Added Sugar Intake Research Articles

Dietary changes in an acceptance-based weight loss pilot intervention study

ObjectiveTo evaluate pre-post changes in dietary intake and the possible role of emotional eating (EE) as a mediator of dietary changes in a novel behavioral weight loss intervention (Live FREE). DesignSecondary analysis of an open label pilot study. ParticipantsThirty-nine adults with overweight/obesity and EE. InterventionLive FREE is a 16-week group-based program in which participants learn emotional regulation skills from Dialectical Behavior Therapy followed by traditional behavioral weight loss techniques. Main outcome measureDietary intake and EE were measured at baseline and post-treatment with the Automated Self-Administered 24-Hour Dietary Assessment Tool and the depression subscale of the revised Emotional Eating Scale. AnalysisPaired sample t-tests and mediation for repeated measures designs. ResultsConsumption of calories (t(33) = 5.31, p < .001), saturated fat (t(33) = 5.25, p < .001), and added sugar (t(33) = 4.44, p < .001) decreased from pre-post-treatment. EE change mediated the effect of the intervention on change in saturated fat intake pre-post-treatment, B = 6.16, BootSE = 2.47, 95 % CI (1.53 to 11.37), but did not mediate change in caloric or added sugar intake. Conclusions and implicationsParticipants reported improvement in caloric, saturated fat, and added sugar intake. Improvement in EE may be closely related to decreasing saturated fat consumption. (200).

Safety evaluation of oubli fruit sweet protein (brazzein) derived from Komagataella phaffii, intended for use as a sweetener in food and beverages

Naturally sweet proteins have no glycemic effect and offer a fundamentally new approach to sweetness and health for individuals seeking to reduce their added sugar intake. However, unlike many commercial sweeteners, little research has been performed on the potential safety implications of adding these uniquely sweet proteins to food and beverages. In this study, a naturally sweet protein found in the West African Oubli plant ( Pentadiplandra brazzeana), referred to as Oubli fruit sweet protein or brazzein, was expressed in Komagataella phaffii (formerly Pichia pastoris) and produced via precision fermentation, and a safety and risk assessment was undertaken for its use as a sweetener in food and beverages. Potential consumption levels of brazzein were estimated to be 3 mg/kg body weight/day based on the National Health and Nutrition Examination Survey. The safety of brazzein derived from K. phaffii was evaluated through in silico allergenicity, in vitro genotoxicity (reverse mutation and mammalian micronucleus assays), and a 90-day dietary oral toxicity study in rats. There was no indication of allergenicity in the in silico analyses. Brazzein was non-genotoxic in the in vitro assays and showed no adverse effects in the 90-day oral toxicity study up to the highest dose tested, where the no-observed-adverse-effect level (NOAEL) was 978 and 985 mg/kg body weight/day in males and females, respectively. The totality of evidence in the in silico allergenicity, in vitro genotoxicity, and 90-day dietary toxicity studies demonstrates that brazzein derived from K. phaffii is considered safe for use as a sweetener in food and beverages.

Application of digital transformations of dietary microdata and factor analysis to study the nutritional patterns of breakfast and its significance in providing the nutritional value of the diet of adults

