High-sugar Snacks Research Articles

Smartphone usage and dietary habits associated with sugar-sweetened beverages preferences among Indonesian female university students.

High sugary beverages have recently gained popularity among young adults. This research aimed to determine the association between smartphone usage and dietary consumption of Sugar-Sweetened Beverages among young female adults in Indonesia. This cross-sectional study conducted an online survey in Malang City. There were 217 female university students aged 18-25 years old who were eligible as participants. The dependent variable was a preference for SSBs consumption, while the independent variables included sociodemographics, BMI, food allergies, smartphone usage, and dietary habits. Chi-square and binary logistics were used to analyse the association between independent variables and SSBs. The results showed that 62.2% of respondents preferred to consume SSBs, and 12.9% of participants were classified as overnutrition (BMi>25). More than half of the respondents had breakfast every day, and a majority of them like to consume high carbohydrates (96.8%) and high-sugar snacks (55.3%). The binary logistic regression showed an association between BMI status, breakfast consumption, watching movies, and eating frequency with high sugar beverage consumption preference (p<0.05). Reducing sugar beverages consumption intervention should consider using media accessible with smartphone.

Pemberian Edukasi Mengenai Ragam Makanan Sehat Siswa SMP Negeri 8 Semarang

Adolescence is the stage at which age begins to be physically active compared to previous periods. Many factors affect the nutritional status of this group, both directly and indirectly. The food factor consumed is a direct determinant of nutritional status in addition to a history of illness or disease. At this age, the level of knowledge of a variety of healthy snacks and adequate nutritional content is still low, so it is necessary to provide education to this age group. SMP Negeri 8 Semarang was chosen as a place of service because the school was adjacent to an area that sells various kinds of food and becomes a gathering place for students after school. Various high-calorie, high-sugar, and low-fiber snacks are sold there. Education was provided online using the Zoom Meeting due to the COVID-19 pandemic situation. The educational activities was successful and conducive. The achievement of the target and the output of this activity has been achieved, namely the feedback from the participants and the question and answer session went well. This shows that there was a change in the level of adolescent knowledge of the material provided. Providing education about this material should be done regularly in schools. This is in view of the importance of knowledge about types of nutritious food and the fulfillment of a balanced nutritional diet, as well as its impact on adolescent growth and development, degenerative diseases, and the menstrual cycle at a young age, so that future health can always be maintained.

Impact of the COVID-19 Pandemic on Diet Behaviour Among UK Adults: A Longitudinal Analysis of the HEBECO Study.

COVID-19 pandemic restrictions impacted dietary habits during the initial months of the pandemic, but long-term effects are unclear. In this longitudinal study, self-selected UK adults (n = 1,733, 71.1% female, 95.7% white ethnicity) completed three online surveys (May–June, August–September, and November–December 2020, with a retrospective pre-pandemic component in the baseline survey), self-reporting sociodemographics, lifestyle, and behaviours, including high fat, salt, and sugar (HFSS) snacks, HFSS meals, and fruit and vegetable (FV) intake. Data were analysed using generalised estimating equations. Monthly HFSS snacks portion intake increased from pre-pandemic levels (48.3) in May–June (57.6, p < 0.001), decreased in August–September (43.7, p < 0.001), before increasing back to pre-pandemic levels in November–December (49.2, p < 0.001). A total of 48.5% self-reported increased [25.9 (95% confidence interval: 24.1, 27.8)] and 47.7% self-reported decreased [24.1 (22.4, 26.0)] monthly HFSS snacks portion intakes in November–December compared with pre-pandemic levels. Monthly HFSS meals portion intake decreased from pre-pandemic levels (7.1) in May–June (5.9, p < 0.001), was maintained in August–September (5.9, p = 0.897), and then increased again in November–December (6.6, p < 0.001) to intakes that remained lower than pre-pandemic levels (p = 0.007). A total of 35.2% self-reported increased [4.8 (4.3, 5.3)] and 44.5% self-reported decreased [5.1 (4.6, 5.6)] monthly HFSS meals portion intakes in November–December compared with pre-pandemic levels. The proportion meeting FV intake recommendations was stable from pre-pandemic through to August–September (70%), but decreased in November–December 2020 (67%, p = 0.034). Increased monthly HFSS snacks intake was associated with female gender, lower quality of life, and – in a time - varying manner – older age and higher HFSS meals intake. Increased monthly HFSS meals intake was associated with female gender, living with adults only, and higher HFSS snacks intake. Reduced FV intake was associated with higher body mass index (BMI) and lower physical activity. These results suggest large interindividual variability in dietary change during the first year of the pandemic, with important public health implications in individuals experiencing persistent increases in unhealthy diet choices, associated with BMI, gender, quality of life, living conditions, physical activity, and other dietary behaviours.

