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Ma KK, Ziegler GR, Hayes JE. Sugar reduction in chocolate compound by replacement with flours containing small insoluble starch granules. J Food Sci 2024; 89:1701-1710. [PMID: 38258973 DOI: 10.1111/1750-3841.16923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Consumer concern about intake of added sugars has increased commercial demand for sugar-reduced chocolates. However, substitution with high-potency sweeteners is not possible as sugar serves as an important bulking agent. Here, we investigated replacement of sucrose in chocolate compound with oat or rice flours, with starch granules smaller than 10 µm, focusing on texture, sweetness, and acceptability. In Study 1, six chocolates were made: a control with 54% sucrose, four sucrose-reduced versions (reductions of 25% or 50%, using either oat or sweet rice flour), and one 54% sucrose chocolate with reduced refining time. These chocolates were compared in a Difference from Control (DFC) test in a within-subject design, with and without nose clips. Particle size distribution, yield stress, and plastic viscosity were measured. Chocolates with 25% sucrose reduction by either sweet rice or oat flour (or reduced refining time) were not significantly different from the blind control (p > 0.05), regardless of nose clip use. In open-ended comments, participants reported differences in rice-flour-containing chocolates were due to a chalkier texture, while oat-flour-containing chocolates were described as smoother, softer, and creamier. DFC scores from the chocolates were positively correlated with plastic viscosity and negatively correlated with yield stress. In Study 2, 25% reduced sugar chocolates made with rice flour were liked significantly less than control, but the oat flour sample did not differ from control. Collectively, these results suggest up to 25% of sucrose in chocolate can be replaced with oat flour without negatively affecting texture or consumer acceptance.
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Affiliation(s)
- Kai Kai Ma
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Gregory R Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - John E Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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2
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Bridge G, Jackson-Morris A, Silva Monteiro L. Editorial: Added sugar consumption: economic and policy perspectives for improving public health. Front Nutr 2024; 11:1379946. [PMID: 38463939 PMCID: PMC10920223 DOI: 10.3389/fnut.2024.1379946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Gemma Bridge
- School of Earth and Environment, University of Leeds, Leeds, United Kingdom
- York Business School, York St John University, York, United Kingdom
| | | | - Luana Silva Monteiro
- Instituto de Alimentação e Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Goins RK, Steffen LM, Yi SY, Zhou X, Van Horn L, Shikany JM, Terry JG, Jacobs DR. Consumption of foods and beverages rich in added sugar associated with incident metabolic syndrome: Coronary Artery Risk Development in Young Adults (CARDIA) study. Eur J Prev Cardiol 2024:zwad409. [PMID: 38170585 DOI: 10.1093/eurjpc/zwad409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
AIMS Numerous studies report positive associations between total carbohydrate (CHO) intake and incident metabolic syndrome (MetS), but few differentiate quality or type of CHO relative to MetS. We examined source of CHO intake, including added sugar (AS), AS-rich CHO foods and sugar-sweetened beverages (SSBs) associated with incident MetS in adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS Among 3154 Black American and White American women and men aged 18-30 years at baseline, dietary intake was assessed by diet history three times over 20 years. Sources of AS-rich CHO foods and beverages include sugar-rich refined grain products, candy, sugar products, and SSBs. Incident MetS was created according to standard criteria. Time-dependent Cox proportional-hazards regression analysis evaluated the associations of incident MetS across quintiles of cumulative intakes of AS-rich CHO foods and beverages, AS, and SSBs adjusted for potential confounding factors over 30 years of follow-up. RESULTS The associations of AS-rich CHO foods and beverages, AS, and SSB intakes with incident MetS were consistent. Compared to the lowest intake, the greatest intake of AS-rich CHOs, AS, and SSBs were associated with 59% (ptrend<0.001), 44% (ptrend=0.01), and 34% (ptrend=0.03) higher risk of developing MetS, respectively. As expected, diet quality was lower across increasing quintiles of AS-rich CHO foods and beverages, AS, and SSBs (all ptrend<0.001). CONCLUSION Our study findings are consistent with an elevated risk of developing MetS with greater consumption of AS, AS-rich CHO foods, and SSBs which support consuming fewer AS-rich CHO foods and SSBs.
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Affiliation(s)
- Rae K Goins
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health; Minneapolis, MN
| | - Lyn M Steffen
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health; Minneapolis, MN
| | - So-Yun Yi
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health; Minneapolis, MN
| | - Xia Zhou
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health; Minneapolis, MN
| | - Linda Van Horn
- Northwestern University, Department of Preventive Medicine, Feinberg School of Medicine; Chicago, IL
| | - James M Shikany
- University of Alabama at Birmingham School of Medicine, Division of Preventive Medicine; Birmingham, AL
| | - James G Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health; Minneapolis, MN
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Yang CL, Kerver JM, Hirko K, Dunietz GL, O'Brien LM, Jansen EC. Delayed Sleep Midpoint Across Pregnancy Is Associated with Excessive Gestational Weight Gain. J Womens Health (Larchmt) 2024; 33:62-72. [PMID: 37552849 PMCID: PMC10794831 DOI: 10.1089/jwh.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Background: Changes in sleep patterns and body weight occur during pregnancy, yet it is unclear whether sleep patterns are related to gestational weight gain (GWG). This study examined the relationship between maternal sleep across pregnancy and excessive GWG. Methods: Participants from the Michigan Archive for Research on Child Health (MARCH) cohort study, who had singleton births and provided information on fall-asleep and wake-up times during early (first or second) and the third trimesters, were included (n = 372). Changes in sleep duration and sleep midpoints throughout pregnancy were calculated. Prepregnancy weight and the last maternal weight before delivery were used to calculate GWG, which was categorized into groups (inadequate, adequate, and excessive). Poisson regression models were used to examine associations between sleep changes and excessive GWG, adjusted for age, race, gestational age, prepregnancy body mass index, income, fetus gender, physical activity, added sugar, and fruit and vegetable intake. Results: Excessive GWG was observed in 46.5% of women, and was more common among those with prepregnancy obesity (p < 0.001). Women who delayed sleep midpoint by 1 hour (or more) from the early trimester assessment to the third trimester experienced higher risk of excessive GWG (Risk ratio: 1.3; 95% confidence interval: 1.1-1.7). Single time points of sleep duration and sleep midpoint or changes in sleep duration were not related to GWG. Conclusions: Delay in sleep midpoint from early-mid pregnancy to the third trimester was associated with excessive GWG. Health professionals should consider changes in sleep patterns during pregnancy to identify those prone to excessive GWG.
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Affiliation(s)
- Chia-Lun Yang
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Jean M. Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Louise M. O'Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica C. Jansen
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Gillespie KM, White MJ, Kemps E, Moore H, Dymond A, Bartlett SE. The Impact of Free and Added Sugars on Cognitive Function: A Systematic Review and Meta-Analysis. Nutrients 2023; 16:75. [PMID: 38201905 PMCID: PMC10780393 DOI: 10.3390/nu16010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
A relationship between excessive sugar consumption and cognitive function has been described in animal models, but the specific effects of sugars in humans remains unclear. This systematic review and meta-analysis aimed to evaluate the current knowledge, research characteristics, and quality of evidence of studies investigating the impacts of free and added sugars on human cognition in healthy participants. The review identified 77 studies (65 experimental trials, n = 3831; 9 cross-sectional studies, n = 11,456; and 3 cohort studies, n = 2059). All cohort studies and eight of the nine cross-sectional studies found significant positive correlations between added sugar consumption and risk of cognitive impairment. Four studies identified reduced risk of cognitive impairment associated with natural fructose-containing foods. The majority of randomised control trials assessed short-term glucose facilitation effects on cognitive outcomes. The results from these studies suggest the need for a tightly regulated blood glucose level, dependent on individualised physiological factors, for optimal cognitive function. A meta-analysis of a subset of studies that assessed the impact of glucose on recall found improvements in immediate free recall compared to controls (p = 0.002). The findings highlight the potentially detrimental effect of excessive, long-term, or prenatal added sugar consumption on cognitive function. Further research is needed to examine the specific effects of free and added sugars on cognitive function.
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Affiliation(s)
- Kerri M. Gillespie
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Melanie J. White
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Eva Kemps
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA 5042, Australia;
| | - Halim Moore
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63170 Clermont-Ferrand, France;
| | - Alexander Dymond
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
| | - Selena E. Bartlett
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
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Liu CH, Wong TC, Chung M, Bai CH, Chen YC. Sugar labeling information and online marketing strategies for hand-shaken tea drinks in northern Taiwan. Front Nutr 2023; 10:1273713. [PMID: 38035354 PMCID: PMC10682441 DOI: 10.3389/fnut.2023.1273713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background Sugar-sweetened beverages (SSBs) are the main cause of excessive sugar intake and increased health risks. Food companies usually use social media to market SSBs in order to increase consumers' purchase intentions. To reduce excessive added sugar consumption from hand-shaken tea drinks, Taiwan has implemented a mandatory policy requiring clear sugar content labeling. This study aimed to investigate the sugar label information and online marketing strategies for hand-shaken tea drinks in northern Taiwan. Methods In this cross-sectional study, content analysis was employed to investigate the sugar labeling information and the current situation of online marketing in hand-shaken tea drink brands based in northern Taiwan. Seventy-two hand-shaken tea drink brands' stores were visited to record their sugar labeling presentation methods, with brands lacking labeling, presenting incomplete labeling, or not offering customized sugar levels being excluded, resulting in 60 brands being chosen for the subsequent data collection process. The sugar and energy contents in 1,581 hand-shaken tea drinks were recorded and calculated. Subsequently, the sugar contents were assessed in accordance with World Health Organization (WHO) sugar recommendations (25 g/day), warning label criteria, and Taiwan's regulations for low-sugar packaged beverages. Seven brands that had high online impressions were further selected and their marketing strategies in 560 Facebook posts were analyzed. Results The presentation methods of labeling varied among the 60 brands, and only 42 brands had obvious and easily accessible labeling. The most common labeling presentation method was posters (n = 28). After converting the sugar content of half-sugar and low-sugar hand-shaken tea drinks, it was found that 60.2% of half-sugar beverages and 13.0% of low-sugar beverages exceeded 25 g of sugar per cup. Over 90% of brands had Facebook and Instagram accounts. The top marketing strategies for tea drink brands on Facebook were specific beverage information, brand information, and nutrition and health marketing. Most posts promoted sugar-sweetened beverages. Conclusion Not all hand-shaken tea drink brands in this study followed Taiwan's labeling regulations. Moreover, high sugar contents in hand-shaken tea drinks labeled as half-sugar and low-sugar could potentially lead people to unconsciously consume excessive amounts of sugar. Future research should explore the impact of online marketing strategies on SSBs consumption behavior and ways to mitigate it among the Taiwanese public.