Eating disorders with skipping meals are considered as a risk factor for chronic non-communicable diseases. Frequent skipping of meals is associated with the risk of developing metabolic syndrome, type 2 diabetes, and obesity. Breakfast is considered to be the most important meal of the day. However, studies on the impact of skipping breakfast on the risk of overweight and obesity are highly controversial. The aim of this study was to analyze the prevalence of skipping the morning breakfast meal and its impact on the actual daily intake of nutrients and energy in the Russian adult population. Material and methods. The data from a sample survey of dietary intake conducted in 2013 by the Russian Federal State Statistics Service have been used. The analysis included adult respondents (19 years and older) in the amount of 163 000 people in 2 stages of the survey (in April and September). The dietary intake of all members of the surveyed households was studied using the 24-hour recall method. Since the survey questionnaires did not contain information about type of meals, therefore, with the help of binning in thзe SPSS program, time intervals of the maximum food energy intake by the respondents were established, which were taken as evidence of the main meals and snacks. Results. Of the main meals, the largest proportion of respondents skipped dinner (23.1%), then breakfast (13.0%), and the smallest proportion skipped lunch (5.7%).The proportion of men and women who skipped breakfast was 12.6 and 13.3%, respectively, a greater frequency of skipping breakfast was observed at a young age (19-30 years, 19.3%) and at an old age (75 years and older, 16.1%). With an increase in the average monthly income of a family, the percentage of those who skip breakfast increases. Adult members of families with many children (3 or more children), whose average per capita income is lower than those in families with 2 children, skip breakfast less frequently. The smallest share of people skipping breakfast was found in the North Caucasian and Southern districts, and the maximum in the Siberian and Far Eastern districts. Adults who skipped breakfast had a higher percentage of malnourished (BMI <18.5 kg/m2) and normal nutritional status (BMI 18.5-24.9 kg/m2). At the same time, the proportion of people who consumed breakfast was significantly higher in overweight people (25.0-29.9 kg/m2), and no differences were found among obese people. It is shown that skipping breakfast is accompanied by a decrease in the energy value of the daily diet by an average of 200 kcal. Despite the increase in the caloric content of the 2nd breakfast, afternoon snack and evening snack in absolute terms (р<0.01), there was no compensation for the loss of energy value in the absence of breakfast. A decrease in the absolute values of nutrient intake associated with a decrease in energy consumption was established. However, skipping breakfast showed a decrease in added sugar intake as a per cent of total calorie intake (12.1±8.6 vs 13.2±9.1%, р<0.01), while the contribution of other macronutrients to energy intake did not change significantly. In connection with the heterogeneity of the actual dietary intake of the population, factor analysis was used to describe the main food models of the breakfast using the principal component method. 6 factors were identified that determine the eating patterns of breakfasts and correlate with 2-4 individual food items of actual dietary intake. Conclusion. The results obtained are consistent in a number of positions with the literature data, in particular, indicating a decrease in daily energy consumption when skipping breakfast.

Building deep neural networks to detect candy from photos and estimate nutrient portfolio

Approximately one third of American youth consume candy on a given day. Consuming excess candy contributes to added sugar intake and may lead to tooth decay and other health concerns. Diet-tracking apps may inform and help regulate candy consumption but depend on the availability of annotated candy image data and predictive models. A recent review documented differences in daily intakes of calories and macronutrients between app predictions and ground truths ranging from 1.4%–10.4%. Transfer learning-based deep neural networks could outperform those benchmarks and reduce the error margin. We built a dataset of 1,008 images comprising nine common candy types and developed four neural network models to detect candy pieces. The best-performing model achieved a mean average precision of 0.8736 for localizing candy pieces of different types in the validation dataset and an accuracy of 99.8% for predicting the quantity and types of multiple candy pieces in the test dataset. By combining candy type-specific nutritional information obtained from the nutrition facts label, the model accurately estimated (within an error margin of 0.5%) the aggregate nutrient portfolios, including total calories, total fat, saturated fat, cholesterol, sodium, carbohydrates, total sugars, and added sugars, of all candy pieces shown in an image. This study demonstrates the feasibility of automating candy calorie/nutrition counting using photos, which may facilitate the development of diet-tracking apps to provide real-time, accurate nutritional information to inform candy consumption.

FTO genotypes (rs9939609 T>A) are Associated with Increased Added Sugar Intake in Healthy Young Adults

