the dietary behaviors. Conclusions There is a need to address the food purchasing behavior of the adolescents using different approaches. The findings also highlight the important role of parents and the home environment for healthy and unhealthy dietary behaviors of adolescents.
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Affiliation(s)
- Mekdes K Gebremariam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway;
| | - Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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30
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Louie JCY, Rangan AM. Patterns of added sugars intake by eating occasion among a nationally representative sample of Australians. Eur J Nutr 2016; 57:137-154. [PMID: 27600377 DOI: 10.1007/s00394-016-1303-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the eating occasion (EO) where most added sugars (AS) were consumed using a nationally representative dataset. METHODS Plausible dietary data from the Australian Health Survey respondents (n = 8202), collected by a multiple-pass 24-h recall, were analyzed. EO was self-reported during the recall. AS content of the foods reported was estimated using a previously published method. Proportion of daily AS consumed (%ASdaily) and the main food sources, at each EO, were calculated. Differences between children/adolescents and adults were tested by one-way ANOVA. Further stratification by age group and sex was performed. RESULTS The majority of the %ASdaily came from non-main meal occasions (NMMOs; 48.3 %, 95 % CI 47.5-49.0 %), followed by breakfast/brunch (20.6 %, 95 % CI 20.1-21.1 %). Children and adolescents consumed more %ASdaily during NMMOs compared with adults (52 vs. 47 %; p < 0.001), while girls/women consumed more %ASdaily during NMMO compared with boys (54 vs. 49 %; p = 0.002) and men (50 vs. 45 %; p < 0.001). Sugar-sweetened beverages were the top contributors to AS at lunch, dinner and NMMOs, while sugar and sweet spreads were the top contributor at breakfast/brunch. Other top contributors at NMMOs included "other foods," ice cream and cakes and biscuits, pastries and batter-based products. CONCLUSION Australians consumed nearly half of %ASdaily during NMMOs, most of which came from high-sugar energy-dense nutrient-poor foods. While the common perception that most AS come from snacks holds true, our results suggest that main meals are also important intervention targets.
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Affiliation(s)
- Jimmy Chun Yu Louie
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia. .,School of Biological Sciences, Faculty of Science, University of Hong Kong, 1 Pokfulam Road, Pokfulam, Hong Kong SAR.
| | - Anna M Rangan
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Peter von Philipsborn
- Technical University Munich; Faculty of Medicine; Stuntzstrasse 12 81677 Munich Germany
| | - Jan M Stratil
- University of Tuebingen; Faculty of Medicine; Wilhelmstrasse 127 Tuebingen Germany 72076
| | - Jacob Burns
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Laura K Busert
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Lisa M Pfadenhauer
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Stephanie Polus
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Christina Holzapfel
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Hans Hauner
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Eva Rehfuess
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
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Miller GF, Sliwa S, Brener ND, Park S, Merlo CL. School District Policies and Adolescents' Soda Consumption. J Adolesc Health 2016; 59:17-23. [PMID: 27021401 PMCID: PMC4920721 DOI: 10.1016/j.jadohealth.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Sugar-sweetened beverages (SSBs) are a significant source of calories and added sugars for youth ages 14-18 years in the United States. This study examined the relationship between district-level policies and practices and students' consumption of regular soda, one type of SSB, in 12 large urban school districts. METHODS Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked by district. The outcome variable was soda consumption and exposure variables were district policies. We used multivariable logistic regression analyses to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after controlling for student characteristics and district free/reduced-price meal eligibility. RESULTS About 18% of students reported consuming regular soda at least once per day. Most districts required high schools to have nutrition education, maintain closed campuses, and required/recommended that schools restrict promotional products and sale of beverages. Fewer districts required/recommended that schools offer healthful alternative beverages. Students in districts that restricted promotional products had lower odds of regular soda consumption (AOR = .84, 95% CI = .71-1.00), as did students in districts that restricted access to SSBs and offered healthful beverages when other beverages were available (AOR = .72, 95% CI = .54-.93, AOR = .76, 95% CI = .63-.91). CONCLUSIONS This study demonstrates that certain district-level policies are associated with student consumption of regular soda. These findings add to a growing consensus that policies and practices that influence the availability of healthier foods and beverages are needed across multiple settings.
