Consumption Of Sugar-sweetened Drinks Research Articles

Research on Consumption of Sugar-Sweetened Drinks and 100% Fruit Juice

Measurement of consumption of sugar-sweetened and 100% fruit juice drinks is typically patchy and often nutritionally focused, particularly in developing countries such as Turkey, with limited public perception and awareness of the health risks associated with excessive SSB consumption, and a low stimulus level of 100% fruit juice intake. In the study, the effects of socio-demographic, economic, and lifestyle characteristics of individuals and households on their different consumption probabilities of pure fruit juice (100% FJ) and sugar-sweetened beverages (SSB) were determined using the random-effects bivariate probit model in the context of family heterogeneity in Turkey. A richer source of information was elicited by deriving different probabilities from the bivariate random effects probit model. The applied model was found to be more compatible with the data and all the correlation coefficients examined were statistically significant. While most of the variables were statistically significant, according to the regressor effect, the probability of consuming 100% fruit juice among sugar-sweetened intakers was found to be greater or less than the probability of consuming 100% fruit juice of a randomly selected individual from the population (e.g., marginal probability). In this context, we can expect that the implementation of distinct intervention health programs that will involve different population segments will contribute greatly to the development of ideal outcomes. In addition, policy recommendations were presented considering the effects of very important variables.

Operationalisation of a standardised scoring system to assess adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in the UK biobank.

In 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the "2018 WCRF/AICR Score" which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank. UK Biobank recruited >500,000 individuals aged 37-73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: "Eat a diet rich in wholegrains, vegetables, fruit, and beans", "Limit consumption of "fast foods" and other processed foods high in fat, starches or sugars" and "Limit consumption of sugar-sweetened drinks"; food frequency questionnaire data were used to assess adherence to "Limit consumption of red and processed meat" and "Limit alcohol consumption". Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system. At our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0-7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants. We describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.

Association of food habits with adolescent hypertension: A study from Manipur

Background: Hypertension is one of the major concerning health issues worldwide. Lately, adolescent hypertension has been on the rise with change in the diet and lifestyle as one of the probable contributing factors.
 Aim of the study: To study the association of food habits with different parameters of hypertension among the adolescents of Manipur.
 Material and Methods: This cross-sectional study included 728 adolescents of the age range 17–19 years comprising of 470 males and 258 females of Manipur, Northeast India. Blood pressure measurements were taken using a mercury sphygmomanometer, and the average value of three measurements was recorded. Statistical analyses were performed using IBM SPSS version 23.
 Results: Statistical analysis showed significant association of hypertension with consumption of salty food (P < 0.05, χ2 = 12.28), junk food (P < 0.05, χ2 = 6.07) and sugar sweetened drinks (P < 0.05, χ2 = 8.37). Mean arterial pressure was also found to be significantly associated with sugar-sweetened drink consumption (χ2 = 6.96, p < 0.05).
 Conclusions: The study highlighted the association of salt, sugar and junk food consumption with hypertension among the adolescents of Manipur.

Changes in health behaviours in adults at-risk of chronic disease: primary outcomes from the My health for life program

BackgroundChronic disease is the leading cause of premature death globally, and many of these deaths are preventable by modifying some key behavioural and metabolic risk factors. This study examines changes in health behaviours among men and women at risk of diabetes or cardiovascular disease (CVD) who participated in a 6-month lifestyle intervention called the My health for life program.MethodsThe My health for life program is a Queensland Government-funded multi-component program designed to reduce chronic disease risk factors amongst at-risk adults in Queensland, Australia. The intervention comprises six sessions over a 6-month period, delivered by a trained facilitator or telephone health coach. The analysis presented in this paper stems from 9,372 participants who participated in the program between July 2017 and December 2019. Primary outcomes included fruit and vegetable intake, consumption of sugar-sweetened drinks and take-away, alcohol consumption, tobacco smoking, and physical activity. Variables were summed to form a single Healthy Lifestyle Index (HLI) ranging from 0 to 13, with higher scores denoting healthier behaviours. Longitudinal associations between lifestyle indices, program characteristics and socio-demographic characteristics were assessed using Gaussian Generalized Estimating Equations (GEE) models with an identity link and robust standard errors.ResultsImprovements in HLI scores were noted between baseline (Md = 8.8; IQR = 7.0, 10.0) and 26-weeks (Md = 10.0; IQR = 9.0, 11.0) which corresponded with increases in fruit and vegetable consumption and decreases in takeaway frequency (p < .001 for all) but not risky alcohol intake. Modelling showed higher average HLI among those aged 45 or older (β = 1.00, 95% CI = 0.90, 1.10, p < .001) with vocational educational qualifications (certificate/diploma: β = 0.32, 95% CI = 0.14, 0.50, p < .001; bachelor/post-graduate degree β = 0.79, 95% CI = 0.61, 0.98, p < .001) while being male, Aboriginal or Torres Strait Islander background, or not currently working conferred lower average HLI scores (p < .001 for all).ConclusionsWhile participants showed improvements in dietary indicators, changes in alcohol consumption and physical activity were less amenable to the program. Additional research is needed to help understand the multi-level barriers and facilitators of behaviour change in this context to further tailor the intervention for priority groups.