Introduction: Single-nucleotide polymorphism (SNP) rs9939609 in the FTO gene has been associated with dietary intake and appetite traits, mainly in participants with obesity; however, it remains widely unexplored in normal weight participants. Thus, the aims of this study were (1) to compare the changes in subjective appetite sensations, ghrelin, and insulin concentrations according to the SNP rs9939609 T>A in FTO and (2) to compare dietary intake between rs9939609 genotype groups in normal weight young participants. Methods: We conducted a quasi-experimental study involving 88 normal weight participants to analyze subjective perception of appetite, hormonal response for hunger and satiety, and dietary intake according to the rs9939609 SNP. Participants received a standardized single breakfast. Visual analogue scales (VAS) were utilized for assessing the subjective perception of appetite at fasting and immediately after breakfast and at 30, 60, 90, and 120 min postprandially. Glucose, lipid profile, ghrelin, and insulin were measured at fasting and at 120 min after breakfast. Dietary intake was assessed with a 3-day food record. The SNP was determined by allelic discrimination with TaqMan probes. To compare dietetic, biochemical, and the subjective appetite sensations, Student t test, ANCOVA test, and the repeated measures ANOVA were used. The linear regression model and the linear mixed model were used for the association analysis. Pearson correlation was used to test the correlation between two quantitative variables. Results: A total of 88 people participated, 81.8% were female, with a mean body mass index of 21.8 ± 2.0 kg/m² and a mean age of 20.6 ± 2.0. Genotype frequencies of the rs9939609 SNP were 52% for the TT allele and 48% for the TA/AA. The subjective perception of appetite named hunger, fullness, satiety, desire to eat, and prospective food consumption were similar between genotypes of the rs9939609. Participants with the TA/AA genotype showed a higher intake of added sugar (p = 0.039) than TT participants. No differences were found in ghrelin, insulin, glucose, or lipid parameters between genotypes. Conclusion: Carriers of the A allele from FTO gene SNP rs9939609 may have an increased preference for foods, specifically for added sugars.

Sleep duration and added sugar intake of Mexican university students and staff

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Sugar intake above international recommendations and oral disease burden: A population-based study.

To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents. This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n= 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling. Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC=0.096; p= 0.007) and AHA (SC=0.056; p= 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators. Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.

Prospective Cohort of Pre- and Post-Diagnosis Diet with Survival Outcomes: an Alberta Endometrial Cancer Cohort Study.

The prognostic relationship between diet and endometrial cancer survival remains largely unknown. We sought to determine pre- and post-diagnosis dietary composition, glycemic load (GL), inflammatory potential (dietary inflammatory index) and quality [Canadian Healthy Eating Index (C-HEI) 2005] associations with disease-free (DFS) and overall survival (OS) among endometrial cancer survivors. In addition, we assessed associations between dietary changes with OS and explored obesity/physical activity effect modification. Survivors, diagnosed in Alberta, Canada between 2002 and 2006, completed past-year, food-frequency questionnaires at-diagnosis (n = 503) and 3-year follow-up (n = 395). Participants were followed to death or January 2022. Cox proportional regression estimated HR [95% confidence intervals (CI)] for dietary survival associations. During 16.9 median years of follow-up, 138 participants had a DFS event and 120 died. Lower pre-diagnosis GL (HRT1vsT3, 0.49; 95% CI, 0.25-0.97) and greater post-diagnosis energy intakes (EI) from total- and monounsaturated-fat (HRT3vsT1, 0.48; 95% CI, 0.26-0.87) were associated with better OS. Higher pre-diagnosis C-HEI, less inflammatory diets and lower added sugar intakes were nonlinearly associated with better DFS. Consistently low pre- to post-diagnosis EI from carbohydrates and total-fats were associated with better (HR, 0.36; 95% CI, 0.18-0.72) and worse (HR, 2.26; 95% CI, 1.21-4.20) OS, respectively. Decreased pre- to post-diagnosis C-HEI was associated with worse OS. In stratified analysis, healthy diets were most beneficial for survivors with obesity and physical inactivity. Adherence to higher quality dietary patterns were associated with better survival. Our study provides novel evidence that both pre- and post-diagnosis diet are important prognostic factors for endometrial cancer survivors. Post-diagnosis survival associations with diet composition and quality highlight the potential for future interventions.

Glycemic Load, Dietary Fiber, Added Sugar, and Spontaneous Abortion in Two Preconception Cohorts

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. We prospectively evaluated the association between preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar and risk of SAB. 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. 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. 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.