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Affiliation(s)
- Gabrielle F Miller
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Sarah Sliwa
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Nancy D Brener
- Division of Adolescent and School Health, National Center for HIV/Aids, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
| | - Sohyun Park
- Division of Nutrition Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Caitlin L Merlo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Grummon AH, Oliva A, Hampton KE, Patel AI. Association Between Student Purchases of Beverages During the School Commute and In-School Consumption of Sugar-Sweetened Beverages, San Francisco Bay Area, 2013. Prev Chronic Dis 2015; 12:E220. [PMID: 26679489 PMCID: PMC5241631 DOI: 10.5888/pcd12.150306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Consumption of sugar-sweetened beverages (SSBs) such as sodas, fruit-flavored drinks, and sports drinks is a major contributor to childhood obesity. One strategy to reduce children's SSB consumption has been to restrict the sale of SSBs in schools. However, such policies may not sufficiently curb students' SSB intake, because students can obtain SSBs elsewhere, including from stores located on their school commute. Little is known about students' purchases of beverages during the school commute or about whether this purchasing behavior is related to in-school SSB consumption. The objective of this study was to describe where students from low-income, ethnically diverse communities obtain the SSBs they drink during school lunchtime and to examine whether students who purchase beverages while traveling to and from school are more likely to drink SSBs during school lunchtime. METHODS We analyzed survey data from a random sample of low-income, ethnically diverse middle school students (N = 597) who participated in a randomized controlled trial of a water promotion intervention. We used logistic regression analysis to examine the association between students' purchase of beverages during the school commute and their SSB consumption during school lunchtime. RESULTS One-fifth (20.4%) of students drank an SSB during lunch. Approximately 23% of SSBs were obtained during the school commute. Students who reported buying beverages during their school commute (50.1% of all students) were more likely to report drinking SSBs during lunch than students who reported that they do not buy beverages during the school commute (adjusted odds ratio 3.32, 95% confidence interval, 2.19-5.05, P < .001). CONCLUSION Students' purchase of beverages during the school commute was strongly associated with SSB consumption during school lunchtime. Interventions could benefit from focusing on retail environments (e.g., encouraging retailers to promote healthy beverages, posting beverage calorie information).
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Affiliation(s)
- Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 135 Dauer Dr, 302 Rosenau Hall, CB No. 7440, Chapel Hill, NC 27599.
| | - Ariana Oliva
- California Food Policy Advocates, Oakland, California
| | | | - Anisha I Patel
- Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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Alagiyawanna A, Townsend N, Mytton O, Scarborough P, Roberts N, Rayner M. Studying the consumption and health outcomes of fiscal interventions (taxes and subsidies) on food and beverages in countries of different income classifications; a systematic review. BMC Public Health 2015; 15:887. [PMID: 26369695 PMCID: PMC4570679 DOI: 10.1186/s12889-015-2201-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 08/27/2015] [Indexed: 11/30/2022] Open
Abstract
Background Governments use fiscal interventions (FIs) on food and beverages to encourage healthy food behaviour and positive health outcomes. The objective of this review was to study the behavioural and health outcomes of implemented food and beverage FIs in the form of taxes and subsidies in countries of different income classifications. Methods The present systematic review was conducted in accordance with Cochrane protocols. The search was carried out on academic and grey literature in English, for studies conducted in different countries on implemented FIs on food and non-alcoholic beverages and health outcomes, with a special focus on the income of those countries. Results Eighteen studies met the inclusion criteria and 14 were from peer- reviewed journals. Thirteen studies came from high-income (HI) countries, four from upper middle-income (UMI) countries and only one came from a lower middle-income (LMI) country. There were no studies from lower-income (LI) countries. Of these 18 studies; nine focused on taxes, all of which were from HI countries. Evidence suggests that FIs on foods can influence consumption of taxed and subsidized foods and consequently have the potential to improve health. Conclusion Although this review supports previous findings that FIs can have an impact on healthy food consumption, it also highlights the lack of evidence available from UMI, LMI and LI countries on such interventions. Therefore, evidence from HI countries may not be directly applicable to middle-income and LI countries. Similar research conducted in middle and low income countries will be beneficial in advocating policy makers on the effectiveness of FIs in countering the growing issues of non-communicable diseases in these countries. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2201-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amaap Alagiyawanna
- Ministry of Health, Health Education Bureau, No 2, Kynsey Road, Colombo, Sri Lanka.