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Affiliation(s)
- Chi-Hsuan Liu
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei, Taiwan
| | - Mei Chung
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, United States
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chun Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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Yingchankul N, Panuspanudechdamrong C, Techapipatchai N, Chanmuang T, Netsiri P, Karawekpanyawong N, Tanasombatkul K, Phinyo P. Is the Consumption of Added Sugar from Common Beverages Associated with the Presence of Attention Deficit Hyperactivity Disorder Symptoms in Thai Medical Students? Nutrients 2023; 15:4395. [PMID: 37892470 PMCID: PMC10610093 DOI: 10.3390/nu15204395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) significantly affects the well-being of medical students in various aspects. Sugar-sweetened beverages (SSBs) pose a potential risk of ADHD. Our study aimed to determine the prevalence of ADHD symptoms and the association between consumption of added sugar in common beverages and ADHD symptoms in Thai medical students. An online cross-sectional survey was conducted among medical students at Chiang Mai University from May 2022 to April 2023. The consumption of added sugar from common beverages in Thailand was assessed using the Thai Adolescence Sugar Sweetened Beverage Intake (THASSI) questionnaire. An Adult ADHD Self-Report Scale (ASRS) score ≥ 3 identified the presence of ADHD symptoms. Multivariable logistic regression was used for the analysis. Of 441 participants, 29.9% had ADHD symptoms. Daily consumption of added sugar from beverages higher than 25 g/day showed an increased risk of ADHD symptoms (adjusted odds ratio (OR) 1.80, 95%CI 1.15 to 2.84, p = 0.011). The same trend was observed when using the sex-specific cutoff points (adjusted OR 1.73, 95%CI 1.10 to 2.73, p = 0.018). Higher consumption of added sugar from beverages may increase the risk of ADHD symptoms in Thai medical students. This finding supports the implementation of health policies that promote healthy consumption behaviors among medical students.
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Affiliation(s)
- Nalinee Yingchankul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
| | - Chompimaksorn Panuspanudechdamrong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
| | - Nuthakul Techapipatchai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
| | - Tiphakorn Chanmuang
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
| | - Pintira Netsiri
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
| | | | - Krittai Tanasombatkul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.Y.); (C.P.); (N.T.); (T.C.); (P.N.); (K.T.)
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
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Zhang J, Tang Z, Lu Z, Lin X, Liao H, Li Z, Chen W, Hu C, He Z, Tang F. The Association between Dietary Sugar Intake and Nephrolithiasis: Results from National Health and Nutrition Examination Survey 2007-2018. J Nutr 2023; 153:2968-2978. [PMID: 37648110 DOI: 10.1016/j.tjnut.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Dietary sugar intake is gradually considered a risk factor for many diseases. A sugary diet was positively associated with risk of nephrolithiasis, but the specific relationships remain undefined. OBJECTIVES To determine associations between risk of nephrolithiasis and dietary sugar intake. METHODS This cross-sectional study involved 21,590 participants based on the National Health and Nutrition Examination Survey from 2007 to 2018. Amounts of dietary sugar intake (g/d) were the main exposure, including total sugar intake, added sugar intake, and food sources. Associations were analyzed by logistic regression models and restricted cubic splines using complex weighted designs. RESULTS Weighted mean intake [standard error] of total sugar and added sugar were 111.2 [2.0] g/d and 73.7 [1.9] g/d in participants with nephrolithiasis, respectively. In the fully adjusted regression model, compared to those in quartile 1, the population in quartile 4 of total sugar intake showed a significant risk of nephrolithiasis [odds ratio (OR): 1.23; 95% confidence interval (CI): 1.00-1.51]; OR for added sugar intake was 1.56 (95% CI: 1.25-1.94). The risks of nephrolithiasis increased steadily when total sugar and added sugar intake exceeded ∼150 g/d and 63 g/d in restricted cubic spline analyses, respectively. The highest sugar intake from beverages was associated with an increased risk of nephrolithiasis (OR for total sugar: 1.36; 95% CI: 1.07-1.72; OR for added sugar: 1.37; 95% CI: 1.09-1.73). Added sugar intake from meat, egg, and oil was significantly associated with risk of nephrolithiasis (quartile 4, OR: 1.22; 95% CI: 1.02-1.47), whereas total sugar intake from dairy products was in reverse (quartile 4, OR: 0.67; 95% CI: 0.54-0.82). CONCLUSIONS Total and added sugar intake, sugar intake from beverages, and added sugar intake from meat, egg, and oil were associated with an increased risk of nephrolithiasis, whereas total sugar intake from dairy products was negatively associated.
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Affiliation(s)
- Jiahao Zhang
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zhicheng Tang
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zechao Lu
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xuqing Lin
- The Second Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haiqin Liao
- The Second Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhibiao Li
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wanru Chen
- The Third Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chuxian Hu
- The Sixth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhaohui He
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Fucai Tang
- Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
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Liu Y, Cheng J, Wan L, Chen W. Associations between Total and Added Sugar Intake and Diabetes among Chinese Adults: The Role of Body Mass Index. Nutrients 2023; 15:3274. [PMID: 37513695 PMCID: PMC10384374 DOI: 10.3390/nu15143274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Sugar intake has been linked to the global rise in diabetes. However, the unique diabetogenic effect of sugar, independent of weight gain, remains controversial. This study aimed to investigate the associations between total and added sugar intake and diabetes status, and to test whether the sugar-diabetes associations were moderated or mediated by the body mass index (BMI). We performed a nationwide cross-sectional study on 12,889 Chinese adults who were enrolled in the China Health and Nutrition Survey (CHNS) 2011. The data for the total and added sugar intake were measured using three consecutive 24 h recalls, and determined based on the U.S. Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 28 (SR28), the Food Patterns Equivalents Database (FPED) 2015-2016, and the labeled ingredients and nutrient contents. A multivariable logistic regression model was used to analyze the associations between the total and added sugar intake and diabetes. A nutrient density model was used to adjust for the total energy intake. A mediation analysis for significant sugar-diabetes associations shown in multivariable logistic analysis (p < 0.05), and a subgroup analysis according to the BMI category were performed, to examine the mediating and moderating effects of the BMI on the sugar-diabetes association, respectively. We included 12,800 individuals, with a mean age of 50.5, in the final analysis. The means of the total and added sugar intake, total sugar (%E), and added sugar (%E) were 28.2 ± 0.2 g/d, 5.0 ± 0.1 g/d, 6.0 ± 0.0%, and 1.0 ± 0.0%, respectively. The overall prevalence of self-reported physician-diagnosed diabetes was 4.0%. A significant association between the total sugar intake and an increased risk of diabetes was found (odds ratio [OR] =1.008, 95% CI 1.001-1.016). The mediation analysis showed a significant mediation effect through the BMI of the effect of the total sugar on diabetes status (p < 0.001), where 11.7% (95% CI: 4.7-35.7%) of the effect of the total sugar on diabetes was mediated through the BMI. The total sugar intake had a significant direct effect on diabetes around the BMI (estimated coefficient = 0.0004, p < 0.001). The overall total-sugar-intake-diabetes association remained significant in normal-weight participants in the subgroup analysis (OR =1.012, 1.000-1.024). In conclusion, although the BMI moderated and mediated the association between the total sugar intake and diabetes, the total sugar still showed some unique weight-independent diabetogenic effects. Our findings call for efforts to prevent and control diabetes by reducing sugar intake, and losing weight appropriately.
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Affiliation(s)
- Yan Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Division of Oral Epidemiology & Dental Public Health, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Jing Cheng
- Division of Oral Epidemiology & Dental Public Health, University of California at San Francisco, San Francisco, CA 94143, USA
| | | | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Fish-Williamson A, Hahn-Holbrook J. Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Front Psychiatry 2023; 14:1193490. [PMID: 37398595 PMCID: PMC10311512 DOI: 10.3389/fpsyt.2023.1193490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression. Methods To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables. Results 412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242). Conclusion The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.
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Della Corte K, Jalo E, Kaartinen NE, Simpson L, Taylor MA, Muirhead R, Raben A, Macdonald IA, Fogelholm M, Brand-Miller J. Longitudinal Associations of Dietary Sugars and Glycaemic Index with Indices of Glucose Metabolism and Body Fatness during 3-Year Weight Loss Maintenance: A PREVIEW Sub-Study. Nutrients 2023; 15:2083. [PMID: 37432216 DOI: 10.3390/nu15092083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Dietary sugars are often linked to the development of overweight and type 2 diabetes (T2D) but inconsistencies remain. OBJECTIVE We investigated associations of added, free, and total sugars, and glycaemic index (GI) with indices of glucose metabolism (IGM) and indices of body fatness (IBF) during a 3-year weight loss maintenance intervention. DESIGN The PREVIEW (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World) study was a randomised controlled trial designed to test the effects of four diet and physical activity interventions, after an 8-week weight-loss period, on the incidence of T2D. This secondary observational analysis included pooled data assessed at baseline (8), 26, 52, 104 and 156 weeks from 514 participants with overweight/obesity (age 25-70 year; BMI ≥ 25 kg⋅m-2) and with/without prediabetes in centres that provided data on added sugars (Sydney and Helsinki) or free sugars (Nottingham). Linear mixed models with repeated measures were applied for IBF (total body fat, BMI, waist circumference) and for IGM (fasting insulin, HbA1c, fasting glucose, C-peptide). Model A was adjusted for age and intervention centre and Model B additionally adjusted for energy, protein, fibre, and saturated fat. RESULTS Total sugars were inversely associated with fasting insulin and C-peptide in all centres, and free sugars were inversely associated with fasting glucose and HbA1c (Model B: all p < 0.05). Positive associations were observed between GI and IGM (Model B: fasting insulin, HbA1c, and C-peptide: (all p < 0.01), but not for added sugars. Added sugar was positively associated with body fat percentage and BMI, and GI was associated with waist circumference (Model B: all p < 0.01), while free sugars showed no associations (Model B: p > 0.05). CONCLUSIONS Our findings suggest that added sugars and GI were independently associated with 3-y weight regain, but only GI was associated with 3-y changes in glucose metabolism in individuals at high risk of T2D.
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Affiliation(s)
- Karen Della Corte
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Liz Simpson
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham NG7 2RD, UK
| | - Moira A Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham NG7 2RD, UK
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Ian A Macdonald
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
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12
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Affiliation(s)
- Carlos A Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Geoffrey Cannon
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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13
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Samuel L, Odoom-Darko E, del Rosario SJ, Blake C. Nutritional quality of snacks and beverages sold through vending machines in a large Hispanic-serving urban college campus in the United States: A cross-sectional study. J Public Health Res 2023; 12:22799036231170842. [PMID: 37152114 PMCID: PMC10161316 DOI: 10.1177/22799036231170842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/01/2023] [Indexed: 05/09/2023] Open
Abstract
Students from nutritionally-vulnerable neighborhoods face dietary challenges through built environment of college vending machines. In this cross-sectional study, snacks and beverages sold in vending machines for a 4-week period in a Bronx-based Hispanic-serving college were recorded. Nutritional information was recorded from nutrition labels. Proportion of low- and high-sodium foods, "smart snacks" with a limit of 200 kcal and 200 mg of sodium, and foods with added sugar were recorded. Snacks had significantly higher calories and sodium per serving (227 kcal, 208 mg) than beverages (132 kcal, 90 mg) (t-test, p < 0.001). Almost a third of the snacks (32%) qualified as "smart snacks" for calories and 62% qualified as "smart snacks" for sodium. Beverages contained less than half the number of ingredients as snacks. About 53% of beverages and almost 60% of snacks listed sugar among the first five ingredients. Results underscore the need for colleges to promote less-processed entities with less added sugar.