A high carbohydrate-to-fiber ratio is associated with a low diet quality and high fat mass in young women

Regular intake of dietary fiber is critical for adequate metabolic health and the prevention of obesity. The relevancy of fiber intake is well illustrated by accounting for the ratio of carbohydrates-to-fiber (CFR). However, it is not well known if the CFR is associated with body composition and the quality of diet in young women who are known to have a higher incidence of eating disorders related to restrictive carbohydrate diets. The purpose of this study was to explore the difference in body composition and the quality of diet in women with a low and high CFR. A total of 22 participants were clustered into two groups (group 1 – below the median CFR and group 2 – above the median CFR). Body composition was analyzed via dual-energy X-ray absorptiometry. Dietary analysis via a 3-day food log was conducted to examine the overall energy intake, macronutrient breakdown, and diet quality. One-way ANOVA and Point-biserial analyses were performed to explore group differences and correlations. The mean CFR for Group 1 was 9.23 ± 2.85 and for Group 2 was 20.75 ± 8.71, which was significantly different between the groups F (1,21) = 17.368, p < 0.001. Group 1 (fat mass: 13.07 ± 3.67 kg; body fat percentage: 21.93 ± 5.78%) had a significantly lower fat mass [ F (1,21) = 4.521, p = 0.046] and body fat percentage [ F (1,21) = 7.574, p = 0.012] than Group 2 (fat mass: 16.06 ± 2.89 kg; body fat percentage: 27.59 ± 3.62%). A higher CFR was associated with a higher percentage of carbohydrate intake ( r pb (20) = 0.466, p = 0.029) and a higher percentage of added sugar intake ( r pb (20) = 0.504, p = 0.017). This study confirms the applicability of the CFR as an indicator of diet quality in young women. In addition, the presented differences in body composition suggest that a diet consisting of a low CFR may play a positive role in body composition by maintaining a lower fat mass. • Age had no effect on the carbohydrate-to-fiber ratio. • The carbohydrate-to-fiber ratio is a good measure of diet quality. • A low carbohydrate-to-fiber ratio is associated with reduced fat mass. • A high carbohydrate-to-fiber ratio is associated with a high intake of added sugars.

Exploring the Feasibility of an Online Diabetes Wellness Programme among Periodontitis Patients with Type II Diabetes Mellitus during the COVID-19 Pandemic.

There were massive interruptions, including patient visits for dietary advice and dental services, during the COVID-19 outbreak. This study assessed the feasibility of an online diabetes wellness programme among periodontitis patients with type II diabetes mellitus. Patients were grouped into the intervention group (IG) and control group (CG). At baseline and week 12, all patients answered online questionnaires on diabetes-related knowledge, physical activity, and oral impacts on daily performances (OIDP). Body weight and waist circumference were self-measured with guided instructions. Diet recalls were used to estimate dietary and added sugar intake. All patients received a weekly educational video, but the IG attended three e-consultation sessions with a dietitian (weeks 1, 3, and 8) and a dentist (week 8) via video call. A semi-structured interview was conducted to collate qualitative feedback among the IG participants at the end of the programme. A total of 24 periodontitis patients (14 IG and 10 CG) participated in this study. Among the IG patients, significant improvements in diabetes knowledge, body weight, BMI, calories, carbohydrates, fat, and added sugar intakes were observed at week 12. The CG patients only had a significant reduction in carbohydrate intake post intervention. No changes were reported in physical activity level and OIDP for both groups. Feedback received from the IG participants included convenience, practical, preferred approach during the pandemic, increased awareness and knowledge, and favourable lifestyle changes. This study demonstrates that an online diabetes wellness programme with healthcare professionals is feasible and can facilitate knowledge and lifestyle improvements that can be adapted during the crisis situation.

The Association between Maternal Sugar-Sweetened Beverage Consumption and Infant/Toddler Added Sugar Intakes.