| | - Nick Townsend
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road, Headington, Oxford, OX3 7LF, UK.
| | - Oli Mytton
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK.
| | - Pete Scarborough
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road, Headington, Oxford, OX3 7LF, UK.
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Old Road, Headington, Oxford, OX3 7LF, UK.
| | - Mike Rayner
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road, Headington, Oxford, OX3 7LF, UK.
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Tipton JA. Reducing Sugar-Sweetened Beverage Intake Among Students: School-Based Programs and Policies That Work. NASN Sch Nurse 2015; 31:102-10. [PMID: 25816431 DOI: 10.1177/1942602x15578456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The amount of sugar-sweetened beverages (SSBs) consumed by U.S. youth has nearly doubled since the 1970s. The majority of children between 2 and 19 years drink SSBs on any given day. Many serious health problems such as childhood overweight and obesity, type 2 diabetes, kidney disease, and cardiovascular problems have been linked to SSBs. This article provides an overview of school-based interventions and policies that have successfully contributed to a reduction in sugar-sweetened intake among children. School nurses and nurses in other community-based settings are well positioned to promote intake of more healthful beverages among children using strategies recommended in this article.
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Affiliation(s)
- Julia A Tipton
- Instructor, Louisiana State University Health Sciences Center, New Orleans, LA
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Le Bodo Y, Paquette MC, Vallières M, Alméras N. Is Sugar the new Tobacco? Insights from Laboratory Studies, Consumer Surveys and Public Health. Curr Obes Rep 2015; 4:111-21. [PMID: 26627095 DOI: 10.1007/s13679-015-0141-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the Americas, mean energy intake from added sugar exceeds recent World Health Organization recommendations for free sugars in the diet. As a leading contributor to this excess, sugar-sweetened beverage (SSB) overconsumption represents a risk for the population's health. This article provides an overview of clinical and epidemiological evidence, marketing practices, corporate influence and prevention strategies related to added sugar and SSB. For each aspect of this multidimensional profile, we briefly compare SSB to the case of tobacco pointing to similarities but also major differences. Tobacco control has demonstrated the effectiveness of long term multifaceted prevention strategies in multiple settings supported by strong public policies which may be applied to the consumption of SSB. However, translating these policies to the specific case of SSB is urgently needed, to inform preventive actions, decide which intervention mix will be used, and evaluate the process and impact of the chosen strategy.
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Affiliation(s)
- Yann Le Bodo
- Evaluation platform on obesity prevention (EPOP), Québec, QC, Canada.
- Faculty of Medicine and Nursing, Laval University, Québec, QC, Canada.
| | - Marie-Claude Paquette
- Institut national de santé publique du Québec (INSPQ), Montréal, QC, Canada.
- Faculty of Medicine, University of Montreal, Montréal, QC, Canada.
| | | | - Natalie Alméras
- Quebec Heart and Lung Institute, Québec, QC, Canada.
- Department of Kinesiology, Faculty of Medicine, Laval University, Québec, QC, Canada.
- Quebec Heart and Lung Institute, 2725, chemin Sainte Foy, Québec, QC, G1V 4G5, Canada.