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Affiliation(s)
- Lalitha Samuel
- Lalitha Samuel, Department of Health Promotion and Nutrition Sciences, Lehman College, The City University of New York, Bronx, NY 10468, USA.
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14
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Daniel-Weiner R, Cardel MI, Skarlinski M, Goscilo A, Anderson C, Foster GD. Enabling Informed Decision Making in the Absence of Detailed Nutrition Labels: A Model to Estimate the Added Sugar Content of Foods. Nutrients 2023; 15:nu15040803. [PMID: 36839162 PMCID: PMC9961734 DOI: 10.3390/nu15040803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world's population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.
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Affiliation(s)
- Reka Daniel-Weiner
- WW International, Inc., New York, NY 10100, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | - Michelle I. Cardel
- WW International, Inc., New York, NY 10100, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL 32611, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | | | | | | | - Gary D. Foster
- WW International, Inc., New York, NY 10100, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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15
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Willis SK, Wise LA, Laursen ASD, Wesselink AK, Mikkelsen EM, Tucker KL, Rothman KJ, Hatch EE. Glycemic Load, Dietary Fiber, Added Sugar, and Spontaneous Abortion in Two Preconception Cohorts. J Nutr 2023; 152:2818-2826. [PMID: 36057842 PMCID: PMC9839996 DOI: 10.1093/jn/nxac202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spontaneous abortion (SAB)-pregnancy loss before the 20th week of gestation-has adverse psychological and physical sequelae. Some medical conditions known to affect insulin sensitivity, including polycystic ovary syndrome and diabetes, can affect the risk of SAB. No prior studies have examined glycemic load and incidence of SAB in populations without conditions known to affect insulin sensitivity. OBJECTIVES We prospectively evaluated the association between preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar and risk of SAB. METHODS During 2013-2020, we recruited pregnancy planners from Denmark (SnartForaeldre.dk; SF) and the United States and Canada (Pregnancy Study Online; PRESTO). Participants completed a baseline questionnaire and a cohort-specific FFQ evaluated for validity. We estimated preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar from individual foods and mixed recipes. We included 2238 SF and 4246 PRESTO participants who reported a pregnancy during the course of the study. SAB data were derived from questionnaires and population registries. We used Cox proportional hazards regression to estimate HRs and 95% CIs. RESULTS In the study population, 15% of SF participants and 22% of PRESTO participants experienced SAB. Across both cohorts, there was no appreciable association between glycemic load, carbohydrate quality, dietary fiber, or added sugar intake and SAB. Compared with daily mean glycemic load <110, the HR for women with daily mean glycemic load ≥130 was 0.76 (95% CI: 0.52, 1.10) in SF and 1.01 (95% CI: 0.86, 1.19) in PRESTO. CONCLUSIONS Diets with high glycemic load, carbohydrates, and added sugars were not consistently associated with risk of SAB in parallel analyses of 2 preconception cohort studies of women in North America and Denmark.
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Affiliation(s)
- Sydney K Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- RTI International, Research Triangle Park, NC, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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16
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Al-Jawaldeh A, Taktouk M, Naalbandian S, Aguenaou H, Al Hamad N, Almamary S, Al-Tamimi HA, Alyafei SA, Barham R, Hoteit M, Hussain M, Massad H, Nasreddine L. Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15. [PMID: 36615712 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
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17
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Tsai MC, Lee YL, Chen YC. Association of the consumption of common drinks with early puberty in both sexes. Front Public Health 2022; 10:854477. [PMID: 36536777 PMCID: PMC9758723 DOI: 10.3389/fpubh.2022.854477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background We examined the effect of sugar-sweetened beverages (SSB) and common drink intake on pubertal development in both sexes. Methods Data were retrieved from Taiwan Children Health Study, which involved detailed pubertal stage assessments of 2,819 schoolchildren aged 11 years in 2011-2012. Drawings of secondary sexual characteristics and self-reported age at menarche or voice breaking were used to assess pubertal stages. Dietary intake was assessed using a detailed semi-quantitative food frequency questionnaire. Generalized estimating equation modeling was applied to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to represent the effects of each drink on early pubertal development outcomes. Results In boys, an one cup/day increment of a SSB was associated with earlier voice breaking (β = -0.12; 95% CI = -0.20, -0.04), whereas consuming yogurt (≥2 cups/day) was a protective factor against early puberty (OR = 0.78; 95% CI = 0.73, 0.83). In girls, SSB consumption was associated with increased risk of early puberty in a dose-response manner, and a similar protective effect of yogurt consumption and fermented probiotic drink (≥2 cups/day) against early puberty was observed (OR = 0.96; 95% CI = 0.94, 0.99). Furthermore, the intake of both total sugar and added sugar within SSBs increased risk of early puberty in girls but not in boys. Conclusions Sugar-sweetened beverages were associated with early puberty, and probiotic drinks appeared to mitigate this link. These findings indicate that the gut-brain axis could play a crucial role in sexual maturation.
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Affiliation(s)
- Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yungling Leo Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan,College of Public Health, China Medical University, Taichung, Taiwan,Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan,Yungling Leo Lee
| | - Yang Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan,*Correspondence: Yang Ching Chen
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18
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Liu Y, Cheng J, Wan L, Chen W. Total and Added Sugar Intakes Are Increasing among Children and Adolescents in China: Findings from CHNS 1997-2011. Nutrients 2022; 14. [PMID: 36014849 DOI: 10.3390/nu14163340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023] Open
Abstract
A high level of sugar intake has been linked to poor dietary quality and a wide range of chronic diseases. However, data on sugar intake are still scarce in China. This study aimed to provide time trends in the total and added sugar intakes among Chinese children and adolescents from 1997 to 2011. A nationwide ongoing open prospective cohort study of Chinese children and adolescents aged 3−17 years (n = 13,212) was conducted by using data from the China Health and Nutrition Survey (CHNS) 1997−2011 (six 1-year cycles). An individual dietary intake was collected from three consecutive 24-h recalls during randomly allocated home visits. Data for total and added sugar contents were determined based on the U.S. Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 28 (SR28), the Food Patterns Equivalents Database (FPED) 2015−2016, and the labeled ingredients and nutrient contents. General linear regression was used to estimate time trends. Over the 15-year period, total sugar and added sugar intakes increased among all age groups studied (3−17 years: total sugar increased from 11.2 ± 0.3 g/d to 28.1 ± 0.5 g/d, added sugar increased from 1.0 ± 0.1 g/d to 7.2 ± 0.3 g/d; 3−6 years: 9.5 ± 0.6 g/d to 25.1 ± 0.9 g/d, 1.3 ± 0.2 g/d to 6.9 ± 0.4 g/d; 7−12 years: 11.4 ± 0.5 g/d to 28.1 ± 0.8 g/d, 0.9 ± 0.1 g/d to 7.1 ± 0.5 g/d; 13−17 years: 11.8 ± 0.4 g/d to 31.4 ± 1.1 g/d, 1.0 ± 0.2 g/d to 7.6 ± 0.6 g/d) (all p for trend < 0.001). Adolescents aged 13−17 years had the highest total sugar intake, and children aged 3−6 years had the highest added sugar intake, except for 2011. Children and adolescents living in urban areas and who were overweight had much higher total and added sugar intakes than those residing in rural areas and of non-overweight/obesity. Furthermore, the dietary sources of total and added sugars have become more diverse over the study period. In conclusion, we observed a notable rise in total and added sugar intakes among children and adolescents across all age groups, both genders, both urban and rural areas, and all BMI categories, with dietary sources of total and added sugars becoming more diverse in China over 15 years.
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Cohen CC, Dabelea D, Michelotti G, Tang L, Shankar K, Goran MI, Perng W. Metabolome Alterations Linking Sugar-Sweetened Beverage Intake with Dyslipidemia in Youth: The Exploring Perinatal Outcomes among CHildren (EPOCH) Study. Metabolites 2022; 12:metabo12060559. [PMID: 35736491 PMCID: PMC9228193 DOI: 10.3390/metabo12060559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to assess intermediary metabolic alterations that link sugar-sweetened beverage (SSB) intake to cardiometabolic (CM) risk factors in youth. A total of 597 participants from the multi-ethnic, longitudinal Exploring Perinatal Outcomes among CHildren (EPOCH) Study were followed in childhood (median 10 yrs) and adolescence (median 16 yrs). We used a multi-step approach: first, mixed models were used to examine the associations of SSB intake in childhood with CM measures across childhood and adolescence, which revealed a positive association between SSB intake and fasting triglycerides (β (95% CI) for the highest vs. lowest SSB quartile: 8.1 (−0.9,17.0); p-trend = 0.057). Second, least absolute shrinkage and selection operator (LASSO) regression was used to select 180 metabolite features (out of 767 features assessed by untargeted metabolomics) that were associated with SSB intake in childhood. Finally, 13 of these SSB-associated metabolites (from step two) were also prospectively associated with triglycerides across follow-up (from step one) in the same direction as with SSB intake (Bonferroni-adj. p < 0.0003). All annotated compounds were lipids, particularly dicarboxylated fatty acids, mono- and diacylglycerols, and phospholipids. In this diverse cohort, we identified a panel of lipid metabolites that may serve as intermediary biomarkers, linking SSB intake to dyslipidemia risk in youth.
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Affiliation(s)
- Catherine C. Cohen
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.S.)
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA;
- Correspondence:
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.S.)
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA;
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Lu Tang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Kartik Shankar
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.S.)