Association of dietary risks, behavioural and lifestyle factors, and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study

BackgroundCancer patients are confronted with a variety of other health-related issues, including physical disability, poor quality of life, and psychological challenges. This study aims to quantify the association of dietary, behavioural and lifestyle risk factors and comorbidities on the magnitude and distribution of disability burden among cancer patients in Australia. MethodsThis study comprised a sample of 2283 cancer patients drawn from the latest nationwide Australian National Health Survey conducted in 2017–18. Negative binomial regression models were used to estimate the incidence rate ratio (IRR) of the number of disabilities and its associations. ResultsForty-five percent of cancer patients experienced at least one disability. The magnitude of disability was significantly associated with sugar-sweetened drink consumption ≥ 3 days per week (IRR= 1.12, 95% CI: 1.02–1.26), a lack of physical activity (IRR = 1.69, 1.38–2.07), frequent or regular alcohol consumption (IRR = 1.95, 1.84–2.08), poor health status (IRR = 1.99, 1.78–2.24) and the presence of five or more chronic comorbid conditions (IRR = 3.59, 2.90–4.46). Cancer patients who consumed vegetables at least two or more times per day had a 10% lower risk of disability burden (IRR = 0.90, 0.82–0.99). ConclusionsThis study shows the association of diet, behavioural, and lifestyle risk factors on the degree of disability burden among cancer patients, highlighting the need for bold and effective policies. The findings will inform the implementation of evidence-based lifestyle interventions and offer a foundation for evaluating their influence on cancer survivors’ health.

Consumption of Sugar-Sweetened or Artificially Sweetened Beverages and Semen Quality in Young Men: A Cross-Sectional Study.

Background: Existing literature suggests that frequent consumption of sugar-sweetened drinks may be associated with lower semen quality. Studies performed in mice suggest a dose-response relationship between intake of saccharin or aspartame, two artificial sweeteners, and sperm and testis function. Methods: A cross-sectional study based on data from The Fetal Programming of Semen Quality (FEPOS) Cohort, including 1047 young men (mean age = 19 years) was performed. Each male participant completed an online questionnaire on health, health behavior and diet, and provided a semen sample. The associations between consumption of sugar-sweetened or artificially sweetened beverages (moderate ≥ 3 days/week; infrequent < 3 days/week) and semen quality were analyzed using a multivariable, negative, binomial regression model. Results: Sugar-sweetened or artificially sweetened beverage consumption was not strongly associated with either semen volume, sperm concentration, total sperm count or total motility in young men. The proportion of morphologically normal sperm was 11% lower (0.89 (95% CI 0.76, 1.04)) for moderate (≥3 days/week) consumption of artificially sweetened beverages relative to infrequent (<3 days/week). Conclusion: Consumption of sugar-sweetened or artificially sweetened beverages, at the levels present in this study had limited effect on the measured markers of semen quality in young men.