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Leermakers ETM, Felix JF, Erler NS, Ćerimagić A, Wijtzes AI, Hofman A, Raat H, Moll HA, Rivadeneira F, Jaddoe VWV, Franco OH, Kiefte-de Jong JC. Sugar-containing beverage intake in toddlers and body composition up to age 6 years: the Generation R study. Eur J Clin Nutr 2015; 69:314-21. [PMID: 25649238 DOI: 10.1038/ejcn.2015.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE Intake of sugar-containing beverages (SCBs) has been associated with higher body mass index (BMI) in childhood. The potential effect of SCB intake during infancy is unclear. We examined the association of SCB intake at 13 months with BMI development until 6 years and body composition at age 6 years. SUBJECTS/METHODS This study included 2371 Dutch children from a population-based prospective cohort study. SCB intake at 13 months was assessed using a Food Frequency Questionnaire with validation against 24-h recalls and was standardized for total energy. BMI was calculated from repeated weight and height measurements, and age- and sex-specific s.d. scores were calculated. Adiposity was measured using Dual-energy X-ray absorptiometry. RESULTS In girls, higher SCB intake at 13 months was significantly associated with higher BMI at ages 2, 3, 4 and 6 years (at age 6 years BMI (s.d. score) increase 0.11 (95% confidence interval (CI) +0.00; 0.23), high versus low intake). We observed a tendency towards higher android/gynoid fat ratio in girls with high intake (s.d. increase 0.14 (95% CI -0.02; 0.29), versus low intake) but not with body fat percentage. In boys, there was no association with BMI or body composition, but boys with high SCB intake at 13 months were taller at age 6 years (s.d. increase 0.14 (95% CI +0.00; 0.27), versus low intake). CONCLUSIONS Higher SCB intake at 13 months was associated with higher BMI up to age 6 years in girls but not in boys. Our results imply that the unfavorable effects of SCB intake start early in life and that dietary advice regarding limiting SCB intake should already be given early in life.
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Affiliation(s)
- E T M Leermakers
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Felix
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [3] Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N S Erler
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Ćerimagić
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A I Wijtzes
- 1] The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V W V Jaddoe
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [3] Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - O H Franco
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J C Kiefte-de Jong
- 1] Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands [2] Leiden University College, The Hague, The Netherlands
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Greathouse KL, Chriqui J, Moser RP, Agurs-Collins T, Perna FM. The association of soda sales tax and school nutrition laws: a concordance of policies. Public Health Nutr 2014; 17:2201-6. [PMID: 24477116 PMCID: PMC10282621 DOI: 10.1017/s1368980013003029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/13/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current research examined the association between state disfavoured tax on soda (i.e. the difference between soda sales tax and the tax on food products generally) and a summary score representing the strength of state laws governing competitive beverages (beverages that compete with the beverages in the federally funded school lunch programme) in US schools. DESIGN The Classification of Laws Associated with School Students (CLASS) summary score reflected the strength of a state's laws restricting competitive beverages sold in school stores, vending machines, school fundraisers and à la carte cafeteria items. Bridging the Gap (BTG) is a nationally recognized research initiative that provided state-level soda tax data. The main study outcome was the states' competitive beverage summary scores for elementary, middle and high school grade levels, as predicted by the states' disfavoured soda tax. Univariate and multivariate analyses were conducted, adjusting for year and state. SETTING Data from BTG and CLASS were used. SUBJECTS BTG and CLASS data from all fifty states and the District of Columbia from 2003 to 2010 were used. RESULTS A higher disfavoured soda sales tax was generally associated with an increased likelihood of having strong school beverage laws across grade levels, and especially when disfavoured soda sales tax was >5 %. CONCLUSIONS These data suggest a concordance between states' soda taxes and laws governing beverages sold in schools. States with high disfavoured sales tax on soda had stronger competitive beverage laws, indicating that the state sales tax environment may be associated with laws governing beverage policy in schools.