Intake of added sugars during early life is associated with poor health outcomes. Maternal dietary intake influences the intake of their children, but little research investigates the relationship between maternal sugar sweetened beverage (SSB) and infant/toddler added sugar intakes. Our objective was to explore the relationship between maternal total sugars and SSB intakes and infant/toddler added sugar intakes. This cross-sectional study (n = 101) of mother-infant dyads measured maternal dietary intake by food frequency questionnaire and infant intake by three 24-h dietary recalls. Pearson’s correlations explored the relations between maternal total sugars and SSB intakes and infant added sugar intakes. Hierarchical stepwise regressions determined if maternal total sugars and SSB intakes explained the variation in infant added sugar intakes after accounting for known risk factors for early introduction of added sugars. Maternal total sugars (r = 0.202, p = 0.043) and SSB (r = 0.352, p < 0.001) intakes were positively correlated with infant/toddler added sugar intakes. In the hierarchical models, maternal total sugar intakes did not account for more variance in infant added sugar intakes (β = 0.046, p = 0.060), but maternal SSB intake was a significant contributor of infant added sugar intakes (β = 0.010, p = 0.006) after accounting for confounders. Interventions to reduced maternal SSB consumption may help reduce infant/toddler added sugar intakes.

Evaluating a Model of Added Sugar Intake Based on Amino Acid Carbon Isotope Ratios in a Controlled Feeding Study of U.S. Adults.

Previous studies suggest that amino acid carbon stable isotope ratios (CIRAAs) may serve as biomarkers of added sugar (AS) intake, but this has not been tested in a demographically diverse population. We conducted a 15-day feeding study of U.S. adults, recruited across sex, age, and BMI groups. Participants consumed personalized diets that resembled habitual intake, assessed using two consecutive 7-day food records. We measured serum (n = 99) CIRAAs collected at the end of the feeding period and determined correlations with diet. We used forward selection to model AS intake using participant characteristics and 15 CIRAAs. This model was internally validated using bootstrap optimism correction. Median (25th, 75th percentile) AS intake was 65.2 g/day (44.7, 81.4) and 9.5% (7.2%, 12.4%) of energy. The CIR of alanine had the highest, although modest, correlation with AS intake (r = 0.32, p = 0.001). Serum CIRAAs were more highly correlated with animal food intakes, especially the ratio of animal to total protein. The AS model included sex, body weight and 6 CIRAAs. This model had modest explanatory power (multiple R2 = 0.38), and the optimism-corrected R2 was lower (R2 = 0.15). Further investigations in populations with wider ranges of AS intake are warranted.

Trends in Diet Quality by Race/Ethnicity among Adults in the United States for 2011-2018.

This study aimed to investigate time trends in diet quality and the consumption of major food groups and nutrients by race/ethnicity among adults in the United States. Dietary data from 19,192 adults aged ≥ 20 years from four National Health and Nutrition Survey (NHANES) cycles (2011–2018) were included. The Healthy Eating Index (HEI) 2015 scores (range: 0–100; higher scores indicate better diet quality) and dietary consumption of food groups and nutrients were estimated for each cycle. Linear regression was used to test trends. For the overall population, the estimated overall HEI-2015 scores significantly decreased (p for trend = 0.011). However, decreases were observed in the estimated consumption of added sugars and total carbohydrates, while the estimated consumption of soy products and polyunsaturated fatty acids was significantly increased. A significant decrease in overall HEI-2015 score was observed in the non-Hispanic white group, but not in other racial/ethnic groups. Decreases in added sugar intake were found in the non-Hispanic black and Hispanic groups; sodium intake significantly decreased in the non-Hispanic Asian group. From 2011 to 2018, there was a decrease in estimated overall diet quality in US adults; however, there were improvements in certain nutrients and dietary components. Nevertheless, disparities in diet quality exist among racial/ethnic groups.

Added sugar intake and its forms and sources in relation to risk of non-alcoholic fatty liver disease: results from the Tianjin Chronic Low-grade Systemic Inflammation and Health cohort study.