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Michael I. Goran
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA;
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA;
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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20
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Yuan C, Joh HK, Wang QL, Zhang Y, Smith-Warner SA, Wang M, Song M, Cao Y, Zhang X, Zoltick ES, Hur J, Chan AT, Meyerhardt JA, Ogino S, Ng K, Giovannucci EL, Wu K. Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite. Am J Clin Nutr 2022; 115:1481-1489. [PMID: 35470384 PMCID: PMC9170474 DOI: 10.1093/ajcn/nqac040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Recent preclinical research strongly suggests that dietary sugars can enhance colorectal tumorigenesis by direct action, particularly in the proximal colon that unabsorbed fructose reaches. OBJECTIVES We aimed to examine long-term consumption of sugar-sweetened beverages (SSBs) and total fructose in relation to incidence and mortality of colorectal cancer (CRC) by anatomic subsite. METHODS We followed 121,111 participants from 2 prospective US cohort studies, the Nurses' Health Study (1984-2014) and Health Professionals Follow-Up Study (1986-2014), for incident CRC and related death. Cox proportional hazards regression was used to compute HRs and 95% CIs. RESULTS During follow-up, we documented 2733 incident cases of CRC with a known anatomic location, of whom 901 died from CRC. Positive associations of SSB and total fructose intakes with cancer incidence and mortality were observed in the proximal colon but not in the distal colon or rectum (Pheterogeneity ≤ 0.03). SSB consumption was associated with a statistically significant increase in the incidence of proximal colon cancer (HR per 1-serving/d increment: 1.18; 95% CI: 1.03, 1.34; Ptrend = 0.02) and a more pronounced elevation in the mortality of proximal colon cancer (HR: 1.39; 95% CI: 1.13, 1.72; Ptrend = 0.002). Similarly, total fructose intake was associated with increased incidence and mortality of proximal colon cancer (HRs per 25-g/d increment: 1.18; 95% CI: 1.03, 1.35; and 1.42; 95% CI: 1.12, 1.79, respectively). Moreover, SSB and total fructose intakes during the most recent 10 y, rather than those from a more distant period, were associated with increased incidence of proximal colon cancer. CONCLUSIONS SSB and total fructose consumption were associated with increased incidence and mortality of proximal colon cancer, particularly during later stages of tumorigenesis.
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Affiliation(s)
- Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Hee-Kyung Joh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Qiao-Li Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Yin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie A Smith-Warner
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Xuehong Zhang
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emilie S Zoltick
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Jinhee Hur
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Food Science and Biotechnology, Sungkyunkwan University, Suwon, Republic of Korea
| | - Andrew T Chan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shuji Ogino
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kana Wu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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21
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Li P, Ren Z, Zhang J, Lan H, Szeto IMY, Wang P, Zhao A, Zhang Y. Consumption of Added Sugar among Chinese Toddlers and Its Association with Picky Eating and Daily Screen Time. Nutrients 2022; 14:nu14091840. [PMID: 35565808 PMCID: PMC9102033 DOI: 10.3390/nu14091840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study aimed to examine the relationship between daily screen time, picky eating, and consumption frequency of sugared foods and sugar-sweetened beverages (SSBs). Methods: The research data came from the Young Investigation (YI) study conducted in 10 cities in China. This study used sociodemographic information, feeding behavior, picky eating reported by parents, and the consumption frequency of sugared foods and SSBs of 879 toddlers aged 1−3 years. The relationship between daily screen time and picky eating behavior was assessed using logistic regression. The zero-inflated negative binomial (ZINB) model was used to fit the consumption frequencies of sugared foods and SSBs. Results: In all, 13.1% (n = 115) of toddlers did not have sugared foods 1 month before the survey, while 73.3% (n = 644) of toddlers did not have SSBs 1 month before the survey. The consumption rate of sugared foods was relatively higher than SSBs (χ2 = 661.25, p < 0.001). After adjusting for social demographic information, no relationship was found between daily screen time and picky eating (OR = 1.437; 95% CI: 0.990,2.092). The ZINB model showed that, among children who ate sugared foods, children who were picky eaters ate them more often (IRR = 1.133; 95% CI: 1.095,1.172), but no association was found between picky eating and the chance of avoiding sugared foods (OR = 0.949; 95% CI: 0.613,1.471). Children who were picky eaters were less likely not to drink SSBs (OR = 0.664; 95% CI: 0.478,0.921). However, among children who consumed SSBs, picky eaters drank them less frequently (IRR = 0.599; 95% CI: 0.552,0.650). Children with a screen time of no less than 1 h/d ate sugared foods more frequently (IRR = 1.383; 95% CI: 1.164,1.644), and they were less likely to avoid sugared foods (OR = 0.223; 95% CI: 0.085,0.587). The longer the screen time per day was, the less likely children did not have SSBs (<1 h/d: OR = 0.272; 95% CI: 0.130, 0.569; ≥1 h/d: OR = 0.136; 95% CI: 0.057, 0.328). Conclusions: The consumption rate of sugared foods was higher than that of SSBs. Picky eating and daily screen time were related to the consumption frequency of added sugar among Chinese toddlers aged 1−3 years. Picky eaters consumed sugared foods more frequently and were more likely to drink SSBs. Children whose daily screen time reached 1 h/d were more likely to eat sugared foods and drink SSBs.
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Affiliation(s)
- Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (P.L.); (Z.R.); (J.Z.)
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (P.L.); (Z.R.); (J.Z.)
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (P.L.); (Z.R.); (J.Z.)
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China; (H.L.); (I.M.-Y.S.)
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China; (H.L.); (I.M.-Y.S.)
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Peiyu Wang
- Department of Social Science and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China;
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
- Correspondence: (A.Z.); (Y.Z.)
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (P.L.); (Z.R.); (J.Z.)
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100022, China
- Correspondence: (A.Z.); (Y.Z.)
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22
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Redruello-Requejo M, Samaniego-Vaesken ML, Partearroyo T, Rodríguez-Alonso P, Soto-Méndez MJ, Hernández-Ruiz Á, Villoslada FL, Leis R, Martínez de Victoria E, Moreno JM, Ortega RM, Ruiz-López MD, Gil Á, Varela-Moreiras G. Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study. Nutrients 2022; 14. [PMID: 35458229 DOI: 10.3390/nu14081667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.
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23
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Martyn D, Darch M, Floyd S, Ngo K, Fallah S. Low- and no-calorie sweetener intakes in the Brazilian population estimated using added sugar substitution modelling. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2022; 39:215-228. [PMID: 35020577 DOI: 10.1080/19440049.2021.2010812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This research examined the intakes of six low- and no-calorie sweeteners (LNCS) (acesulfame-K, aspartame, cyclamate, saccharin, steviol glycosides, and sucralose) by the Brazilian population using an added sugar substitution approach. Detailed exposure modelling requires the use of proprietary concentration data, which can be difficult to obtain. Two exposure models were conducted using nationally representative food consumption data. The first model ('per person') estimated added sugar intakes on an individual person basis, replacing 50% of added sugar intakes >10% total energy with each LNCS considering sucrose sweetness equivalence. The second model ('per food') replaced 50% of the added sugar content in foods and beverages with each LNCS, incorporating sucrose sweetness equivalence and Brazilian tonnage data. Both models predicted that intakes would be below the JECFA ADI for five of the six LNCS in all population groups examined (≥10 years) for average and heavy consumers. For cyclamate, exceedance of the ADI was determined for all age groups amongst heavy consumers in the 'per person' model, while estimated intakes in the 'per food' model were below or reached the ADI for the cohort. Additional research is needed for younger age groups to confirm whether these findings are applicable to the entire Brazilian population.
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Affiliation(s)
- Danika Martyn
- Food & Nutrition, Intertek Health Sciences Inc., Farnborough, UK
| | - Maryse Darch
- Food & Nutrition, Intertek Health Sciences Inc., Mississauga, ON, Canada
| | - Seth Floyd
- Food & Nutrition, Intertek Health Sciences Inc., Mississauga, ON, Canada
| | - Karen Ngo
- Food & Nutrition, Intertek Health Sciences Inc., Mississauga, ON, Canada
| | - Shafagh Fallah
- Food & Nutrition, Intertek Health Sciences Inc., Mississauga, ON, Canada
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24
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Davies T, Louie JCY, Ndanuko R, Barbieri S, Perez-Concha O, Wu JHY. A Machine Learning Approach to Predict the Added-Sugar Content of Packaged Foods. J Nutr 2022; 152:343-349. [PMID: 34550390 DOI: 10.1093/jn/nxab341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dietary guidelines recommend limiting the intake of added sugars. However, despite the public health importance, most countries have not mandated the labeling of added-sugar content on packaged foods and beverages, making it difficult for consumers to avoid products with added sugar, and limiting the ability of policymakers to identify priority products for intervention. OBJECTIVE The aim was to develop a machine learning approach for the prediction of added-sugar content in packaged products using available nutrient, ingredient, and food category information. METHODS The added-sugar prediction algorithm was developed using k-nearest neighbors (KNN) and packaged food information from the US Label Insight dataset (n = 70,522). A synthetic dataset of Australian packaged products (n = 500) was used to assess validity and generalization. Performance metrics included the coefficient of determination (R2), mean absolute error (MAE), and Spearman rank correlation (ρ). To benchmark the KNN approach, the KNN approach was compared with an existing added-sugar prediction approach that relies on a series of manual steps. RESULTS Compared with the existing added-sugar prediction approach, the KNN approach was similarly apt at explaining variation in added-sugar content (R2 = 0.96 vs. 0.97, respectively) and ranking products from highest to lowest in added-sugar content (ρ = 0.91 vs. 0.93, respectively), while less apt at minimizing absolute deviations between predicted and true values (MAE = 1.68 g vs. 1.26 g per 100 g or 100 mL, respectively). CONCLUSIONS KNN can be used to predict added-sugar content in packaged products with a high degree of validity. Being automated, KNN can easily be applied to large datasets. Such predicted added-sugar levels can be used to monitor the food supply and inform interventions aimed at reducing added-sugar intake.
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Affiliation(s)
- Tazman Davies
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jimmy Chun Yu Louie
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Rhoda Ndanuko
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Oscar Perez-Concha
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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25
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Rawal S, Duffy VB, Berube L, Hayes JE, Kant AK, Li CM, Graubard BI, Hoffman HJ. Self-Reported Olfactory Dysfunction and Diet Quality: Findings from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Nutrients 2021; 13:nu13124561. [PMID: 34960113 PMCID: PMC8704378 DOI: 10.3390/nu13124561] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/20/2023] Open
Abstract
We identified associations between self-reported olfactory dysfunction (OD) and dietary attributes in participants aged ≥40 years (n = 6,356) from the nationally representative 2011–2014 National Health and Nutrition Examination Survey (NHANES). The chemosensory questionnaire and 24-h dietary recalls were administered by trained interviewers. OD was defined as self-report of either smell problems in the last year, worse smell relative to age 25, or perceiving phantom odors. Dietary outcomes included Healthy Eating Index 2015 score (HEI) with adequacy and moderation components (higher scores indicated higher diet quality), dietary diversity, energy density, and intake of major food groups. Survey-weighted linear regression models estimated OD–diet associations, adjusting for socio-demographic, lifestyle, and clinical factors. Adjusted mean difference (95% CI) between those with versus without OD, showed that adults with OD had significantly lower HEI moderation score (−0.67 (−1.22, −0.11)) and diets higher in energy density (0.06 (0.00, 0.11)), and percent energy from saturated fat (0.47 (0.12, 0.81)), total fat (0.96 (0.22, 1.70)), and added sugar (1.00 (0.33, 1.66)). Age and sex-stratified analyses showed that younger females (40–64 years) primarily accounted for the associations with diet quality and total/saturated fat intake. These findings inform dietary screening and recommendations for adults who report OD, including those experiencing transient or persistent smell loss with COVID-19.