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Affiliation(s)
- K Leigh Greathouse
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
- Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD, USA
| | - Jamie Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard P Moser
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
| | - Tanya Agurs-Collins
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
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Taber DR, Chriqui JF, Vuillaume R, Chaloupka FJ. How state taxes and policies targeting soda consumption modify the association between school vending machines and student dietary behaviors: a cross-sectional analysis. PLoS One 2014; 9:e98249. [PMID: 25083906 PMCID: PMC4118851 DOI: 10.1371/journal.pone.0098249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/30/2014] [Indexed: 01/28/2023] Open
Abstract
Background Sodas are widely sold in vending machines and other school venues in the United States, particularly in high school. Research suggests that policy changes have reduced soda access, but the impact of reduced access on consumption is unclear. This study was designed to identify student, environmental, or policy characteristics that modify the associations between school vending machines and student dietary behaviors. Methods Data on school vending machine access and student diet were obtained as part of the National Youth Physical Activity and Nutrition Study (NYPANS) and linked to state-level data on soda taxes, restaurant taxes, and state laws governing the sale of soda in schools. Regression models were used to: 1) estimate associations between vending machine access and soda consumption, fast food consumption, and lunch source, and 2) determine if associations were modified by state soda taxes, restaurant taxes, laws banning in-school soda sales, or student characteristics (race/ethnicity, sex, home food access, weight loss behaviors.) Results Contrary to the hypothesis, students tended to consume 0.53 fewer servings of soda/week (95% CI: -1.17, 0.11) and consume fast food on 0.24 fewer days/week (95% CI: -0.44, -0.05) if they had in-school access to vending machines. They were also less likely to consume soda daily (23.9% vs. 27.9%, average difference = -4.02, 95% CI: -7.28, -0.76). However, these inverse associations were observed primarily among states with lower soda and restaurant tax rates (relative to general food tax rates) and states that did not ban in-school soda sales. Associations did not vary by any student characteristics except for weight loss behaviors. Conclusion Isolated changes to the school food environment may have unintended consequences unless policymakers incorporate other initiatives designed to discourage overall soda consumption.
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Affiliation(s)
- Daniel R. Taber
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Renee Vuillaume
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
| | - Frank J. Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Mâsse LC, de Niet-Fitzgerald JE, Watts AW, Naylor PJ, Saewyc EM. Associations between the school food environment, student consumption and body mass index of Canadian adolescents. Int J Behav Nutr Phys Act 2014; 11:29. [PMID: 24666770 PMCID: PMC3987130 DOI: 10.1186/1479-5868-11-29] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing attention has been paid to the school food environment as a strategy to reduce childhood obesity. The purpose of this study was to examine associations between the school food environment, students' dietary intake, and obesity in British Columbia (BC), Canada. METHODS In 2007/08, principal responses about the school environment (N=174) were linked to grades 7-12 students (N=11,385) from corresponding schools, who participated in the BC Adolescent Health Survey. Hierarchical mixed-effect regression analyses examined the association between the school food environment and student's intake of sugar-sweetened beverages (SSBs), food consumption, and body mass index. Analyses controlled for school setting, neighborhood education level and student's age and sex. RESULTS School availability of SSBs was positively associated with moderate (Odds Ratio (OR)=1.15, 95% Confidence Interval (CI)=1.02-1.30) and high (OR=1.43, 95% CI=1.13-1.80) SSB intake as were less healthful school nutrition guidelines for moderate SSB consumers only (OR=0.65, 95% CI=0.48-0.88). Availability of SSBs at school and its consumption were positively associated with student obesity (OR=1.50, 95% CI=1.12-2.01 and OR=1.66, 95% CI=1.19-2.34, respectively) but not with overweight. In contrast, consumption of less healthful food was positively associated with overweight (OR=1.03, 95% CI=1.01-1.06). CONCLUSIONS The results of this study provide further evidence to support the important role of schools in shaping adolescents' dietary habits. Availability and consumption of SSBs, but not less healthful foods, at school were associated with higher adolescent obesity highlighting that other environments also contribute to adolescent obesity.