It has been suggested that added sugar intake is associated with non-alcoholic fatty liver disease (NAFLD). However, previous studies only focused on sugar-sweetened beverages; the evidence for associations with total added sugars and their sources is scarce. This study aimed to examine the associations of total added sugars, their physical forms (liquid v. solid) and food sources with risk of NAFLD among adults in Tianjin, China. We used data from 15538 participants, free of NAFLD, other liver diseases, CVD, cancer or diabetes at baseline (2013-2018 years). Added sugar intake was estimated from a validated 100-item FFQ. NAFLD was diagnosed by ultrasonography after exclusion of other causes of liver diseases. Multivariable Cox proportional hazards models were fitted to calculate hazard ratios (HR) and corresponding 95 % CI for NAFLD risk with added sugar intake. During a median follow-up of 4·2 years, 3476 incident NAFLD cases were documented. After adjusting for age, sex, BMI and its change from baseline to follow-up, lifestyle factors, personal and family medical history and overall diet quality, the multivariable HR of NAFLD risk were 1·18 (95 % CI 1·06, 1·32) for total added sugars, 1·20 (95 % CI 1·08, 1·33) for liquid added sugars and 0·96 (95 % CI 0·86, 1·07) for solid added sugars when comparing the highest quartiles of intake with the lowest quartiles of intake. In this prospective cohort of Chinese adults, higher intakes of total added sugars and liquid added sugars, but not solid added sugars, were associated with a higher risk of NAFLD.

Corporate political activity in the context of sugar-sweetened beverage tax policy in the WHO European Region.

BackgroundSugar-sweetened beverage (SSB) taxes have emerged as an effective and increasingly popular tool to reduce added sugar intake, an important contributor to obesity and non-communicable diseases. A common barrier to the implementation of well-designed SSB taxes is the opposition of commercial actors. Focusing on the WHO European Region, this study seeks to map if and how key stakeholders have experienced industry efforts to influence SSB taxes.MethodsWe identified 11 countries in the WHO European Region which have implemented SSB taxes or attempted to do so. Using an online survey informed by the global literature on industry interference with SSB taxation, we approached 70 in-country policymakers, advocates and academics. The data were analysed using an existing framework of corporate political activity.ResultsTwenty-three experts from nine countries responded to the survey. Transnational SSB producers and their business associations were identified as the most active opponents of SSB taxation. Industry claims that the policy would have negative economic effects were identified as the most common and powerful arguments. Direct lobbying was reported in all study countries. Shifts in political activity were recognisable across stages of the policy process, moving from outright opposition to attempts to delay or weaken the policy after its announcement.ConclusionThose seeking to introduce effective SSB taxation can use our findings to pre-empt and counter industry opposition. We identify several measures for preventing and mitigating industry interference with SSB tax policy.

Trends in added sugars intake and sources among U.S. adults using the National Health and Nutrition Examination Survey (NHANES) 2001–2018

Research on trends over time in added sugars intake is important to help gain insights into how population intakes change with evolving dietary guidelines and policies on reducing added sugars. The purpose of this study was to provide an analysis of dietary trends in added sugars intakes and sources among U.S. adults from 2001 to 2018, with a focus on variations according to the sociodemographic factors, age, sex, race and ethnicity and income, and the health-related factors, physical activity and body weight. Data from nine consecutive 2 year cycles of the National Health and Nutrition Examination Survey (NHANES) were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001 to 2018. Trends were examined in the whole sample (19+ years) and in subsamples stratified by age (19–50, 51+ years), sex, race and ethnicity (Asian, Black, Hispanic, White), household income (poverty income ratio low, medium, high), physical activity level (sedentary, moderate, vigorous) and body weight status (normal, overweight, obese). From 2001 to 2018, added sugars intake (% kcal) decreased significantly (P &amp;lt; 0.01), from 16.2 to 12.7% among younger adults (19–50 years), mainly due to declines in added sugars from sweetened beverages, which remained the top source. There were no changes in intake among older adults, and by 2018, the 23% difference in intake between younger and older adults that existed in 2001 almost disappeared. Declines in added sugars intake were similar among Black and White individuals, and all income, physical activity and body weight groups. Population-wide reductions in added sugars intake among younger adults over an 18 year time span coincide with the increasing public health focus on reducing added sugars intake. With the updated Nutrition Facts label now displaying added sugars content, it remains to be seen how added sugars intake trends carry forward in the future.