Impact of COVID-19 Pandemic on Weight and BMI among UK Adults: A Longitudinal Analysis of Data from the HEBECO Study.

COVID-19-related restrictions impacted weight and weight-related factors during the initial months of the pandemic. However, longitudinal analyses are scarce. An online, longitudinal study was conducted among self-selected UK adults (n = 1818), involving three surveys (May–June, August–September, November–December 2020), covering anthropometric, sociodemographic, COVID-19-related and behavioural measures. Data were analysed using generalised estimating equations. Self-reported average weight/body mass index (BMI) significantly increased between the May–June period and the August–September period (74.95 to 75.33 kg/26.22 kg/m2 to 26.36kg/m2, p < 0.001, respectively), and then significantly decreased to November–December (to 75.06 kg/26.27 kg/m2, p < 0.01), comparable to May–June levels (p = 0.274/0.204). However, there was great interindividual variation, 37.0%/26.7% increased (average 3.64 kg (95% confidence interval: 3.32, 3.97)/1.64 kg/m2 (1.49, 1.79)), and 34.5%/26.3% decreased (average 3.59 kg (3.34, 3.85)/1.53 kg/m2 (1.42, 1.63)) weight/BMI between May–June and November–December. Weight/BMI increase was significantly negatively associated with initial BMI, and positively associated with monthly high fat, salt and sugar (HFSS) snacks intake and alcohol consumption, and for BMI only, older age. Associations were time-varying; lower initial BMI, higher HFSS snacks intake and high-risk alcohol consumption were associated with maintaining weight/BMI increases between August–September and November–December. The average weight/BMI of UK adults fluctuated between May–June and November–December 2020. However, the substantial interindividual variation in weight/BMI trajectories indicates long-term health impacts from the pandemic, associated with food and alcohol consumption.

Sugar-sweetened beverage knowledge and consumption among third-grade primary students in Nanjing