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Affiliation(s)
- Louise C Mâsse
- School of Population and Public Health, University of British Columbia, F508-4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
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Nickelson J, Lawrence JC, Parton JM, Knowlden AP, McDermott RJ. What proportion of preschool-aged children consume sweetened beverages? THE JOURNAL OF SCHOOL HEALTH 2014; 84:185-194. [PMID: 24443780 DOI: 10.1111/josh.12136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/20/2013] [Accepted: 09/04/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Obesity affects nearly 17% of US children and youth 2-19 years old and 10% of infants and toddlers under the age of 2 years. One strategy for addressing obesity is to discourage sugar-sweetened beverage (SSB) consumption. Compared with their older school-aged counterparts, children ≤ 5 years depend largely on parents for the purchase and serving of SSBs. Therefore, recognizing parental factors associated with children's intake of SSBs is important. METHODS This study used cross-sectional data from parents of children ≤ 5 years old to examine SSB consumption and associated factors. Elements of the Health Belief Model and Theory of Reasoned Action facilitated data analysis and interpretation. RESULTS The most consistent predictor of SSB intake was child age. Nearly 94% of children aged 3-5 years consumed sweetened milk products, 88% consumed fruity drinks, 63% consumed sodas, and 56% consumed sports drinks and sweet tea. Adjusting for all other factors, the only parental psychosocial factor associated with SSB intake was self-efficacy (predicting fruity drinks consumption). CONCLUSIONS More children drink SSBs as they get older. Interventions designed to prevent SSB consumption should occur early, before children reach preschool age. Additional study of parental factors influencing SSB intake in early childhood is recommended.
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Affiliation(s)
- Jen Nickelson
- Assistant Professor, , Department of Health Science, University of Alabama, PO Box 870311,Tuscaloosa, AL 35487-0311
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Yon BA, Johnson RK. Dietary Patterns and Sugar-Sweetened Beverage Consumption among Adolescents and Adults. Curr Nutr Rep 2014. [DOI: 10.1007/s13668-013-0071-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Quiles-Izquierdo J. Un dulce impuesto para no amargar la salud. GACETA SANITARIA 2014; 28:72-3. [DOI: 10.1016/j.gaceta.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/25/2022]
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Barragan NC, Noller AJ, Robles B, Gase LN, Leighs MS, Bogert S, Simon PA, Kuo T. The “Sugar Pack” Health Marketing Campaign in Los Angeles County, 2011-2012. Health Promot Pract 2013; 15:208-16. [DOI: 10.1177/1524839913507280] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As part of a comprehensive approach to combating the obesity epidemic, the Los Angeles County Department of Public Health launched the “Sugar Pack” health marketing campaign in fall 2011. Carried out in three stages, the campaign sought to educate and motivate the public to reduce excess calorie intake from sugar-sweetened beverage consumption. The primary Sugar Pack creative concepts provided consumers with information about the number of sugar packs contained in sugary drinks. Data from formative market research as well as lessons from previous campaigns in other U.S. jurisdictions informed the development of the materials. These materials were disseminated through a multipronged platform that included paid outdoor media on transit and billboards and messaging using social media (i.e., Twitter, Facebook, YouTube, and sendable e-cards). Initial findings from a postcampaign assessment indicate that the Sugar Pack campaign reached broadly into targeted communities, resulting in more than 515 million impressions. Lessons learned from the campaign suggest that employing health marketing to engage the public can lead to increased knowledge, favorable recognition of health messages, and self-reported intention to reduce sugar-sweetened beverage consumption, potentially complementing other obesity prevention strategies in the field.