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Affiliation(s)
- Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen Str., Newark, NJ 07107-1709, USA
- Correspondence:
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd., Storrs, CT 06269, USA;
| | - Lauren Berube
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - John E. Hayes
- Sensory Evaluation Center, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA;
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA
| | - Ashima K. Kant
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY 11367, USA;
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA; (C.-M.L.); (H.J.H.)
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20894, USA;
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA; (C.-M.L.); (H.J.H.)
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26
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Hafner E, Pravst I. The Sharp Rise in the Use of Low- and No-Calorie Sweeteners in Non-Alcoholic Beverages in Slovenia: An Update Based on 2020 Data. Front Nutr 2021; 8:778178. [PMID: 34869543 PMCID: PMC8640248 DOI: 10.3389/fnut.2021.778178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
Abstract
Reducing added sugars in non-alcoholic beverages is an important public health goal, which can result in increased use of low- and no-calorie sweeteners (LNCS). The aim of this study was to investigate recent changes in the use of LNCS in non-alcoholic beverages in the Slovenian food supply. The national branded foods dataset was updated with beverages available in 2020, and compared with previous datasets. The data were extracted from food labels. In 2020, N = 1,650 unique beverages were found in shops from five different retailers, covering the majority of the national market. The use of LNCS increased from 13.2% in 2017 and 15.5% in 2019 to 20.2% in 2020, with a major growth in soft drinks (16.8, 19.6, and 26.7%, respectively). We observed a significant growth of beverages containing both LNCS and added sugar. Results were also consistent with sales data, which showed that increased offer of beverages with LNCS also resulted in similarly increased sales of such beverages. The average energy and total sugar content in non-alcoholic beverages decreased, which reflects both the higher percentage of beverages with LNCS, and also the reduction of the sugar content in beverages with only added sugar. Analyses of product-specific reformulation practices highlighted reduced sugar content in 16.8% of products, and in 3.6% with the use of LNCS. The most commonly used LNCS are acesulfame K, sucralose, and aspartame. Typically, combinations are used, however steviol glycosides, sucralose and saccharin are also used alone, in most cases combined with added sugar. The results indicated rapid changes in the use of LNCS in non-alcoholic beverages in the Slovenian food supply, making further monitoring of this area highly relevant.
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Affiliation(s)
- Edvina Hafner
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia.,Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia.,Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia.,VIST-Higher School of Applied Sciences, Ljubljana, Slovenia
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27
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Basu D, Nguyen HB. Eating Healthy: Understanding Added Sugar through Proportional Reasoning. Int J Environ Res Public Health 2021; 18:12821. [PMID: 34886547 DOI: 10.3390/ijerph182312821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022]
Abstract
Research suggests that integrated STEM activities can best support students in developing their mathematical and scientific understanding. On one hand, while science provides mathematics with real-life authentic problems to investigate, mathematics provides science powerful tools to explore those problems. In line with this call, in this study, we designed an integrated lesson at the cross-section of proportional reasoning and added sugar present in food products to explore how added sugar provides students with a meaningful context to engage in proportional reasoning and how proportional reasoning helps students identify the quantity of added sugar present in different food products and provides students with a platform to initiate a conversation around quality of food products. Developed on the theoretical framework of Realistic Mathematics Education (RME), this lesson was remotely implemented on three middle school students. The result section highlights the design principle of the lesson that provided students with an opportunity to construct an understanding of both the disciplines through a mutual interaction.
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28
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Janzi S, González-Padilla E, Najafi K, Ramne S, Ahlqvist E, Borné Y, Sonestedt E. Single Nucleotide Polymorphisms in Close Proximity to the Fibroblast Growth Factor 21 (FGF21) Gene Found to Be Associated with Sugar Intake in a Swedish Population. Nutrients 2021; 13:3954. [PMID: 34836209 DOI: 10.3390/nu13113954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Hereditary mechanisms are partially responsible for individual differences in sensitivity to and the preference for sweet taste. The primary aim of this study was to examine the associations between 10 genetic variants and the intake of total sugar, added sugar, and sugars with sweet taste (i.e., monosaccharides and sucrose) in a middle-aged Swedish population. Two single nucleotide polymorphisms (SNPs) within the Fibroblast grow factor 21 (FGF21) gene, seven top hits from a genome-wide association study (GWAS) on total sugar intake, and one SNP within the fat mass and obesity associated (FTO) gene (the only SNP reaching GWAS significance in a previous study), were explored in relation to various forms of sugar intake in 22,794 individuals from the Malmö Diet and Cancer Study, a population-based cohort for which data were collected between 1991-1996. Significant associations (p = 6.82 × 10-7 - 1.53 × 10-3) were observed between three SNPs (rs838145, rs838133, and rs8103840) in close relation to the FGF21 gene with high Linkage Disequilibrium, and all the studied sugar intakes. For the rs11642841 within the FTO gene, associations were found exclusively among participants with a body mass index ≥ 25 (p < 5 × 10-3). None of the remaining SNPs studied were associated with sugar intake in our cohort. A further GWAS should be conducted to identify novel genetic variants associated with the intake of sugar.
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29
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Mennella JA, Smethers AD, Decker JE, Delahanty MT, Stallings VA, Trabulsi JC. Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial. Nutrients 2021; 13:nu13113946. [PMID: 34836199 PMCID: PMC8625308 DOI: 10.3390/nu13113946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/22/2022] Open
Abstract
This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.
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Affiliation(s)
- Julie A. Mennella
- Monell Chemical Senses Center, Philadelphia, PA 19104, USA;
- Correspondence:
| | | | - Jessica E. Decker
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE 19173, USA; (J.E.D.); (M.T.D.); (J.C.T.)
| | - Michelle T. Delahanty
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE 19173, USA; (J.E.D.); (M.T.D.); (J.C.T.)
| | | | - Jillian C. Trabulsi
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE 19173, USA; (J.E.D.); (M.T.D.); (J.C.T.)
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30
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Bably MB, Paul R, Laditka SB, Racine EF. Factors Associated with the Initiation of Added Sugar among Low-Income Young Children Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in the US. Nutrients 2021; 13:3888. [PMID: 34836143 DOI: 10.3390/nu13113888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022] Open
Abstract
Added sugar intake at a young age is associated with chronic diseases including cardiovascular diseases, asthma, elevated blood pressure, and overweight. The Dietary Guidelines for Americans 2020–2025 and the American Heart Association recommend delaying the introduction of added sugar until age 2. The aims of this study were to identify the timing of added sugar initiation; factors associated with added sugar initiation; and the top five added sugar foods and beverages consumed by infants and children at three age ranges (<7 months, 8–13 months, and 14–24 months). Data were from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2, a longitudinal, national population of WIC participants enrolled in WIC eligible clinics (n = 3835). The Cox proportional hazards model was used to examine the factors associated with introducing added sugar. About 25% of children were given added sugar at or before 7 months. Contributing factors were caregivers’ race/ethnicity, education, employment, weight status, parity, child sex, and premature birth (all p < 0.05). The top added sugar foods consumed between 1–24 months were cereal, crackers, apple sauce, dessert, yogurt, sweetened beverages, syrup and preserves, and cookies. Further research to examine the impact of early initiation of added sugar on health outcomes and taste preferences is warranted.
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31
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Drewnowski A, Henry CJ, Dwyer JT. Proposed Nutrient Standards for Plant-Based Beverages Intended as Milk Alternatives. Front Nutr 2021; 8:761442. [PMID: 34746213 PMCID: PMC8564006 DOI: 10.3389/fnut.2021.761442] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Plant-based beverages (PBB) that are marketed as alternatives to cow milk are gaining in popularity worldwide. Nutrient quality of PBB can be highly variable. Objective: To develop a set of voluntary or mandatory nutrient standards for the PBB product category in order to assist innovation and guide product development and reformulation. Methods: The present goal was to develop standards for PBB energy content, minimum protein content and quality, maximum content for added fat, sugar, and salt, and to suggest fortification levels for selected vitamins and minerals. The standards were based on dietary recommendations and guidelines and current practices of federal agencies in the US. Results: The proposed energy and nutrient content for PBB milk alternatives are maximum 85-100 kcal energy per 100 g; a minimum for 2.2/100 g of high-quality protein, low content of saturated fat (<0.75/100 g) and added sugar (5.3-6.25/100 g) and consistent fortification with calcium, vitamins A, D, B-2, and B-12 at levels comparable to those found in cow milk (1%). Ideally, the protein content ought to be increased (2.8/100 g) and added sugar content reduced even further (2.7-3.1/100 g) for "best of class" products. These proposed standards were applied to the 641 existing PBB products listed in the 2018 version of the USDA Branded Food Products Database (BFPDB). The standards were met by <5% of the PBB on the US market. Conclusion: Often viewed as equivalent to milk in nutritional value, many PBB are often low in protein and are fortified with varying amounts of calcium, and vitamins A and D. Nutrient standards for this category should be adopted by the food industry, by public health regulatory authorities, and by standardization bodies such as the Codex Alimentarius.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Singapore, Singapore
| | - Johanna T. Dwyer
- Frances Stern Nutrition Center Tufts Medical Center and Jean Mayer USDA Human Nutrition Research Center on Aging, Department of Medicine, School of Medicine and Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
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Berger PK, Monk C, Bansal R, Sawardekar S, Goran MI, Peterson BS. Association of Prenatal Sugar Consumption with Newborn Brain Tissue Organization. Nutrients 2021; 13:2435. [PMID: 34371944 PMCID: PMC8308814 DOI: 10.3390/nu13072435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Animal studies have shown that exposure to excess sugar during the prenatal and postnatal periods may alter early brain structure in rat pups. However, evidence in humans is lacking. The aim of this study was to determine associations of maternal total and added sugar intake in pregnancy with early brain tissue organization in infants. Adolescent mothers (n = 41) were recruited during pregnancy and completed 24 h dietary recalls during the second trimester. Diffusion tensor imaging was performed on infants using a 3.0 Tesla Magnetic Resonance Imaging Scanner at 3 weeks. Maps of fractional anisotropy (FA) and mean diffusivity (MD) were constructed. A multiple linear regression was used to examine voxel-wise associations across the brain. Adjusting for postmenstrual age, sex, birth weight, and total energy intake revealed that maternal total and added sugar consumption were associated inversely and diffusely with infant MD values, not FA values. Inverse associations were distributed throughout all of the cortical mantle, including the posterior periphery (Bs = -6.78 to -0.57, Ps < 0.001) and frontal lobe (Bs = -4.72 to -0.77, Ps ≤ 0.002). Our findings suggest that maternal total and added sugar intake during the second trimester are significantly associated with features of brain tissue organization in infants, the foundation for future functional outcomes.