AACE2021-A-1029: Identifying and Addressing the Determinants That Affect Successful Control of Diabetes Mellitus Type II

Various life variables are known not essential to the advancement of type 2 diabetes including weight, absence of adequate physical action, terrible eating routine, anxiety, and urbanization. A number of dietary factors such as consumption of sugar-sweetened drinks in excess and the type of fats in the diet also appear to play a role. Objectives: Estimating the prevalence of successful control of type 2 diabetes mellitus (DM) and its determinants at Diabetic Centre, Prince Mansur Military Hospital for Community Medicine, Taif, Kingdom of Saudi Arabia A cross-sectional study was adopted. It included adult DM type 2 patients (18-60 years), at (PMFCH), Armed Forces Hospital, Taif region. Successful control of type 2 DM has been defined strictly by achievement of targeted glycemic control glycated hemoglobin (HBA1C) <7. An Arabic self-administered questionnaire was utilized to collect data from patients. It includes demographic data, disease history, and lifestyle (social factors). HBA1C was recorded from the file of the patient. Trained nurse measured the weight (in kg) and height of each patient to calculate body mass index (BMI). Among 370 diabetic patients, 331 returned completed questionnaire giving a response rate of 89.5%. More than one-quarter of them (27.2%) aged over 60 and 48.4% aged between 40 and 60 years. DM was controlled among only 27.5% of the diabetic patients (HBA1C <7%) while it was uncontrolled among most of them (72.5%). In logistic regression analysis, the duration of DM, diabetes treatment, BMI, family support, and compliance with diabetic diet regimen were all significantly related to glycemic control based on HBA1C value. The patients with poor glycemic control were high, which is nearly comparable to that reported from many countries. Longer duration of diabetes, and not adherent to diabetes self-care management behaviors, obesity, combination therapy, and lack of family support were associated with poor glycemic control.

Water Drinking and its Correlation with Beverage Consumption in Korean Adolescents.

Objectives: Water intake has been recognized as a critical factor for important health outcomes. This study was an investigation of the status of water drinking and its correlation with beverage consumption among Korean adolescents. Methods: The population of this cross-sectional study included Korean adolescents (N = 57,302) from the 15th Korea Youth Risk Behavior Survey (2019). Descriptive statistical and multiple logistic regression analyses were conducted to assess the water-drinking behavior during a previous 7-day period according to the general characteristics of the adolescents. Associations were tested between water drinking and beverage consumption (carbonated beverages, sugar-sweetened beverages, energy/high-caffeine drinks, and milk). Results: Overall, 4.1% of adolescents drank less than one glass, 19.6% drank one to 2 glasses, 23.1% drank 3 glasses, 17.8% drank 4 glasses, and 35.4% drank ≥ 5 glasses of water per day during the last 7 days. The distribution of water drinking differed according to the characteristics of adolescents and was associated with the frequencies of consumption of carbonated drinks, and sugar-sweetened drinks. More than 3 times the carbonated drink (aOR = 1.28, 95% CI = 1.19-1.38) and sugar-sweetened drink consumption (aOR = 1.25, 95% CI = 1.16-1.34) were associated with lower water drinking. Conclusions: Higher consumption of carbonated and sugar-sweetened beverages was associated with less water drinking.

Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research Recommendations and Breast Cancer in the SUN Project.

A proportion of breast cancer cases are attributable to combined modifiable risk factors. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has recently updated the recommendations for cancer prevention and a standard scoring system has been published. The aim of this study was to evaluate the association between compliance with the 2018 WCRF/AICR cancer prevention recommendations (Third Expert Report) and the risk of breast cancer in the SUN (“Seguimiento Universidad de Navarra”) prospective cohort. Spanish female university graduates, initially free of breast cancer, were included (n = 10,930). An 8-item score to measure compliance to the recommendations was built: body fat, physical activity, consumption of wholegrains/vegetables/fruit/beans, “fast foods”, red/processed meat consumption, sugar-sweetened drinks consumption, alcohol intake, and breastfeeding. A stratified analysis was conducted according to menopausal status. A non-significant inverse association was observed for overall breast cancer. The inverse association became statistically significant for post-menopausal breast cancer after multivariable adjustment (hazard ratio for > 5 vs. ≤ 3 points = 0.27; 95% CI: 0.08-0.93). The results suggested that the possible inverse association with breast cancer was attributable to the combined effects of the different nutritional and lifestyle components.

