‘Like an older family member’: Young Africans’ perceptions of Coca-Cola’s sugar-sweetened beverage brand in South Africa and Nigeria

Sugar-sweetened beverages, milk intake, and obesity in children and adolescents

Increased sugar-sweetened beverage (SSB) consumption is linked to childhood obesity. The risk of increased SSB consumption is multifactorial. Limited studies have examined children’s SSB consumption and social networks. In order to examine the association between SSB consumption and SSB preferences of a child’s social network, a cross-sectional survey was administered to patients aged 8–17 years from June to September 2016. In a questionnaire, subjects completed a beverage consumption recall, identified people important to them along with each person’s favorite beverage, and answered questions about habits, environment, and attitudes. Subjects with higher SSB consumption (>16 fl oz) were compared to subjects with lower SSB consumption (≤16 fl oz). 202 surveyed: 55% female, 53% Hispanic, 45% Black, 28% overweight or obese. Children drank an average of 3 cups/day of SSBs, range of 0–15 cups/day. Social networks included caregiver, relative, and friend. Subjects with higher SSB consumption (n = 96) were compared to those with lower SSB consumption (n = 106). We found children with higher SSB consumption had higher odds of reporting a higher number of people in their immediate social networks who prefer SSB, adjusted for habits, environment, and attitudes (aOR 1.41; 95% CI: 1.02–1.99; p < 0.05). Children are more likely to have higher SSB consumption if they list people in their immediate social network who prefer SSB as their favorite drink. Further research is required to explore the influence of social networks on health behaviors of children.

Effectiveness of a Text Message Pilot Program Targeting Low-Income Latinos' Dietary Behaviors

BackgroundOverweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students’ health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population.MethodsWe performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics.ResultsThe school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption).ConclusionsThe low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.

Introduction: Several previous studies have reported a link between sugar-sweetened beverage (SSB) consumption and numerous cardiovascular disease (CVD) risk factors including hypertension, dyslipidemia, and obesity. However, our understanding of how SSB consumption affects cardiovascular function remains limited. We sought to investigate the association between SSB consumption and coronary flow reserve (CFR), a measure of overall coronary vasodilator capacity and microvascular function. Hypothesis: Increased SSB consumption is associated with lower CFR. Methods: A sample of 320 male middle-aged twins, including 128 monozygotic and dizygotic twin pairs and 64 unpaired twins, with no previous history of coronary heart disease (CHD) and diabetes, was recruited from the Vietnam Era Twin Registry. All twins underwent comprehensive cardiovascular assessments and completed the Willett food-frequency questionnaire. Reported intakes of fruit drinks, regular carbonated beverages with sugar, low-calorie carbonated beverages with sugar, and other SSBs were used to derive habitual daily SSB consumption for the previous 12 months. Positron emission tomography [N 13 ] ammonia with quantitation of myocardial blood flow at rest and after adenosine stress was used to measure CFR. Mixed-effect regression analysis was used to examine the association between SSB consumption and CFR both at the individual level and between and within twin pairs. Potential confounders included demographic characteristics, lifestyle factors (including physical activity), traditional CVD risk factors, total energy intake, and other nutritional factors such as intake of cholesterol, fiber, sodium, alcohol, and saturated, monounsaturated, and polyunsaturated fatty acids. Results: The mean age of the twins was 55 years (SD = 3.2) and 94.4% (302 out of 320) were white. Across quintiles of twins consuming less than 2 SSBs per day, 2 to less than 4, 4 to less than 6, 6 to less than 8, and 8 or more, adjusted geometric mean CFR measurements were, respectively, 2.49, 2.45, 2.43, 2.37, and 2.18 ( P = 0.032 for linear trend) with the top quintile having a 12.4% lower CFR than the bottom quintile. The inverse association observed at the individual level persisted between-pairs ( P = 0.042), but was substantially reduced and no longer significant within twin pairs. These associations did not differ by zygosity. Conclusions: SSB consumption is inversely associated with CFR, a measure of coronary microvascular function, independent of traditional CVD risk factors. However, shared familial factors, such as growing up in the same home environment and adopting parental behaviors throughout youth and adolescence, may mediate the association between SSB consumption and CFR. Our study supports the importance of early-life, family-level interventions to promote healthy eating and improve cardiovascular health.