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Affiliation(s)
- Paige K. Berger
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (R.B.); (S.S.); (B.S.P.)
| | - Catherine Monk
- Departments of Obstetrics and Gynecology and Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA;
| | - Ravi Bansal
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (R.B.); (S.S.); (B.S.P.)
| | - Siddhant Sawardekar
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (R.B.); (S.S.); (B.S.P.)
| | - Michael I. Goran
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (R.B.); (S.S.); (B.S.P.)
| | - Bradley S. Peterson
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (R.B.); (S.S.); (B.S.P.)
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Lopez-Gonzalez D, Avila-Rosano F, Montiel-Ojeda D, Ortiz-Obregon M, Reyes-Delpech P, Diaz-Escobar L, Clark P. Maternal Factors and Their Association with Patterns of Beverage Intake in Mexican Children and Adolescents. Children (Basel) 2021; 8:385. [PMID: 34067968 DOI: 10.3390/children8050385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
Childhood and adolescence represent critical periods where beverage and food consumption behaviors are learned and developed. Mexican mothers' presence and influence are instrumental in shaping such behaviors. The aim of this study was to estimate the prevalence and risk associations of maternal factors for unhealthy patterns of beverage intake. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents from Mexico City. Data of subject's total water intake (TWI) and its' sources were collected using two 24-h recall surveys. Patterns of beverage intake were constructed based on the guidance system of beverage consumption in the US. Maternal factors of interest included age, body mass index (BMI), mother's educational level (MEL), socioeconomic status (SES), and belongingness to the paid workforce (BPW). Data of 1532 subject-mother dyads informed that 47% of subjects did not meet the Institute of Medicine (IOM) recommendations for TWI, and 94.6% showed an unhealthy beverage intake pattern, mainly consisting in a lower intake of water and a higher intake of caloric beverages with some nutrients; and calorically sweetened beverages. The major sources of hydration were caloric beverages with some nutrients (i.e., whole milk, fruit water, and flavored milk). The highest risk association for an unhealthy beverage intake pattern was seen in those subjects with mothers in the cluster with lower SES, lower MEL, lower proportion of BPW, higher BMI, and younger age (OR = 9.3, 95% CI 1.2-72.8, P = 0.03). Thus, there is a remarkably high prevalence of an unhealthy pattern of beverage intake, and specific maternal factors may be implicated as enablers of such behaviors, which is also addressable for future interventions.
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González-Padilla E, Janzi S, Ramne S, Thuneland C, Borné Y, Sonestedt E. Association between Sugar Intake and Intima Media Thickness as a Marker for Atherosclerosis: A Cross-Sectional Study in the Malmö Diet and Cancer Study (Sweden). Nutrients 2021; 13:1555. [PMID: 34063058 DOI: 10.3390/nu13051555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022] Open
Abstract
It has been suggested that sugar intake may play a role in the development of atherosclerosis. However, studies on this matter are lacking. Intima media thickness (IMT) is a well-established measurement of subclinical atherosclerosis. This study aimed to investigate the cross-sectional association between sugar intake (i.e., added, free and total sugar and sugar-rich foods and beverages) and IMT. Our study comprised 5269 individuals (45–73 years, 40% men) of the Malmö Diet and Cancer Study, a population-based cohort conducted in Sweden with data collected from 1991 to 1994. Measurements of IMT were performed with B-mode ultrasound at the right common carotid artery (IMTcca) and the bifurcation of the carotids (IMTbif). Dietary intake was estimated using a combination of a 7-day food record, diet questionnaire and interview. After adjusting for methodological, lifestyle and dietary confounders, no statistically significant associations were observed for any of the sugar intake variables and IMT. For example, added sugar intake presented no significant linear association with IMTcca or IMTbif (Ptrends: IMTcca 0.81 for men and 0.98 for women and IMTbif 0.20 for men and 0.40 for women). In conclusion, we found no clear association between sugar intake and IMT measurements in this study.
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Abstract
Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.
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Affiliation(s)
- Rebekah Schulz
- Graduate student, University of Minnesota, St. Paul, MN, USA
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Russell C, Dickie S, Baker P, Lawrence M. Does the Australian Health Star Rating System Encourage Added Sugar Reformulation? Trends in Sweetener Use in Australia. Nutrients 2021; 13:898. [PMID: 33802024 PMCID: PMC7998813 DOI: 10.3390/nu13030898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
Dietary risk factors, including excess added sugar intake, are leading contributors to Australia's burden of disease. An objective of the Australian Health Star Rating (HSR) system is to encourage the reformulation of packaged foods. Manufacturers may improve a product's HSR by replacing added sugar with non-nutritive sweeteners (NNS). Concerns have been raised regarding the potential substitution effects of ultra-processed foods containing NNS for whole foods, and the long-term impact this may have on population health. The aim of this study was to determine whether the implementation of the HSR system has impacted the use of added sugars and NNS in the food supply. Four product categories were used: products with no added sweetener, products containing added sugar only, products containing NNS only, and products containing a combination of added sugar and NNS. Of 6477 newly released products analyzed displaying a HSR in Australia between 2014-2020, 63% contained added sugars. The proportion of new products sweetened with added sugars increased over time, while NNS use did not, despite a higher average and median HSR for products sweetened with NNS. These findings suggest that at the current time, the HSR system may not discourage the use of added sugars in new products or incentivize the reformulation of added sugar with NNS. As the health risks of NNS are questioned, increased reformulation of products with NNS to reduce the presence of added sugar in the food supply may not address broader health concerns. Instead, supporting the promotion of whole foods and drinks should be prioritized, as well as policy actions that reduce the proliferation and availability of UPFs.
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Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
| | - Sarah Dickie
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
| | - Phillip Baker
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3217, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3217, Australia
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Maj M, Harbottle B, Thomas PA, Hernandez GV, Smith VA, Edwards MS, Fanter RK, Glanz HS, Immoos C, Burrin DG, Santiago-Rodriguez TM, La Frano MR, Manjarín R. Consumption of High-Fructose Corn Syrup Compared with Sucrose Promotes Adiposity and Increased Triglyceridemia but Comparable NAFLD Severity in Juvenile Iberian Pigs. J Nutr 2021; 151:1139-1149. [PMID: 33693900 PMCID: PMC8112773 DOI: 10.1093/jn/nxaa441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fructose consumption has been linked to nonalcoholic fatty liver disease (NAFLD) in children. However, the effect of high-fructose corn syrup (HFCS) compared with sucrose in pediatric NAFLD has not been investigated. OBJECTIVES We tested whether the isocaloric substitution of dietary sucrose by HFCS would increase the severity of NAFLD in juvenile pigs, and whether this effect would be associated with changes in gut histology, SCFA production, and microbial diversity. METHODS Iberian pigs, 53-d-old and pair-housed in pens balanced for weight and sex, were randomly assigned to receive a mash diet top-dressed with increasing amounts of sucrose (SUC; n = 3 pens; 281.6-486.8 g/kg diet) or HFCS (n = 4; 444.3-724.8 g/kg diet) during 16 wk. Diets exceeded the animal's energy requirements by providing sugars in excess, but met the requirements for all other nutrients. Animals were killed at 165 d of age after blood sampling, and liver, muscle, and gut were collected for histology, metabolome, and microbiome analyses. Data were analyzed by multivariate and univariate statistics. RESULTS Compared with SUC, HFCS increased subcutaneous fat, triacylglycerides in plasma, and butyrate in colon (P ≤ 0.05). In addition, HFCS decreased UMP and short-chain acyl carnitines in liver, and urea nitrogen and creatinine in serum (P ≤ 0.05). Microbiome analysis showed a 24.8% average dissimilarity between HFCS and SUC associated with changes in SCFA-producing bacteria. Body weight gain, intramuscular fat, histological and serum markers of liver injury, and circulating hormones, glucose, and proinflammatory cytokines did not differ between diets. CONCLUSIONS Fructose consumption derived from HFCS promoted butyrate synthesis, triglyceridemia, and subcutaneous lipid deposition in juvenile Iberian pigs, but did not increase serum and histological markers of NAFLD compared with a sucrose-enriched diet. Longer studies could be needed to observe differences in liver injury among sugar types.
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Affiliation(s)
- Magdalena Maj
- Biological Sciences Department, California Polytechnic State University, San Luis Obispo, CA, USA,Center for Applications in Biotechnology, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Brooke Harbottle
- Animal Science Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Payton A Thomas
- Animal Science Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Gabriella V Hernandez
- Animal Science Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Victoria A Smith
- Animal Science Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Mark S Edwards
- Animal Science Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Rob K Fanter
- College of Agriculture, Food and Environmental Sciences, California Polytechnic State University, San Luis Obispo, CA, USA,Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Hunter S Glanz
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Chad Immoos
- Chemistry and Biochemistry Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Douglas G Burrin
- United States Department of Agriculture-Agricultural Research Services, Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Michael R La Frano
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA,Food Science and Nutrition Department, California Polytechnic State University, San Luis Obispo, CA, USA
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Hafner E, Hribar M, Hristov H, Kušar A, Žmitek K, Roe M, Pravst I. Trends in the Use of Low and No-Calorie Sweeteners in Non-Alcoholic Beverages in Slovenia. Foods 2021; 10:387. [PMID: 33578908 DOI: 10.3390/foods10020387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Excessive sugar intake and the associated increased obesity risk indicate that food reformulation is needed. Non-alcoholic beverages are often high in free sugars, making reformulation with low and no-calorie sweeteners (LNCS) a common choice. Our knowledge of the use of LNCS in the European food supply is, however, very limited. This study aimed to evaluate the trends in the use of LNCS in different non-alcoholic beverages in the Slovenian food supply over the course of two years. We assessed which LNCS are most used and how the use of LNCS affects energy and sugar content. We analyzed labeling information of non-alcoholic beverages in selected grocery stores, covering the majority of the Slovenian food supply. Selected grocery stores were located in the capital city (Ljubljana). LNCS were present in 13.2% and 15.5% of non-alcoholic beverages in the years 2017 and 2019, respectively. The use of LNCS has significantly increased only in energy drinks (p < 0.01). The most used LNCS in 2017 were acesulfame K, aspartame, and cyclamates. In 2019 the use of sucralose increased significantly (p < 0.01) to become the second most used LNCS. Energy and sugar content varied between subcategories, which depended on the presence of added sugar and LNCS. Comparison between the energy value and the presence of the LNCS showed an almost 50% lower energy content of beverages containing both added sugar and LNCS (E2017 = 92.8 kJ; E2019 = 96.2 kJ per 100 mL), compared with beverages with only added sugar (E2017 = 161.8 kJ; E2019 = 159.0 kJ per 100 mL). In beverages sweetened only with LNCS, the difference was even more noticeable (E2017 = 22.3 kJ; E2019 = 14.3 kJ per 100 mL). Results show that the use of LNCS can help producers reduce the energy value of non-alcoholic beverages. Still, compared to other countries, the offer of such products in the Slovenian food supply is relatively low. However, due to possible public health risks of excessive use of LNCS, producers should be further encouraged for reformulation and production of less sweet products without LNCS, enabling consumers to adapt to less sweet taste of beverages. Further monitoring of LNCS in the food supply is therefore recommended, preferably also with consideration of sales data.