Objective To explore the knowledge and consumption of sugar-sweetened beverage (SSB) and its influencing factors among third-grade primary students, to provide basis for take targeted intervention measures. Methods In September 2019, 1 686 primary school students of grade 3 were randomly selected from 2 primary schools in 1 urban area and 1 outer suburb area of 12 districts in Nanjing by using a multistage cluster sampling method, and a self-administered questionnaire were offered to them to collect the knowledge about sugar-sweetened beverage and its intake. Results Totally 753 students (44.7%) answered 6 or more SSB knowledge questions correctly, and the rate of 389 students (50.2%) in urban areas was higher than that of 364 students (40.0%) in suburban areas. There were 780 (46.3%) students who knew that dairy-containing beverage could not replace milk, the rate of 403 (52.0%) students in urban area was higher than that of 377 (41.4%) students in suburban area (χ 2 = 17.76, 18.99, P<0.05). Logistic regression analysis showed that compared with the frequency of consumption of SSB <1 time per week, the behavioral risk factors of primary school students who drink SSB ≥4 times per week were: urban area ( OR = 1.55), low parents educational level ( OR = 2.44), and frequent storage of SSB at home ( OR = 1.62). The protective factors were as follows: duration of extracurricular physical activity <120 min/week ( OR = 0.68), video time <120 min/day ( OR = 0.50), awareness rate of SSB ≥60% ( OR = 0.75), and restriction of high-sugar snacks by parents ( OR =0.60). Conclusion The knowledge associated with SSB among third-grade students in Nanjing is relatively low. Consumption of SSB has been influenced by areas, parents’ educational level, knowledge about SSB and family factors. SSB consumption among primary students should be interfered at the school and family level. The health food education need to carry out based on the school and family, so as to create a supportive atmosphere integrating the school-family to drink less sugar beverages. 【摘要】 目的 了解南京市三年级学生含糖饮料知识知晓和饮用情况及其影响因素, 为采取有针对性的干预措施提供依 据。 方法 2019 年 9 月, 采用多阶段随机整群抽样方法, 在南京市 12 个行政区随机抽取 1 个城区和 1 个远郊地区, 每个区 随机抽取 2 所小学, 以所有在校三年级学生共 1 686 名为研究对象, 通过自填式问卷收集含糖饮料相关知识及摄人情况。 结果 含糖饮料相关知识答对 6 题及以上的学生有 753 名 (44.7%), 城区 (50.2%) 高于郊区 (40.0%); 含乳饮料不能替代 牛奶知晓率为 46.3% (780 名), 城区 (52.0%) 高于郊区 (41.4%), 差异均有统计学意义 (χ 2 值分别为 17.76, 18.99, P 值均<0.05)。Logistic 回归分析显示, 与喝含糖饮料频率 <1 次/周相比, 与小学生喝含糖饮料频率 ≥4 次/周呈正相关的因素有城 区 ( OR =1.55)、父母亲文化程度较低 ( OR = 2.44)、家中经常有含糖饮料储备 ( OR =1.62), 呈负相关的因素有校外体育活动 时长 <120 min/周 ( OR = 0.68)、视屏时间 <120 min/d ( OR = 0.50)、含糖饮料知识正确率 ≥60% ( OR = 0.75)、父母限制吃高糖 零食行为 ( OR = 0.60)。 结论 南京市三年级学生含糖饮料知识知晓水平较低, 学生含糖饮料摄人情况受地区、父母亲文化 程度、含糖饮料知识知晓及家庭因素影响。应在学校和家庭层面对学生的含糖饮料摄人行为进行干预, 营造学校-家庭一体的少喝含糖饮料支持性氛围。

Can Visual Cues to Portion Size Reduce the Number of Portions of Consumed? Two Randomized Controlled Trials.

Since 1950, the portion size of many snack foods has more than doubled and obesity rates have tripled. Portion size determines energy intake, often unwittingly. This paper tests whether salient visual cues to portion size on the packaging of high fat, sugar, or salty (HFSS) snacks can reduce consumption. Two preregistered randomized controlled trials (N = 253 and N = 674) measured consumption in a lab and the home environment. Cues were salient, labeled stripes that demarcated single portions. Participants were randomized to cue condition or control. Consumption was measured without awareness. The main preregistered effect of the visual cue was not statistically significant. There was some variation by subgroup. In Study 1, men were more likely to eat the whole can of potato chips than women but significantly reduced consumption when visual cues were on the pack. The effect size was large: the number of men eating more than the recommended portion fell by 33%. Study 2 monitored household consumption of chocolate biscuits (cookies) sent to family homes in gift packs. Again, the main effect was nonsignificant but there was significant subgroup variation. When the person receiving the biscuits was female, households were more likely to eat more than the recommended portion per person per day, but less likely when the visual cues were displayed. The gender of the eaters was not known. The effect size was again large: the number of households eating more than the recommended portion fell by 26%. Households with children were also less likely to open packs with visual cues compared to control packs. Both studies recorded significant increases in the likelihood of observing serving size information, together with confusion about what it means. The studies offer some evidence that salient visual cues could play a role in tackling the high consumption of unhealthy snacks, but the effects are confined to specific subgroups and warrant further investigation.

The Effects of Snack Exposure, Package Size, and Variety on Subsequent Energy Intake in Healthy Adults