To estimate the effect of increased sugar-sweetened beverage (SSB) consumption on future adult obesity prevalence in South Africa in the absence of preventive measures. A model was constructed to simulate the effect of a 2·4 % annual increase in SSB consumption on obesity prevalence. The model computed the change in energy intake assuming a compounding increase in SSB consumption. The population distribution of BMI by age and sex was modelled by fitting measured data from the 2012 South African National Income Dynamics Survey to the log-normal distribution and shifting the mean values. Over the past decade the prevalence of obesity and related non-communicable diseases has increased in South Africa, as have the sales and availability of SSB. Soft drink sales in South Africa are projected to grow between 2012 and 2017 at an annual compounded growth rate of 2·4 % in the absence of preventive measures to curb consumption. A 2·4 % annual growth in SSB sales alongside population growth and ageing will result in an additional 1 287 000 obese adults in South Africa by 2017, 22 % of which will be due to increased SSB consumption. In order to meet the South African target of reducing the number of people who are obese and/or overweight by 10 % by 2020, the country cannot afford to delay implementing effective population-wide interventions. In the face of plans to increase growth of SSB, the country will soon face even greater challenges in overcoming obesity and related non-communicable diseases.

BackgroundIn 2016, Oklahoma launched “Shape Your Future – Rethink Your Drink” (SYF/RYD), an obesity prevention health communication program targeting parents and caregivers of children. The aims of this study are to compare sugar-sweetened beverage (SSB) consumption before and after the program and to report factors associated with SSB consumption, knowledge, and attitudes.MethodsThis repeated cross-sectional study involved 2656 Oklahoma adults with ≥ one child under 18 years in the home. Weighted prevalence estimates were calculated and the relationship between SSB consumption and covariates of interest were examined using logistic regression techniques appropriate for survey data.ResultsFollowing the SYF/RYD program, SSB consumption decreased 18.6% (p = 0.0232) and heavy SSB consumption, ≥ three SSB per day, decreased 42.9% (p = 0.0083). Factors associated with SSB consumption, 1 year after the launch of SYF/RYD included high school education or less (AOR = 1.33 with 95% CI = 1.02, 1.73), fair or poor health status (AOR = 2.02 with 95% CI = 1.47, 2.78), drinking less than eight cups of water daily (AOR = 1.77 with 95% CI = 1.39, 2.25), inability to afford healthy foods (AOR = 1.33 with 95% CI = 1.06, 1.67), and self-identifying as American Indian/Alaska Native (AOR = 1.59 with 95% CI = 1.10, 2.29).ConclusionsHealth communication campaigns, such as SYF/RYD, are an evidence-based strategy for health behavior change and likely contributed to the declines observed in SSB consumption. Important differences in SSB consumption by population subgroups persist and have implications for future message development.

High Sugar-Sweetened Beverage Consumption Is Associated with Increased Health Care Utilization in Patients with Inflammatory Bowel Disease: A Multiyear, Prospective Analysis

Introduction: Ceramides are a class of sphingolipid that have been implicated in the pathogenesis of cardiometabolic diseases, and their circulating concentrations may be affected by foods that can alter hepatic lipid metabolism. We hypothesized that sugar-sweetened beverage (SSB) consumption may influence plasma concentrations of three ceramide species. Methods: Framingham Offspring cohort participants (N=2142; mean age, 65 years; 57% women) were categorized based on SSB consumption, as non-consumers (0 to &lt; 1 serving/month), occasional consumers (1 serving/month to &lt;1 serving/week), frequent consumers (1 serving/week to &lt;1 serving/day), and daily consumers (≥1 serving/day). Plasma ceramide concentrations were assayed using a validated LC-MS/MS protocol. Multivariable linear regression models related frequency of SSB consumption to plasma ceramide concentrations (C16:0, C22:0, and C24:0), and to ceramide ratios (C22:0/C16:0 and C24:0/C16:0). Models adjusted for age, sex, smoking status, use of lipid-lowering medication, total energy, alcohol, diet quality, physical activity, and BMI. We explored if the SSB effects were modified by use of lipid-lowering medication, BMI (&lt; 25 vs ≥ 25), or diabetes status (pre-diabetic/diabetic vs non-diabetic). Analyses were repeated using mean cumulative SSB consumption reflective of usual intake over 14 years. Results: Approximately 49% of participants were non-consumers, 20% occasional consumers, 25% frequent consumers, and 6% daily consumers, of SSBs. On average daily SSB consumers were younger, more likely to be men, more likely to smoke, had a lower diet quality, and were slightly more physically active (P trend &lt;0.05). Concentrations (LS mean [95% CI] μg/mL) of the C16:0 ceramide were 0.163 [0.161, 0.166] for non-consumers and 0.169 [0.163, 0.175] for daily consumers (P trend &lt;0.05). Concentrations of the C22:0 ceramide were 0.601 [0.599, 0.620] for non-consumers and 0.634 [0.604, 0.664] for daily consumers (P trend &lt;0.05). There were no statistically significant associations between SSB consumption and plasma concentrations of the C24:0 ceramide or with ceramide ratios (C22:0/C16:0 and C24:0/C16:0). None of the interactions evaluated were statistically significant. Results of analyses using mean cumulative SSB consumption were similar but additionally indicated a significant positive association with concentrations of the C24:0 ceramide; concentrations were 2.252 [2.193, 2.312] for non-consumers and 2.428 [2.313, 2.542] for daily consumers (P trend &lt;0.05). Conclusion: In our cross-sectional community-based sample of middle-aged adults, SSB consumption was positively associated with plasma concentrations of several ceramide species but not with ceramide ratios. This study may help to elucidate mechanisms mediating the association between SSB consumption and higher risk of cardiometabolic diseases.