Total and Added Sugar Intakes Are Increasing among Children and Adolescents in China: Findings from CHNS 1997-2011.

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.

Macronutrient and Micronutrient Intake in Adolescents With Non-alcoholic Fatty Liver Disease: The Association With Disease Severity.

While dietary changes are recommended to treat pediatric non-alcoholic fatty liver disease (NAFLD), the role of specific nutrients in disease progression is unclear. The objective of this study is to (1) assess the macronutrient and micronutrient intake in adolescents with liver biopsy proven NAFLD [with and without non-alcoholic steatohepatitis (NASH)] and lean controls; (2) determine nutritional predictors of disease severity amongst these groups. Adolescents with biopsy-proven NAFLD and lean controls completed the Harvard Food Frequency Questionnaire. Twenty-eight NAFLD and 15 lean controls were studied. NAFLD with (n = 20) and without NASH (n = 8) had similar total calorie, protein, fat, and carbohydrate intake. Subjects with NASH had higher total sugar (122.3 ± 48.3 vs 83.1 ± 38.8 g), glucose (24.3 ± 9.3 vs 15.2 ± 7.5 g), sucrose (42.3 ± 16.9 vs 28.8 ± 11.7 g), and fructose (29.4 ± 12.5 vs 18.1 ± 8.0 g) intake than those with NAFLD but without NASH ( P < 0.05). Both NAFLD groups had similar micronutrient intake. Alanine aminotransferase (ALT) correlated with total caloric intake ( ρ = 0.4; P = 0.04). Total carbohydrate calories correlated with a higher NAS summary score ( ρ = 0.38; P = 0.04) and lobular inflammation ( ρ = 0.50; P = 0.007). Percent calories from added sugar and glucose correlated with worsening NAS summary score ( ρ = 0.44, P = 0.02; ρ = 0.48, P = 0.009) and lobular inflammation ( ρ = 0.51, P = 0.006; ρ = 0.53, P = 0.004). Percent calories from fructose correlated with lobular inflammation ( ρ = 0.56; P = 0.002). Total daily calories, protein, fat, carbohydrate, and micronutrient intake were similar between NAFLD and lean controls. NASH patients consume similar total calories, protein, and fat as those without NASH, but have significantly higher sugar intake. NAFLD and lean children, however, have similar macro/micronutrient intake. Histologic disease severity correlates with total carbohydrate and added sugar intake, supporting a role for simple sugar intake in NAFLD progression.

Global trends in added sugars and non-nutritive sweetener use in the packaged food supply: drivers and implications for public health.

The health implications of excessive added sugar intakes have led to national policy actions to limit their consumption. Subsequently, non-nutritive sweeteners (NNS) may be used to maintain product sweetness. We aimed to assess trends in quantities of added sugars and NNS sold in packaged food and beverages worldwide, and the association between these trends and the number of national policy actions across regions to reduce added sugar consumption. (i) Longitudinal analysis of Euromonitor sales data (2007-2019) to assess the quantity of added sugars (kg) and NNS (g) sold in packaged foods and beverages globally, across regions, and across country income categories; (ii) policy-mapping of policy actions targeting added sugar consumption globally from the NOURISHING database; and (iii) Spearman's correlations to assess the association between national policy actions across regions and changes in added sugar/NNS sales. Worldwide. Not applicable. Per capita volumes of NNS from beverage sales increased globally (36 %). Added sugars from beverage sales decreased in high-income countries (22 %) but increased in upper-middle-income countries (UMIC) and lower-middle-income countries (LMIC) (13-40 %). Added sugars from packaged food sales increased globally (9 %). Regions with more policy actions had a significant increase in NNS quantities from beverage sales (r = 0·68, P = 0·04). The sweetness of the packaged food supply (the sweetness of each NNS and added sugar, relative to sucrose, multiplied by sales volume) increased over time. The increasing use of NNS to sweeten beverages globally, and in packaged food in UMIC and LMIC, may have health and dietary implications in the future. Their use as a substitute for added sugar should be considered in public health nutrition policymaking.