Abstract Objectives The purpose of this study was to examine whether snack exposure, package size, and variety influence subsequent energy intake and food choice in healthy adults. Methods Thirty-one healthy young adults (age: 23.6 ± 0.7y; BMI: 23.0 ± 0.5 kg/m2) participated in a randomized crossover study. At baseline, participants completed a 3-day snack recall in which they reported any snack foods or beverages consumed outside of breakfast, lunch, and dinner eating occasions (Control). Following baseline, the participants were provided, in randomized order, with the following isocaloric pack-out coolers to consume for 3 non-consecutive days/pack-out type: 1) Standard: containing 11 commonly consumed snacks (e.g., salty snacks, desserts &amp; candy, fruit, vegetables, etc.); 2) Large Package: containing the same snacks at Standard but in larger package sizes; and 3) Variety: containing the same types of snacks as Standard plus an additional eight snacks. During the Control and pack-out assessment periods, standardized breakfasts, lunches, and dinners were provided. Three-day averaged ad libitum snack energy intake and food choices were assessed. Results Three-day average snack intake from Control was 747 ± 59 kcal, Standard was 1121 ± 111 kcal, Large Package was 1274 ± 138 kcal, and Variety was 1110 ± 103 kcal. Regardless of type, the exposure to free, snack pack-outs increased snack energy intake compared to Control (all, P &amp;lt; 0.005). Large Package increased snack energy intake vs. Standard (P = 0.01) and Variety (P = 0.02). Further, Large Package increased consumption of desserts &amp; candy, high fat, high sugar, and salty snacks vs. Standard (all, P &amp;lt; 0.03) and Variety (P &amp;lt; 0.02 to P = 0.06). Alternately, Variety increased consumption of fruits and vegetables compared to Large Package (P = 0.01) and Standard (P &amp;lt; 0.005). No other differences were observed. Conclusions Exposure to free, highly palatable snacks provided in larger package sizes led to greater energy consumption, especially from energy-dense snacks, in healthy adults, whereas snack variety increased nutrient-dense snacking without increased energy consumption. These results suggest that snack exposure, package size, and variety should be considered when developing dietary strategies to promote energy balance and healthy eating habits. Funding Sources Sabra Dipping Company and Internal Funds.

Compliance with the Eatwell guide: a case study using supermarket transaction records in Yorkshire and the Humber

AbstractIntroductionSupermarket transaction data, generated from loyalty cards, offers a novel source of food purchase information. Data are available for large sample sizes, over sustained periods of time, allowing for habitual purchasing patterns to be generated. In the UK, recommended dietary patterns to achieve a healthy diet are pictorially illustrated using the Eatwell Guide. Foods include: Fruit and vegetables; starchy products including potatoes, bread, pasta, rice; dairy or dairy alternatives; proteins such as beans, pulses, fish, eggs and meat; oils and spreads; and advice to limit foods high in salt, fat and sugar. Through mapping of foods purchased to the categories of the Eatwell Guide it is possible to review population performance against these national recommendations.Materials and methodsAll loyalty card transaction records for purchases made in a UK supermarket chain, by residents of Yorkshire and the Humber during 2016 were included in this research. Customers who purchased foods from 7 or 11 Living Cost and Food Survey (LCFS) categories on ten or more occasions throughout the year were included in the sample, as these customers were considered to be purchasing the majority of their foods from the supermarket. All foods purchased were mapped to the Eatwell Guide food groups via the LCFS categories.ResultsHouseholds purchased: 25% of their total spend on fruits and vegetables, compared with 39% recommended; 13% on starchy products compared to 37% recommended; 23% of protein rich foods compared with 12% recommended; 12% dairy and alternatives compared to 8%; oils and spreads 2% compared to 1% recommended; and 25% foods that should be limited compared to 3% (recommended, but not pictorially illustrated on the plate).DiscussionSupermarket transaction data is a novel source of food purchase information which can be used to illustrate dietary behaviours in the UK population. However, it represents foods purchased, not consumed and is at a household level, not individual. Food purchases outside the home are not included. That said, it is arguably an objective measure for dietary assessment. From this study, it is clear to see that food purchases do not match the recommendations. Purchases of high sugar, high fat and high salt snacks constitute a significant proportion of spending, when they should in fact be limited. Protein rich products are also over-represented. Fruit and vegetables and starchy products are under-represented. This insight can benefit both retailers and policy makers for understanding the food purchase behaviours of our society.

Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study

ObjectiveTo estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks.DesignModelling study.SettingGeneral adult population of the United Kingdom.Participants36...