BackgroundThe benefit of reducing sugar-sweetened beverage (SSB) consumption is widely accepted, but updated and in-depth data on New Zealand (NZ) children’s SSB consumption is lacking. The aims of this study were to describe beverage consumption, focusing on SSBs in primary school age children living in Auckland; to examine the association of selected socio-demographic, home, community and school factors and children’s beverage knowledge/attitudes with regards to beverage consumption; to explore the relationship between SSBs consumption and adiposity in children.MethodsA cross-sectional, Auckland-wide survey of 578 school age children (8-12 years) was conducted using questionnaires to collect data on beverage consumption, beverage knowledge/attitudes, and selected socio-demographic and home, community, school factors. Body fat percentage (BF%) was assessed using bioelectrical impedance (BIA).ResultsNinety-six percent of children consumed ≥1 serving of SSBs a week; with ≥5 servings reported by 62% of children. Of all SSBs assessed, consumption of ≥1 serving of sugar sweetened milk-based beverages (85%, mainly milk drinks made from powder) was most prevalent, followed by fruit juice (46%) and sugar-containing carbonated drinks (39%, mainly soft/fizzy drinks). Among unsweetened beverages, plain water was reported to be consumed < 2 times a day by 22% of children, and plain milk < 1 serving a day by 53%. Higher consumption of SSBs was associated with socio-economic disadvantage, non-NZ European ethnicities (Māori, Pacific, Asian, others), availability of SSBs in the home, frequent takeaway/convenience shop visits, children’s incorrect perception of adequate SSBs consumption frequency, and higher BF% (females only). School health policy and encouragement of children to consume un-sweetened beverages was not associated with SSBs consumption.ConclusionsThe consumption of SSBs is prevalent in NZ school age children, with higher consumption rates observed among those from socially disadvantaged areas. This high consumption is associated with higher BF% in females. Multi-contextual interventions to decrease SSBs should target children, and their families/environment, particularly those from socially disadvantaged areas.

Water Insecurity Is Associated with Sugar-Sweetened Beverage Consumption in a Small-Scale Population in Lowland Bolivia Experiencing Lifestyle Changes.

P117 Factors Associated with Sugar-Sweetened Beverage Consumption Among Children and Adolescents in the United States by Race/Ethnicity: NHANES 2011-2016

Objective: To assess the consumption of ultra-processed food and sugar-sweetened beverages and to identify the association of this consumption with overweight among vegetarians. Methods: A cross-sectional study with a convenience sampling method was conducted. Data were collected using an online questionnaire from 8/24/2015 to 10/8/2015. Subjects were male and female vegetarians aged &gt;16 years. Using a food frequency questionnaire, we assessed the weekly consumption of ultra-processed food and sugar-sweetened beverages and described the frequency of daily consumption overall and according to type of vegetarianism. The association between overweight and excessive daily intake of ultra-processed food was analyzed by multiple logistic regression (OR [95CI%]). Results: Information was retrieved from 503 individuals (29.8±8.5 years old); 83.7% were women. The most frequent types of vegetarianism in our sample were ovo-lacto (45.5%) and vegan (41.7%), and the median time of vegetarianism was 5.3 years. The consumption of sugar-sweetened beverages (≥2x/day) and ultra-processed food (≥3x/day) was 21.0% and 16.0%, respectively, and regarding the different vegetarianism types, vegans showed the lowest frequency of excessive daily sugar-sweetened beverages and ultra-processed food consumption. In the multivariable analysis, consumption of ultra-processed food ≥3x/day (2.33 [1.36-4.03]), male sex (1.73 [1.01-2.96]), age ≥35 years (2.03 [1.23-3.36]) and not preparing one’s food (1.67 [0.95-2.94]) were independently associated with overweight. Conclusion: Although vegetarianism is frequently associated with a healthier diet and, consequently, prevention of poor health outcomes, this study found that the excessive consumption of sugar-sweetened beverages and ultra-processed food was associated with overweight.