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Affiliation(s)
- Noel C. Barragan
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ali J. Noller
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Lauren N. Gase
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Michael S. Leighs
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Suzanne Bogert
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Paul A. Simon
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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The Dilemma of Sugar-Sweetened Beverages. Curr Nutr Rep 2013. [DOI: 10.1007/s13668-013-0049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Levy DT, Friend KB. Simulation modeling of policies directed at youth sugar-sweetened beverage consumption. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:299-313. [PMID: 22810953 DOI: 10.1007/s10464-012-9535-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Childhood obesity is a significant public health problem requiring innovative solutions. While recent reviews indicate that some policies show promise, there is a lack of information regarding which policies, and policy combinations, work best. Low-nutrition, energy-dense foods and beverages such as sugar-sweetened beverages (SSBs) have been identified as a major contributor to the problem. The purpose of this paper is to use simulation modeling to show how changes in three categories of SSB policies-school nutrition, school-based education, and taxes-impact SSB and other food consumption. The model shows that policies directed at SSBs, particularly tax hikes, could lead to substantial reductions in the number of calories consumed by youth. The estimates, however, are subject to a high degree of uncertainty. Estimates from school-based nutrition and school-based education policies, while also helping to reduce caloric intake, generally show smaller effects than tax policies and considerable variation around parameter estimates for individual and combined policies. We conclude with a discussion of the limits of the model, and suggest where additional information is needed. Limitations notwithstanding, simulation modeling is a promising methodology that can help advance our understanding of policy effects, thereby helping policymakers to better formulate effective policies to reduce obesity prevalence and the associated social harms.
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Affiliation(s)
- David T Levy
- Cancer Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
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Briefel RR, Wilson A, Cabili C, Hedley Dodd A. Reducing Calories and Added Sugars by Improving Children's Beverage Choices. J Acad Nutr Diet 2013; 113:269-75. [DOI: 10.1016/j.jand.2012.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/19/2012] [Indexed: 12/31/2022]
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Abstract
PURPOSE OF REVIEW Obesity is well recognized as a major public health crisis throughout the USA. In recent years, governmental bodies at the federal, state and local levels have enacted policies intended to prevent the transition to obesity. Researchers have had the opportunity to study these policies and evaluate their impact on prevention of obesity. RECENT FINDINGS Most public policies have been directed principally, but not exclusively, to the prevention of obesity in school-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing the composition of competitive foods and affecting food advertising directed at children as well as collecting BMI information. Efforts more directed at adults include encouraging workplace wellness programs and improving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus. SUMMARY For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture might be less positive due to the poor quality of research and publication bias. Push back by industry and others will require higher quality experimental and real world studies. All interventions fail to accommodate the multifactorial aspects of obesity.
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Affiliation(s)
- Morgan Downey
- Downey Obesity Report, Washington, District of Columbia, USA.
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Armstrong LE, Barquera S, Duhamel JF, Hardinsyah R, Haslam D, Lafontan M. Recommendations for healthier hydration: addressing the public health issues of obesity and type 2 diabetes. Clin Obes 2012; 2:115-24. [PMID: 25586246 DOI: 10.1111/cob.12006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 10/01/2012] [Accepted: 10/26/2012] [Indexed: 01/04/2023]
Abstract
Given the rapid increase in the prevalence of overweight, obesity, type 2 diabetes and other obesity-related conditions across the world, despite a plethora of evidence-based guidance for clinicians, innovative campaigns aimed at the general public and widespread government public health initiatives, it is clear that a novel approach is required. The importance of fluid intake has been overlooked in campaigns and guidelines and also in the clinical setting, where the question 'what do you drink?' is often omitted. It is a significant oversight that food pyramids and healthy-eating plates across the world omit fluids from their graphics and advice. While guidelines include recommendations on changes in physical activity and diet, often little or no advice is offered on the importance of healthier hydration practices, neglecting to highlight the contribution of beverages high in sugar, alcohol or additives. An interdisciplinary group of experts in medicine, nutrition, physiology and public health discussed issues surrounding healthy-hydration practices in March 2010 in Paris to create a consensus statement on hydration and gain of body weight and provide recommendations.
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Affiliation(s)
- L E Armstrong
- Departments of Kinesiology & Nutritional Sciences, University of Connecticut, Storrs, CT, USA
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Affiliation(s)
- Guillermo Melendez
- Fundación Mexicana para la Salud AC, Av. Periférico 4809, Col. Arenal Tepepan, Mexico City, Mexico.
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