Which snack factors and nutritional ingredients influence college students’ snack choices? Evidence from discrete choice experiments

Objective: The study examined which snack factors and nutritional ingredients influence college students’ snack choices using a discrete choice experiment (DCE). Participants: In November 2016, a total of 1,624 undergraduate students participated in the study. Methods: Two DCEs were constructed using a unique approach of block fractional factorial designs. The first DCE examined four three-level snack factors: healthiness, taste, convenience, and price. The second DCE focused on six two-level nutritional ingredients: sugar, salt, calories, fat, all natural, and fiber. Results: Students preferred quick and cheap snacks, but higher prices on healthy snacks did not affect their decision significantly. Healthiness and sugar had the highest relative importance of snack factors and nutritional ingredients, respectively. High-sugar snacks were less favored if students considered themselves educated in nutrition. Conclusion: Thus, potential ways to improve the snack choices for college students are to offer healthier snacks on college campuses and to promote nutrition education.

Association of diet in nurseries and physical activity with zBMI in 2\u20134-year olds in England: a cross-sectional study

BackgroundChildhood obesity tracks into adulthood with detrimental effects on health. We aimed to examine the relationships of diet in childcare settings and daily physical activity (PA) of preschoolers with body mass index z-score (z-BMI).MethodsWe conducted a cross-sectional study of 150 children aged 2–4-years participating in the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) UK study to examine the associations of their diet in childcare settings and daily PA with z-BMI. Dietary intake was observed and recorded by fieldworkers using a validated tick-list food questionnaire and diet quality was assessed based on adherence to Children’s Food Trust (CFT) guidelines. PA was measured using accelerometers. We derived z-BMI scores using the UK 1990 and International Obesity Taskforce growth reference charts. Multilevel regression models were used to estimate associations between diet and PA with z-BMI separately, adjusted for age, gender, ethnicity, parental education level and clustering.ResultsAmong children who consumed one main meal or snack at childcare, 34.4% and 74.3% met the standards on fruits and vegetables and high sugar or fat snacks, respectively. Adherence to CFT guidelines was not associated with zBMI. Only 11.4% of children met recommended UK guidelines of three hours per day of physical activity. Minutes spent in light PA (β = 0.08, 95% CI = 0.01, 0.15) and active time (β = 0.07, 95% CI = 0.01, 0.12) were positively associated with UK 1990 zBMI scores.ConclusionsThe low proportion of children meeting the standards on fruits and vegetables and high sugar or fat snacks and recommended physical activity levels highlight the need for more work to support nurseries and parents to improve preschool children’s diet and activity. In our exploratory analyses, we found children with higher zBMI were more physically active which could be attributed to fat-free mass or chance finding and so requires replication in a larger study.Trial registrationISRCTN16287377. Registered 12 June 2014.

The effect of dietary changes on distinct components of the metabolic syndrome in a young Sri Lankan population at high risk of CVD.

South Asian populations are predisposed to early onset of the metabolic syndrome. Lifestyle intervention programmes have demonstrated a reduction in the metabolic syndrome and CVD risk; however, the most effective components of the multi-faceted lifestyle interventions are unknown. We studied 2637 Sri Lankan males (n 1237) and females (n 1380), with a mean BMI of 23·9 (sd 4·2) kg/m2, aged 22·5 (sd 10·0) years, who had participated in a 5-year lifestyle-modification programme to examine the effect of dietary changes on distinct components of the metabolic syndrome. The dietary intervention comprised advice to replace polished starches with unpolished starches, high-fat meat and dairy products with low-fat products and high-sugar beverages and snacks with low-sugar varieties. For the purposes of this analysis, data from the control and intensive lifestyle groups were combined. Anthropometric and biochemical data were recorded, and a FFQ was completed annually. Multiple regression was used to determine the effect of the dietary changes on distinct components of the metabolic syndrome. The ratio unpolished:polished rice was inversely related to change in fasting glucose (β=-0·084, P=0·007) and TAG (β=-0·084, P=0·005) and positively associated with change in HDL-cholesterol (β=0·066, P=0·031) at the 5-year follow-up after controlling for relevant confounders. Red meat intake was positively associated with fasting glucose concentrations (β=0·05, P=0·017), whereas low-fat (β=-0·046, P=0·018) but not high-fat dairy products (β=0·003, P=0·853) was inversely related to glucose tolerance at the follow-up visit. Replacement of polished with unpolished rice may be a particularly effective dietary advice in this and similar populations.