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Bencze Z, Mahrouseh N, Andrade CAS, Kovács N, Varga O. The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study. Nutrients 2021; 13:455. [PMID: 33573027 DOI: 10.3390/nu13020455] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.
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Trumpff C, Sturm G, Picard M, Foss S, Lee S, Feng T, Cardenas A, McCormack C, Champagne FA, Monk C. Added sugar intake during pregnancy: Fetal behavior, birth outcomes, and placental DNA methylation. Dev Psychobiol 2021; 63:878-889. [PMID: 33415750 DOI: 10.1002/dev.22088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/23/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
Pregnancy is a critical time for the effects of environmental factors on children's development. The effect of added sugar intake on fetal development and pregnancy outcomes remains understudied despite increasing dietary intake in the United States. This study investigated the effect of added sugar on fetal programming by examining the association between maternal added sugar consumption, fetal movement, birth outcomes, and placental DNA methylation. Further, primary human fibroblasts were cultured under normal or high glucose conditions to assess the effect of high glucose exposure on cells' DNA methylation. We found that higher added sugar intake across pregnancy was associated with reduced 3rd-trimester fetal movement (p < .05) and shorter gestation (p < .01). Our sample size was not powered to detect the alteration of individual placental CpG with genome-wide significance. However, a secondary analysis suggested that added sugar consumption was associated with differential methylation of functionally related gene families across pregnancy. Consistent with this, high glucose exposure in primary cultured human fibroblasts altered the methylation of 17% of all CpGs, providing converging evidence for an effect of sugar on DNA methylation. Our results suggest that diets high in added sugar during pregnancy may have implications for offspring health via prenatal programming effects measurable before birth.
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Affiliation(s)
- Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sturm
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA
| | - Sophie Foss
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA.,Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Tianshu Feng
- Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Andrès Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Clare McCormack
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frances A Champagne
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Catherine Monk
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
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Probst YC, Charlton KE, Davison SJ, Louie JCY. Trends in food sources of added sugar in Australian eating patterns between 1995 and 2012 using national consumption survey data. J Hum Nutr Diet 2020; 34:286-299. [PMID: 33085990 DOI: 10.1111/jhn.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND When aiming to develop dietary messaging to achieve reductions in added sugar intakes, it is necessary to identify key food contributors. Food contributors are not expected to remain static over time. Therefore, the present study aimed to compare the total added sugars (AS) intake and related food sources for adult respondents of two Australian national consumption surveys. METHODS Repeated 24-h recall data from the 1995 National Nutrition Survey (1995NNS, n = 10 851) and the 2011-12 National Nutrition and Physical Activity Survey (2012NNPAS, n = 9341) was used to estimate AS consumption. Food group sources of AS were examined per consumer and per capita and the food group predictors of energy provided by AS were determined. RESULTS A significant difference in total AS intake was identified by age and gender between the surveys (all P < 0.001). Increased variability in food group contributions per consumer was also identified. Nine of the top 20 food groups from the 1995NNS differed (P < 0.001) in their contribution to AS in 2012NNPAS per consumer. Fewer changes were apparent at the population level, with >40% AS coming from only three food groups. Age-stratified analyses showed that the 'sugar, honeys and syrups' and the 'sweetened beverages' food groups were the top contributors between the surveys up to the age group of 70 years. 'Sugar, honey and syrups', 'chocolate and chocolate-based confectionery,' and 'other confectionery' (all, P < 0.001) were significant predictors of AS intake (1995NNS, r2 = 0.755; 2012NNPAS r2 = 0.740). CONCLUSIONS At a population level, food group contributions to AS intakes for Australian adults have not changed substantially over time, yet notable shifts in AS can be seen when targeting only the consumers of these food sources. 'Cake type desserts' appear to be increasingly consumed though 'sweetened beverages' remain a major contributor to AS intakes warranting targeted public health strategies.
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Affiliation(s)
- Y C Probst
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - K E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - S J Davison
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - J C Y Louie
- School of Biological Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
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Ramne S, Drake I, Ericson U, Nilsson J, Orho-Melander M, Engström G, Sonestedt E. Identification of Inflammatory and Disease-Associated Plasma Proteins that Associate with Intake of Added Sugar and Sugar-Sweetened Beverages and Their Role in Type 2 Diabetes Risk. Nutrients 2020; 12:E3129. [PMID: 33066363 PMCID: PMC7602152 DOI: 10.3390/nu12103129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023] Open
Abstract
It has been suggested that high intake of added sugar and sugar-sweetened beverages (SSBs) increase the level of circulating inflammatory proteins and that chronic inflammation plays a role in type 2 diabetes (T2D) development. We aim to examine how added sugar and SSB intake associate with 136 measured plasma proteins and C-reactive protein (CRP) in the Malmö Diet and Cancer-Cardiovascular Cohort (n = 4382), and examine if the identified added sugar- and SSB-associated proteins associate with T2D incidence. A two-step iterative resampling approach was used to internally replicate proteins that associated with added sugar and SSB intake. Nine proteins were identified to associate with added sugar intake, of which only two associated with T2D incidence (p < 0.00045). Seven proteins were identified to associate with SSB intake, of which six associated strongly with T2D incidence (p < 6.9 × 10-8). No significant associations were observed between added sugar and SSB intake and CRP concentrations. In summary, our elucidation of the relationship between plasma proteome and added sugar and SSB intake, in relation to future T2D risk, demonstrated that SSB intake, rather than the total intake of added sugar, was related to a T2D-pathological proteomic signature. However, external replication is needed to verify the findings.
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Affiliation(s)
- Stina Ramne
- Department of Clinical Sciences Malmö, Lund University, 214 28 Malmö, Sweden; (I.D.); (U.E.); (J.N.); (M.O.-M.); (G.E.); (E.S.)
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Taillie LS, Hall MG, Gómez LF, Higgins I, Bercholz M, Murukutla N, Mora-Plazas M. Designing an Effective Front-of-Package Warning Label for Food and Drinks High in Added Sugar, Sodium, or Saturated Fat in Colombia: An Online Experiment. Nutrients 2020; 12:E3124. [PMID: 33066130 DOI: 10.3390/nu12103124] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022] Open
Abstract
Policies to require warnings on the front of food and drinks high in nutrients of concern (e.g., added sugar, sodium, or saturated fat) are becoming increasingly common as an obesity prevention strategy. Colombia, a country with growing prevalence of obesity, is considering implementing a similar policy. The objective of this study was to assess perceptions and reactions to different warning designs. We conducted a randomized experiment in an online panel of adults age > 18y (n = 1997). Participants were randomized to view one of four labels: a control label (barcode), an octagon warning, a circle warning, and a triangle warning. Participants viewed their randomly assigned label on a series of products and answered questions (continuous outcomes ranged from 1–4). Compared to the control, all warnings led to higher perceived message effectiveness (increase in mean from 1.79 in the control to 2.59–2.65 in the warning conditions, p < 0.001), a higher percentage of participants who correctly identified products high in nutrients of concern (from 48% in the control condition to 84–89% in the warning conditions, p < 0.001), and reduced intentions to purchases these products (decrease in mean from 2.59 to 1.99–2.01 in the warning conditions, p < 0.001). Relative to the control, warnings performed similarly across education levels, suggesting this policy would be equitable in Colombia. Looking at differences by warning type, the pattern of results suggested that the octagon warnings performed best. After viewing all label types, 49% of participants selected the octagon warning as the one that most discouraged them from consuming products high in nutrients of concern, while 21% and 27% selected the circle and triangle warning. Colombian policymakers should consider the octagon warning as part of a front-of-package labeling policy to help consumers identify and reduce consumption of foods and drinks high in nutrients of concern.
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Alderete TL, Wild LE, Mierau SM, Bailey MJ, Patterson WB, Berger PK, Jones RB, Plows JF, Goran MI. Added sugar and sugar-sweetened beverages are associated with increased postpartum weight gain and soluble fiber intake is associated with postpartum weight loss in Hispanic women from Southern California. Am J Clin Nutr 2020; 112:519-526. [PMID: 32597935 PMCID: PMC7458774 DOI: 10.1093/ajcn/nqaa156] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity prevalence remains high in the United States, and there is an increased risk among women who do not lose their gestational weight gain during the postpartum period. Indicators of dietary carbohydrate quality including added sugar consumption, glycemic load, and glycemic index have been linked with weight gain, whereas fiber may protect against obesity. However, these dietary factors have not been examined during the postpartum period. OBJECTIVES The aim of this study was to determine whether dietary sugars and fiber intake were associated with changes in postpartum weight. METHODS We examined Hispanic women from the longitudinal Southern California Mother's Milk Study (n = 99) at 1 and 6 mo postpartum. Maternal assessments included height, weight, and dietary intake based on 24-h diet recalls. We used multivariable linear regression to examine the relation between maternal diet and change in postpartum weight after adjusting for maternal age, height, and energy intake. RESULTS Higher intake of added sugar was associated with postpartum weight gain (β: 0.05; 95% CI: 0.004, 0.10; P = 0.05). In addition, a half 8-ounce (8 fluid ounces = 236.6 mL) serving per day increase in soft drinks was associated with a 1.52-kg increase in weight (95% CI: 0.70, 2.34 kg; P < 0.001). A high glycemic index (β: 0.25; 95% CI: 0.07, 0.42; P = 0.006) and glycemic load (β: 0.04; 95% CI: 0.002, 0.08; P = 0.04) were associated with postpartum weight gain. Higher soluble fiber was associated with a decrease in postpartum weight (β: -0.82 kg; 95% CI: -1.35, -0.29 kg; P = 0.003) and the negative effects of added sugar, sugary beverages, and high-glycemic-index and -load diets were partially attenuated after adjusting for soluble fiber intake. CONCLUSIONS Increased consumption of added sugar, sugar-sweetened beverages, and high-glycemic diets were associated with greater weight gain in the first 6 mo postpartum. In addition, increased consumption of soluble fiber was associated with postpartum weight loss, which may partially offset the obesogenic effects of some dietary sugars.