Effects of high and low sucrose-containing beverages on blood glucose and hypoglycemic-like symptoms

Background and AimsThere is this intriguing but not yet well-explored suggestion that highly absorbable sucrose-sweetened drinks might exacerbate hunger by promoting temporal hypoglycemia-like responses already in non-diabetic healthy individuals. This might provide a possible additional explanatory mechanism for previous reported associations between consumption of sugar-sweetened drinks and body weight gain. The current study involves two separate and independently conducted human experiments exploring the effects of two different single-doses of sugar-sweetened beverages on temporal blood glucose nadir and possible related behavioral hypoglycemic-like symptoms in healthy participants. MethodsBy way of two separately conducted between-subjects experiments, effects of 1) a low (29 g) sugar-containing beverage compared to a sweetened zero-energy drink and a milk drink (experiment-1) or 2) a high (80 g) sugar-sweetened beverage compared to a zero-energy and a non-sweetened colored water drink (experiment-2) were measured on changes in blood glucose, behavioral hypoglycemia, appetite and mood. ResultsExperiment-1: The 29 g sucrose containing beverage caused a high (37%) glycemic increase and a smaller response (15%) to the milk drink, which both peaked 30 min after consumption, whereas the sweetened zero-energy drink had very little effect on blood glucose. Regardless of the different magnitude of peak glycemic responses, both the sugar and milk drinks rather equally caused blood glucose concentrations to return to normal and stable baseline values 90 min later. There were no (different) effects of the beverages on behavioral hypoglycemic-like symptoms, appetite or mood. Experiment-2: the 80 g sucrose containing beverage caused a large (72%) glycemic peak response at +30 min after consumption, whereas neither the sweetened zero-energy nor the non-sweetened colored water drink had any meaningful effect on blood glucose. After intake of the 80 g sugar beverage, blood glucose concentrations remained elevated (13%) at +120 min and returned to lower baseline values in the direction of hypoglycemia levels at +165 min. There were no (differential) effects of the beverages on behavioral hypoglycemic symptoms, appetite or mood. ConclusionsThe current findings indicate that instead of a low (29 g) sugar-containing beverage, a high (80 g) sugar-containing beverage caused blood glucose concentrations to fall below baseline values almost reaching hypoglycemia levels at the end of measurements. There were no hypoglycemic-like behavioral symptoms including changes in appetite or mood: at least not at end of measurements +165 min after consumption. Since this might include that in particular consumption of high-glycemic index drinks could still promote symptoms in the longer run, further research is needed to explore possible hypoglycemic-like effects of high dosages of sugar-sweetened beverages across more extended/delayed time measurements.

Obesity in Toddlers and Young Children: Causes and Consequences.

The rapid rise in obesity in toddlers and young children (aged 0-5 years) is a major concern for public health globally. Understanding risk factors for obesity in the early years is therefore fundamental to help guide parents, educators, and health care professionals caring for young children and to develop preventative strategies. Most research has focused on biological risk factors, which can be broadly categorized as genetic predisposition, poor diet (and the behaviors that influence excessive food intake), insufficient physical activity, and the role of developmental factors in early life that influence long-term health. The latter includes establishment of dietary habits and dietary patterns in young (preschool) children and the effect of a high protein intake on the increasing risk of later obesity. Other risk factors particularly relevant to young children include inadequate sleep, high consumption of sugar-sweetened drinks, and large food portions. Understanding the causes of obesity in preschool children is particularly important in view of long-term detrimental consequences of obesity in this age group on the risk of obesity and cardiometabolic disease in adults. The present chapter reviews causes of obesity in preschool children and its consequences for long-term health, focusing particularly on modifiable nutritional risk factors.

Health behaviors and goal setting among Karen youth

Purpose The purpose of this paper is to describe and compare the health behaviors of Karen youth with that of the other subpopulation seen at a Minnesota clinic. Design/methodology/approach Demographic information and data on health status, recommended health behaviors and goal-setting patterns were collected via a review of the medical records of patients seen at a family medicine residency clinic in St Paul, Minnesota during a one-year period (July 2015–June 2016). Data were summarized using descriptive statistics. Data on Karen patients were compared with data on other populations. Findings The study included 765 youths aged 3–17 years. The Karen youth in the study engaged in recommended health behaviors more frequently than their peers on almost every measure. There were statistically significant differences in the amount of sleep, intake of fruits and vegetables, screen time, number of active days per week and consumption of sugar-sweetened drinks between the Karen and their peers overall. Karen youth also reported consuming fewer sweets and fried or processed food than their peers, and they had lower BMI percentiles than other youth. Research limitations/implications The study relied on participant self-report, which is subject to potential inaccuracies in recall and reporting. Originality/value To the authors’ knowledge, this is the first study detailing health behaviors of Karen youth in the USA. The findings suggest a window of opportunity to support and empower Karen families to maintain healthy habits in order to prevent the development of chronic disease in this community.

Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis.

Accumulating research evidence suggests that individual dietary factors and dietary patterns might be implicated in the risk of development of rheumatoid arthritis (RA). This narrative review aims to present this evidence and provide nutritional recommendations for reducing RA risk in susceptible individuals. Overall, a 'Western' type diet rich in energy intake, total and saturated fat, an unbalanced ratio of n-3 to n-6 fatty acids, high in refined carbohydrates and sugar and low in fiber and antioxidants might increase the risk of RA both directly through increasing inflammation and indirectly through increasing insulin resistance and obesity, with the latter being a known risk factor for RA. On the contrary, consumption of long-chain omega-3 polyunsaturated fatty acids, derived from fish and fish oil, is associated with a reduced risk of RA probably due to their anti-inflammatory properties. The Mediterranean diet (MD), rich in plant-based foods such as wholegrains, legumes, fruit, vegetables, extra-virgin olive oil and low in red meat consumption, might have the potential to reduce the risk of RA. Based on current research evidence, it is suggested that adherence to the MD enhanced with an increased consumption of fatty fish, reduced consumption of sugar-sweetened drinks and maintenance of a normal body weight, contributes to reducing the risk of RA. Further research on RA susceptibility will allow for more specific dietary recommendations to be made.

Sugar tax reduces consumption of sugar-sweetened drinks

Sugar tax reduces consumption of sugar-sweetened drinks

Identifying and addressing the determinants that affect successful control of diabetes mellitus type II

Background: Various life variables are known not essential to the advancement of type 2 diabetes including weight, absence of adequate physical action, terrible eating routine, anxiety, and urbanization. A number of dietary factors such as consumption of sugar-sweetened drinks in excess and the type of fats in the diet also appear to play a role. Objectives: Estimating the prevalence of successful control of type 2 diabetes mellitus (DM) and its determinants at Diabetic Centre, Prince Mansur Military Hospital for Community Medicine, Taif, Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was adopted. It included adult DM type 2 patients (18-60 years), at (PMFCH), Armed Forces Hospital, Taif region. Successful control of type 2 DM has been defined strictly by achievement of targeted glycemic control glycated hemoglobin (HBA1C)

Quantitative shotgun proteomics reveals extensive changes to the proteome of the orbitofrontal cortex in rats that are hyperactive following withdrawal from a high sugar diet.

In most Westernized societies, there has been an alarming increase in the consumption of sugar-sweetened drinks. For many adults these drinks represent a substantial proportion of their total daily caloric intake. Here we investigated whether extended exposure to sugar changes behavior and protein expression in the orbitofrontal cortex (OFC). Male adult Sprague-Dawley rats (n = 8 per group) were treated for 26 days with either water or a 10% sucrose solution. Locomotor behavior was measured on the first and last day of treatment, then 1 week after treatment. Following the 1-week period free from treatment, sucrose treated rats were significantly more active than the control. Two hours following final behavioral testing, brains were rapidly removed and prepared for proteomic analysis of the OFC. Label free quantitative shotgun proteomic analyses of three rats from each group found 290 proteins were differentially expressed in the sucrose treated group when compared to the control group. Major changes in the proteome were seen in proteins related to energy metabolism, mitochondrial function and the cellular response to stress. This research does not seek to suggest that sugar will cause specific neurological disorders, however similar changes in proteins have been seen in neurological disorders such as Alzheimer's disease, Parkinson's disease and schizophrenia.

Association of dietary habits with levels of physical activity and screen time among adolescents living inSaudiArabia