Functional Imagery Training to reduce snacking: Testing a novel motivational intervention based on Elaborated Intrusion theory

Functional Imagery Training (FIT) is a new theory-based, manualized intervention that trains positive goal imagery. Multisensory episodic imagery of proximal personal goals is elicited and practised, to sustain motivation and compete with less functional cravings. This study tested the impact of a single session of FIT plus a booster phone call on snacking. In a stepped-wedge design, 45 participants who wanted to lose weight or reduce snacking were randomly assigned to receive a session of FIT immediately or after a 2-week delay. High-sugar and high-fat snacks were recorded using timeline follow back for the previous 3 days, at baseline, 2 and 4 weeks. At 2 weeks, snacking was lower in the immediate group than in the delayed group, and the reduction after FIT was replicated in the delayed group between 2 and 4 weeks. Frequencies of motivational thoughts about snack reduction rose following FIT for both groups, and this change correlated with reductions in snacking and weight loss. By showing that FIT can support change in eating behaviours, these findings show its potential as a motivational intervention for weight management.

Streptococcus mutans and Lactobacillus Species Infection in Obese and Non-Obese School Children in Accra, Ghana

Introduction Several bacteria colonize the oral cavity. Some are involved in oral diseases including dental caries. Dental caries is one of the commonest oral problems in children [1]. Acid producing oral bacteria such as Streptococcus mutans and Lactobacillus species are the major bacteria associated with caries [2]. For a long time it was thought that the presence of these bacteria alone may lead to dental caries but later studies have demonstrated that there were cases where caries occurred even in the absence of these bacteria [3,4]. Some of these other bacteria include Streptococcus sanguinis, Streptococcus oralis, Neisseria subflava. However, when Streptococcus mutans and Lactobacillus species dominate the plaque caries occurs faster [2,3]. Colonization by some of the oral bacterial starts even before the eruption of teeth in the mouth of children [5]. These bacteria are thought to be transmitted from mother to child [6-9]. Background: Streptococcus mutans and Lactobacillus species are major bacteria associated with dental caries. In the presence of fermentable sugars and poor oral hygiene these bacteria increase risk of caries. Some studies have associated obesity with dental caries while others did not. High sugar snacks are risks for both obesity and dental caries. Citation: Ndanu TA, Aryeetey R, Sackeyfio J, Otoo G, Lartey A, et al. (2015) Streptococcus Mutans and Lactobacillus Species Infection in Obese and Non-Obese School Children in Accra, Ghana. J Obes Overweig 1(1): 101 Objectives: This study aimed at determining Streptococcus mutans and Lactobacillus species infection and its relationship with dental caries among obese and non-obese children. Methods: Oral plaque was taken from 75 each of obese and non-obese children from private schools in Accra, Ghana. The plaque was pre-enriched in thioglycollate broth for 48 hours at 37 °C. Streptococcus mutans and Lactobacillus species were recovered after sub-culturing the broths onto Mitis Salivarius Bacitracin (MSB) and Man Rogosa Sharpe (MRS) selective plates, respectively, and incubation at 37 °C under anaerobic conditions. Bacteria isolates on the selective plates were identified using Gram morphology and catalase activity. Results: Streptococcus mutans was isolated in 51 (33.6%) of all 150 children. The prevalence of Streptococcus mutans was significantly higher in the obese children 31 (41.3%) than the non-obese 20 (26.0%), p=0.033. Recovery of Lactobacillus species was low 2 (1.3%). Caries prevalence was similar in the obese 14.9% and non-obese 15.1%. There was no significant association between Streptococcus mutans infection and the dental caries. Overall Silness and LOe Plaque Index of 1.1 ± 0.5 indicate good oral hygiene status for the children. Conclusion: Obese school children had higher oral Streptococcus mutans infections than non-obese children but this was not significantly associated with dental caries prevalence.