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Affiliation(s)
- Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Laura E Wild
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Savannah M Mierau
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Maximilian J Bailey
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - William B Patterson
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Paige K Berger
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Roshonda B Jones
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Jasmine F Plows
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
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Yun HY, Tinker LF, Neuhouser ML, Schoeller DA, Mossavar-Rahmani Y, Snetselaar LG, Van Horn LV, Eaton CB, Prentice RL, Lampe JW, O'Brien DM. The Carbon Isotope Ratios of Serum Amino Acids in Combination with Participant Characteristics can be Used to Estimate Added Sugar Intake in a Controlled Feeding Study of US Postmenopausal Women. J Nutr 2020; 150:2764-2771. [PMID: 32712658 PMCID: PMC7549297 DOI: 10.1093/jn/nxaa195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The carbon isotope ratio (CIR) is a proposed biomarker for added sugar (AS) intake in the United States; however, because the CIR is also associated with meat intake in most populations the need for specificity remains. The CIR of amino acids (AAs) has the potential to differentiate sugars from meat intakes, because essential AAs must derive from dietary protein whereas certain nonessential AAs can be synthesized from sugars. OBJECTIVES We tested whether serum CIR-AAs in combination with participant characteristics could meet a prespecified biomarker criterion for AS intake in the Nutrition and Physical Activity Assessment Study Feeding Study (NPAAS-FS) of the Women's Health Initiative, a population in which the whole-serum CIR was not associated with AS intake. METHODS Postmenopausal women (n = 145) from Seattle, WA, were provided with individualized diets that approximated their habitual food intakes for 2 wk. Dietary intakes from consumed foods were characterized over the feeding period using the Nutrition Data System for Research. The CIR of 7 AAs-Ala, Gly, Val, Leu, Ile, Pro, and Phe-were measured in fasting serum collected at the end of the 2-wk feeding period, using gas chromatography-combustion isotope ratio mass spectrometry. Biomarker models were evaluated using regression R2 ≥ 0.36 as a major biomarker criterion, based on the benchmark R2 values of well-established recovery biomarkers in the NPAAS-FS. RESULTS AS intake was associated with CIR-Ala (ρ = 0.32; P < 0.0001). A model of AS intake based on CIR-Ala, CIR-Gly, CIR-Ile, smoking, leisure physical activity, and body weight met the biomarker criterion (R2 = 0.37). Biomarker-estimated AS intake was not associated with meat or animal protein intake. CONCLUSIONS Results support serum CIR-AAs in combination with participant characteristics as potential biomarkers of AS intake in US populations, including those with low AS intake.The Women's Health Initiative is registered at clinicaltrials.gov (NCT00000611).
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Affiliation(s)
- Hee Young Yun
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dale A Schoeller
- Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | | | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Charles B Eaton
- Department of Family Medicine, Alpert Medical School, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Willis SK, Wise LA, Wesselink AK, Rothman KJ, Mikkelsen EM, Tucker KL, Trolle E, Hatch EE. Glycemic load, dietary fiber, and added sugar and fecundability in 2 preconception cohorts. Am J Clin Nutr 2020; 112:27-38. [PMID: 31901163 PMCID: PMC7326597 DOI: 10.1093/ajcn/nqz312] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Glycemic load (GL) reflects the quantity and quality of carbohydrates in the diet; dietary fiber and added sugar are components of GL. Few epidemiologic studies have assessed the association between these dietary factors and fecundability. OBJECTIVE We prospectively evaluated the associations of GL, total carbohydrates, dietary fiber, and added sugar with fecundability. METHODS Snart Foraeldre (SF) and Pregnancy Study Online (PRESTO) are parallel web-based prospective preconception cohorts of couples attempting to conceive in Denmark and North America. At baseline, female participants completed a web-based questionnaire on demographic and lifestyle factors and a validated FFQ. We calculated GL, total carbohydrate intake, total dietary fiber, carbohydrate-to-fiber ratio, and added sugar based on reported frequencies for individual foods, standard recipes for mixed foods, and average serving sizes. The analysis included 2709 SF participants and 4268 PRESTO participants. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% CIs. RESULTS Compared with an average daily GL of ≤100, FRs for an average daily GL of ≥141 were 0.89 (95% CI: 0.73, 1.08) in SF and 0.87 (95% CI: 0.77, 0.98) in PRESTO participants. Compared with consuming ≤16 g/d of dietary fiber, FRs for consuming ≥25 g/d were 0.99 (95% CI: 0.81, 1.22) in SF and 1.06 (95% CI: 0.94, 1.20) in PRESTO. Compared with a carbohydrate-to-fiber ratio of ≤8, FRs for a ratio of ≥13 were 0.86 (95% CI: 0.73, 1.01) in SF and 0.87 (95% CI: 0.78, 0.98) in PRESTO. Compared with ≤27 g/d of added sugar, FRs for ≥72 g/d were 0.87 (95% CI: 0.68, 1.10) in SF and 0.86 (95% CI: 0.75, 0.99) in PRESTO participants. CONCLUSIONS Among women attempting to conceive in Denmark and North America, diets high in GL, carbohydrate-to-fiber ratio, and added sugar were associated with modestly reduced fecundability.
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Affiliation(s)
| | - Lauren A Wise
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Amelia K Wesselink
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Kenneth J Rothman
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA,RTI International, Research Triangle Park, NC, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Katherine L Tucker
- Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Ellen Trolle
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Elizabeth E Hatch
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
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Shrapnel WS, Butcher BE. Sales of Sugar-Sweetened Beverages in Australia: A Trend Analysis from 1997 to 2018. Nutrients 2020; 12:nu12041016. [PMID: 32272711 PMCID: PMC7230225 DOI: 10.3390/nu12041016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023] Open
Abstract
Lowering intake of sugar-sweetened beverages (SSBs) is being advocated as an obesity prevention strategy in Australia. The purpose of this study was to extend on previous reports of trends in national volume sales of SSBs. Data were extracted from commercially available datasets of beverage sales (AC Nielsen (1997–2011) and IRI Australia (2009–2018)). Linear regression was used to examine trends for the period 1997 to 2018. Per capita attribution of volume sales and sugar contribution was estimated by dividing by the Australian resident population for the relevant year. Per capita volume sales of SSBs fell 27%, from 83L/person to 61L/person, largely driven by declining sales of sugar-sweetened carbonated soft drinks (76 to 45L/person). Volume sales of non-SSB increased, from 48 to 88L/person, the largest contributor being pure unflavoured still waters (6 to 48L/person). Volume sales of non-SSBs have exceeded those of SSBs since 2015. The yearly contribution of SSBs to the sugar content of the national diet declined from 9.0 to 6.4kg/person. Major, long-term shifts are occurring in the market for non-alcoholic, water-based beverages in Australia, notably a fall in per capita volume sales of SSBs and an increase in volume sales of water. Both trends are consistent with obesity prevention strategies.
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Affiliation(s)
- William S. Shrapnel
- Shrapnel Nutrition Consulting Pty Ltd., 790 Pinnacle Road, Orange, NSW 2800, Australia
- Correspondence:
| | - Belinda E. Butcher
- WriteSource Medical Pty Ltd., Lane Cove, NSW 2066, Australia;
- School of Medical Science, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
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Thomas DR, Hodges ID. Dietary Research on Coffee: Improving Adjustment for Confounding. Curr Dev Nutr 2020; 4:nzz142. [PMID: 31938763 PMCID: PMC6949275 DOI: 10.1093/cdn/nzz142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022] Open
Abstract
Meta-analyses have reported higher levels of coffee consumption to be associated with lower mortality. In contrast, some systematic reviews have linked coffee consumption to increased risks for lung cancer and hypertension. Given these inconsistencies, this narrative review critically evaluated the methods and analyses of cohort studies investigating coffee and mortality. A specific focus was adjustment for confounding related to smoking, healthy and unhealthy foods, and alcohol. Assessment of 36 cohort samples showed that many did not adequately adjust for smoking. Consuming 1-5 cups of coffee per day was related to lower mortality among never smokers, in studies that adjusted for pack-years of smoking, and in studies adjusting for healthy and unhealthy foods. Possible reduced health benefits for coffee with added sugar have not been adequately investigated. Research on coffee and health should report separate analyses for never smokers, adjust for consumption of healthy and unhealthy foods, and for sugar added to coffee.
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Affiliation(s)
- David R Thomas
- Social and Community Health, University of Auckland, Auckland, New Zealand
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Sneed NM, Patrician PA, Morrison SA. Influences of added sugar consumption in adults with type 2 diabetes risk: A principle-based concept analysis. Nurs Forum 2019; 54:698-706. [PMID: 31612529 DOI: 10.1111/nuf.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to describe the concept added sugar in the context of type 2 diabetes (T2D) risk in adults. BACKGROUND Dietary added sugars are associated with a greater risk for T2D; however, it is unclear if added sugars influence T2D risk directly or if their effects are mediated by excess caloric intake and weight gain. DESIGN A principle-based concept analysis following the PRISMA guidelines was conducted to clarify the concept of added sugar. A systematic search was conducted using PubMed and Embase. Multidisciplinary, empirical evidence was appraised using four guiding principles outlined by the principle-based concept analysis method. RESULTS Thirty-five publications were included in this concept analysis. The concept, added sugar in the context of T2D risk, was found to be epistemologically immature and lacked conceptual clarity. CONCLUSIONS Added sugar is an immature concept warranting further refinement for conceptual advancement. To enhance conceptual clarity, the term "added sugar" should be used consistently in the scientific literature when discussing foods or beverages containing added sugars or caloric sweeteners. A clearer delineation of added sugar and its association with T2D risk in adults is critical to advance this concept within the scientific literature.
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Affiliation(s)
| | - Patricia A Patrician
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shannon A Morrison
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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Mansoori S, Kushner N, Suminski RR, Farquhar WB, Chai SC. Added Sugar Intake is Associated with Blood Pressure in Older Females. Nutrients 2019; 11:E2060. [PMID: 31484293 DOI: 10.3390/nu11092060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 02/08/2023] Open
Abstract
Hypertension or high blood pressure (BP) is highly prevalent in the aging population. Notably, diet and lifestyle have a strong influence on BP. We investigated the association between dietary factors and BP in older adults. This cross-sectional study included 128 participants, aged 65–80 years. Multiple linear regressions were conducted to examine the associations between diet, including meats, vegetables, grains, fruits, dairy, fats, and added sugar, and BP. There was a significant association between intake of added sugar and systolic BP and diastolic BP in females after controlling for age, income, body mass index, physical activity levels, daily calorie intake, and BP medication use. The model predicted that a decrease of 2.3 teaspoons (0.5 standard deviation) of added sugar would result in a 8.4 mmHg drop in systolic BP and a 3.7 mmHg drop in diastolic BP. Whole fruit was associated with a reduction in diastolic BP in both males and females, and the model predicted that, for every 0.71 cup increase in whole fruit consumption, there would be a decrease in diastolic BP of 2.8 mmHg. Our findings support the dietary guidelines of limiting daily intake of added sugar and increasing fruit consumption to promote overall cardiovascular health in older adults.
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