Understanding the inter-relationships between lifestyle factors in youth is important with respect to the development of effective promotional programmes for healthy eating and active living. The present study aimed to explore the associations of dietary habits (DH) with physical activity (PA) and screen time (ST) among Saudi adolescents aged between 15 and 19years of age relative to gender. Data were obtained from the Arab Teens Lifestyle Study, a school-based multicentre lifestyle study conducted in 2009/2010 in three major cities in Saudi Arabia. A multistage stratified cluster random sampling technique was used. The number of participants with complete data for DH and PA was 2886 and the respective number for DH and ST was 2822. Assessment included weight, height, body mass index, total daily ST (television viewing, video/computer games and Internet use), PA and DH using self-reported questionnaires. Females were significantly more sedentary and less active than males (P<0.001). Two-way analysis of covariance, controlling for age, showed significant (P<0.05) gender by PA and gender by ST interactions for several DH. Logistic regression analyses revealed significant associations of higher PA with a higher consumption of fruit, vegetables, milk, French fries/potato chips and energy drinks, whereas higher ST was significantly associated with a higher consumption of sugar-sweetened drinks, fast foods, cake/doughnuts and energy drinks. Healthful dietary habits were associated mostly with PA, whereas sedentary behaviours, independent of PA, negatively impacted upon eating behaviours. The low PA levels and high sedentary levels of Saudi females represent a great concern. The results reported in the present study have important implications for both youth public health policies and intervention programmes.

Self-Reported Academic Grades and Other Correlates of Sugar-Sweetened Soda Intake among US Adolescents

High consumption of sugar-sweetened drinks has been associated with obesity and other adverse health consequences. This cross-sectional study examined the association of demographic characteristics, weight status, self-reported academic grades, and behavioral factors with sugar-sweetened soda intake among a nationally representative sample of US high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 16,188 students in grades 9 through 12. The main outcome measure was daily sugar-sweetened soda intake (eg, drank a can, bottle, or glass of soda [excluding diet soda] at least one time per day during the 7 days before the survey). Nationally, 29.2% of students reported drinking sugar-sweetened soda at least one time per day. Logistic regression analyses showed factors significantly associated with sugar-sweetened soda intake at least one time per day included male sex (adjusted odds ratio [OR]=1.47), Hispanic ethnicity (vs whites; OR=0.81), earning mostly B, C, and D/F grades (vs mostly As; OR=1.26, 1.66, and 2.19, respectively), eating vegetables fewer than three times per day (OR=0.72), trying to lose weight (OR=0.72), sleeping <8 hours (OR=1.18), watching television >2 hours/day (OR=1.71), playing video or computer games or using a computer for other than school work >2 hours/day (OR=1.53), being physically active at least 60 minutes/day on <5 days during the 7 days before the survey (OR=1.19), and current cigarette use (OR=2.01). The significant associations with poor self-reported academic grades, inadequate sleep, sedentary behaviors, and cigarette smoking suggest research should examine why soda consumption is associated with these behaviors to inform the design of future nutrition interventions.

Competitive Food Sales in Schools and Childhood Obesity: A Longitudinal Study.

The vast majority of American middle schools and high schools sell what is known as "competitive foods", such as soft drinks, candy bars, and chips, to children. The relationship between consumption of sugar-sweetened drinks and snacks and childhood obesity is well established but it remains unknown whether competitive food sales in schools are related to unhealthy weight gain among children. We examined this association using data from the Early Childhood Longitudinal Study Kindergarten Cohort. Employing fixed effects models and a natural experimental approach, we found that children's weight gain between 5(th) and 8(th) grades was not associated with the introduction or the duration of exposure to competitive food sales in middle school. Also, the relationship between competitive foods and weight gain did not vary significantly by gender, race/ethnicity, or family SES, and remained weak and insignificant across several alternative model specifications. One possible explanation is that children's food preferences and dietary patterns are firmly established before adolescence. Also, middle school environments may dampen the effects of competitive food sales because they so highly structure children's time and eating opportunities.

Fructose, Obesity, and Related Epidemiology

Fructose occurs in fruits, vegetable, and sweetened drinks alongside glucose as free sugars or bound in sucrose, but may also be bought in a pure form. A link between sugar-sweetened drinks (SSD) and body mass index (BMI, kg/m2) is inferred from systematic reviews of both prospective cohort studies (PCSs) and randomized, controlled trials (RCTs) (Malik et al., 2006; Wolf and Dansinger, 2008). The link is seemingly strong because such studies rank highly among types of studies according to evidence-based principles on causality. On the other hand, the study results are heterogeneous, and more objective meta-analysis shows SSDs to have a “small” effect on BMI (Forshee et al., 2008); therefore, a focus on fructose and SSD may then serve only to divert attention from major causes of obesity (Storey, 2008). A number of complications and false claims arise when interpreting epidemiological and interventional studies on fructose or SSDs. The first is a notion that high-fructose corn syrup (HFCS) differs from suc...