Testing Satter’s Division of Responsibility in Feeding in the context of restrictive snack-management practices

Testing Satter’s Division of Responsibility in Feeding in the context of restrictive snack-management practices

Hypercaloric diets with increased meal frequency, but not meal size, increase intrahepatic triglycerides: A randomized controlled trial

American children consume up to 27% of calories from high-fat and high-sugar snacks. Both sugar and fat consumption have been implicated as a cause of hepatic steatosis and obesity but the effect of meal pattern is largely understudied. We hypothesized that a high meal frequency, compared to consuming large meals, is detrimental in the accumulation of intrahepatic and abdominal fat. To test this hypothesis, we randomized 36 lean, healthy men to a 40% hypercaloric diet for 6 weeks or a eucaloric control diet and measured intrahepatic triglyceride content (IHTG) using proton magnetic resonance spectroscopy (1H-MRS), abdominal fat using magnetic resonance imaging (MRI), and insulin sensitivity using a hyperinsulinemic euglycemic clamp with a glucose isotope tracer before and after the diet intervention. The caloric surplus consisted of fat and sugar (high-fat-high-sugar; HFHS) or sugar only (high-sugar; HS) and was consumed together with, or between, the three main meals, thereby increasing meal size or meal frequency. All hypercaloric diets similarly increased body mass index (BMI). Increasing meal frequency significantly increased IHTG (HFHS mean relative increase of 45%; P = 0.016 and HS mean relative increase of 110%; P = 0.047), whereas increasing meal size did not (2-way analysis of variance [ANOVA] size versus frequency P = 0.03). Abdominal fat increased in the HFHS-frequency group (+63.3 ± 42.8 mL; P = 0.004) and tended to increase in the HS-frequency group (+46.5 ± 50.7 mL; P = 0.08). Hepatic insulin sensitivity tended to decrease in the HFHS-frequency group while peripheral insulin sensitivity was not affected. Conclusion: A hypercaloric diet with high meal frequency increased IHTG and abdominal fat independent of caloric content and body weight gain, whereas increasing meal size did not. This study suggests that snacking, a common feature in the Western diet, independently contributes to hepatic steatosis and obesity. (Trial registration: http://www.forestplots.net; nr.NCT01297738.) (Hepatology 2014;60:545–553)

Change in Dietary Energy Density after Implementation of the Texas Public School Nutrition Policy

Consumption of energy-dense foods has been associated with rising obesity rates and the metabolic syndrome. Reducing dietary energy density is an important strategy to address obesity, but few studies have examined the effect of nutrition policies on children's energy density. The study's objective was to assess the impact of the Texas Public School Nutrition Policy on children's energy density by using a pre- and post-policy evaluation. Analysis of variance/covariance and nonparametric tests compared energy density after the Texas policy change to intakes at baseline. Two years of lunch food records were collected from middle school students in Southeast Texas at three public middle schools: baseline (2001-2002) and 1 year after implementation of the Texas Policy (2005-2006). Students recorded the amount and source of foods consumed. The Texas Public School Nutrition Policy was designed to promote a healthy school environment by restricting portion sizes of high-fat and high-sugar snacks and sweetened beverages, fat content of foods, and serving of high-fat vegetables like french fries. Energy density (kcal/g): energy density−1 was the energy of foods only (no beverages) divided by the gram weight and has been previously associated with obesity and insulin resistance; energy density−2 included all food and beverages to give a complete assessment of all sources of calories. Following implementation of the Texas policy, students' energy density−1 significantly decreased from 2.80±1.08 kcal/g to 2.17±0.78 kcal/g ( P<0.0001). Similarly, energy density−2 significantly decreased from 1.38±0.76 kcal/g to 1.29±0.53 kcal/g ( P<0.0001). In conclusion, the Texas Public School Nutrition Policy was associated with desirable reductions in energy density, which suggests improved nutrient intake as a result of student school lunch consumption.

Obesity and its association with diets and sedentary life style among school children in Seoul, Korea: Compliance with Dietary References Intakes for Koreans food guides