This study examines the prospective association between sugar-sweetened beverages (SSB) consumption and change in body weight over a 4-5-year period in a socio-economically disadvantaged South African population. This is a longitudinal study involving 800 adults (212 men, 588 women); 247 from the original METS (Modelling the Epidemiological Transition Study) cohort (N = 504) and 553 of the original 949 members of the PURE (Prospective Urban and Rural Epidemiology) Study. Both cohorts were drawn from low-income, socio-economically disadvantaged communities. Mean follow-up duration and age were 4.5 (SD 0.45) and 50.0 (SD 11.8) years, respectively. Harmonised measurements included body mass index, self-reported moderate-to-vigorous physical activity, and intake of meat, snacks and 'take-aways', fruits and vegetables and SSB (in servings/week). Multivariate logistic regression models were developed to determine the extent to which SSB consumption predicted relative weight gain, after controlling for potential confounders and known predictors. Nearly a third (29%) of participants had a relative weight change ≥5.0%; higher in the non-obese compared to the obese group (32% vs. 25%; p = 0.026). The average SSB consumption was 9.9 servings/week and was higher in the food insecure compared to the food secure group (11.5 vs. 9.0 servings/week; p = 0.006); but there wereno differences between women and men (10.3 vs. 9.1 servings/week; p = 0.054). Mean SSB consumption was higher in the group who gained ≥5% weight compared to those who did not (11.0 vs. 8.7; p = 0.004). After adjustment, SSB consumption of 10 or more servings/week was associated with a 50% greater odds of gaining at least 5% body weight (AOR: 1.50, 95% CI (1.05-2.18)). These results show that higher intake of SSB predicts weight gain in a sample of South Africans drawn from low-income settings. Comprehensive, population-wide interventions are needed to reduce SSB consumption in these settings.

Sugar-sweetened beverage (SSB) consumption and inadequate moderate-to-vigorous physical activity (MVPA) have been suggested as potential contributors to overweight/obesity during childhood or adolescence; however, the results of previous studies are inconsistent. It was crucial to estimate the independent and joint association of SSB consumption and inadequate MVPA for childhood and adolescent overweight/obesity. The "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2021-2022" initiative provided us with representative population-based data that we studied. SSB consumption and inadequate MVPA were determined by self-reported SSB habit and MVPA frequency (days/week). The body mass index for each gender and age subgroup was used to identify those who were overweight or obese. With stratified analyses to ascertain differences in age or gender, we employed the logistic regression model to assess the association of SSB and MVPA with overweight/obesity and applied the likelihood ratio test to explore the interactions. Approximately 38.2% of the study population (119,467 students aged 8-17) were overweight/obese. After adjusting covariates, SSB consumption or inadequate MVPA was associated with overweight/obesity (OR = 1.05, 95% CI = 1.02-1.07; and OR = 1.07, 95% CI = 1.03-1.10). In comparison to students with "no SSB consumption and adequate MVPA", those with "SSB consumption and inadequate MVPA" had a higher risk of being overweight/obese (OR = 1.13, 95% CI = 1.08-1.18). Regardless of age and gender subgroups, the correlation of SSB and MVPA alone and together with being overweight/obese was generally similar, with the adolescent group aged 13-17 years (OR = 1.15, 95% CI = 1.09-1.22) and females (OR = 1.09, 95% CI = 1.02-1.17) being more susceptible. Moreover, there was a significant interaction between SSB consumption and gender (p < 0.001), as well as between SSB consumption and inadequate MVPA (p = 0.008). Hence, SSB consumption in students is significantly associated with overweight/obesity, especially when MVPA is inadequate. In light of the rapidly expanding childhood and adolescent obesity epidemic, proper attention should be given to these modifiable behaviors, particularly SSB and MVPA.