This study compared obese children's food group intakes with the new Dietary References Intakes for Koreans (KDRIs) food guides for 5th-6th grade school children. This study also determined the extent of sedentary life styles related with obesity in this area of children. This is a cross-sectional study of 799 school children. The dietitian sent a survey form describing the project and a questionnaire to the subject's family. The questionnaire included child demographics, family history of chronic diseases, the daily servings of five food groups, such as grains, meat and beans, dairy products, fruits, and vegetables. The daily or weekly hours of physical activity, television viewing, and computer usage were also surveyed. Obesity index (%) of the subjects was calculated, and children with an obesity index (%) equal to or greater than 20 were classified as the obese. Among the 799 participants, 50.7% were female. The percentages of the normal and the obese were 691 (86.5%) and 108 (13.5%) respectively. Obese children reported eating less vegetables (p<0.05), more high sugar snacks (p<0.05), and high fat snacks (p<0.05) than normal children. No significant differences in food servings of grains, meats and beans, and fruits, and dairy products between the normal and the obese were shown. Obese children reported fewer hours of physical activities (p<0.05) and more hours of computer usage (p<0.05) than normal children. Girls showed less likelihood of being obese (odds ratio, 0.575, CI (0.38, 0.87), p<0.05). More hours of physical activity significantly decreased the likelihood of being obese (odds ratio, 0.572, CI (0.35, 0.92), p<0.05). Family history of obesity almost doubled the likelihood of obesity in children (odds ratio, 2.653, CI (1.660, 4.241), p<0.05). In conclusion, frequent snacking, inadequate vegetable consumption, and sedentary lifestyle increased significantly the likelihood of obesity in children, which suggest that obesity intervention in this age group should focuse more on those variables.

Effects of increasing increments of fat- and sugar-rich snacks in the diet on energy and macronutrient intake in lean and overweight men.

Two studies have examined the effect on energy intake and macronutrient selection of increasing increments of mandatory high-fat or high-sugar snacks into the diet in men. The present study used a within-subject, repeated-measures design. In each experiment, six lean and six overweight, unrestrained men were each studied over three 7 d treatment periods, during which they were given mandatory snacks of the same energy density (550 kJ/100 g) comprising the following (in terms of percentage energy as fat-carbohydrate-protein): high-fat, 80:10:10; high-sugar, 10:80:10, of which 65 % was sugar, and 15 % starch. Subjects were given 0, 1.5 or 3.0 MJ/d snacks, in a randomised counterbalanced design, to be consumed mid-morning and mid-afternoon. Throughout each day, subjects had access ad libitum to fifteen high-protein, fifteen high-fat and fifteen high-carbohydrate foods, rotated on a 3 d menu. Mandatory high-fat snacks significantly elevated energy intake and fat intake, whereas high-sugar snacks elevated energy intake and carbohydrate intake (all P<0.02). Mandatory increases in sugar intake did not displace fat from the diet or vice versa. It was concluded that the ingestion of up to 3 MJ/d high-fat and high-sugar foods promoted weak compensation (18 % and 30 %, respectively) and therefore elevated daily energy intake by approximately 2.0-2.5 MJ.

P82: DRAGON Program: Nutrition Education for Chinese Preschoolers

Preschoolers' health behaviors should not be taken for granted, but can and should be learnt and shaped by kindergarten nutrition education. However, only minimal health messages are taught to combat childhood obesity in Hong Kong preschools. The “Diets and Regular Activities—Gifts Obtainable from Nurseries” (DRAGON) Program, targeting Chinese preschoolers aged 3 to 6 years, was developed and introduced in three kindergartens in 2005. DRAGON's 20-lesson curriculum, focusing on three themes, “Balanced Diets”, “Regular Meals” and “Active ME!” was taught through sensory experiences, songs, stories and exercises followed by three booster activities emphasizing parent-child involvement. Self-administered parental questionnaires (Education: Npre = 435; Npost = 374 and Control: Npre = 216; Npost = 206), teachers' after-class evaluations (n = 25) and three teacher focus groups and principal interviews evaluated DRAGON's efficacy and feasibility. After completing all 20 lessons, teachers reported students liked making foods, moving rhythmically, playing actively and also improved their health knowledge and teatime behaviors. At home, Education Group children consumed high-sugar snacks, e.g. pastry or cream cake, and high fat foods, e.g. meat with visible fat, significantly (P < .001 for both) less frequently. Also, only Education Group parents significantly reduced the frequency of some negative mealtime behaviors e.g. urging their child to finish eating all food on the plate (P < .001) or offering their child's desired food after he/she ate healthy food (P = .005). Principals agreed both students and teachers gained better health knowledge and supported continuing DRAGON nutrition education for their students. We conclude the DRAGON Program was effective and feasible. Funding was granted from The Chinese University of Hong Kong.