Sugar-sweetened Beverage Intake Research Articles

Carbohydrates – a scoping review for Nordic Nutrition Recommendations 2023

Background: Dietary carbohydrates are a major source of energy in the Nordic and Baltic countries. The health effects of different types of carbohydrates vary and there is a need to update the evidence regarding specific carbohydrates and their effects on health-related outcomes.
 Objective: The aim of this scoping review was to describe the evidence for the role of total carbohydrates (fiber excluded), glycemic index (GI) or glycemic load (GL) and added or free sugars for health-related outcomes as a basis for setting and updating dietary reference values for the Nordic Nutrition Recommendation (NNR) 2023.
 Method: We included evidence from several qualified systematic reviews (the World Cancer Research Fund, the European Food Safety Authority, the World Health Organization, the United States Dietary Guidelines Advisory Committee, the United Kingdom Scientific Advisory Committee on Nutrition) identified by the NNR project in line with the protocol description.
 Results: There is limited evidence that total carbohydrate intake (fiber excluded) outside of the current recommended range of 45–60% of energy is associated with health-related outcomes. There were no consistent benefits on clinical outcomes when changing the GI of a diet. High intake of dietary sugars is well known to be associated with dental caries. There was evidence from randomized control trials on surrogate disease endpoints, for a positive and causal relationship between the intake of added and free sugars and risk of some chronic metabolic diseases with moderate level of certainty for obesity and dyslipidaemia. The level of certainty was high for an association between high intake of sugar-sweetened beverages and risk of several chronic metabolic diseases.
 Conclusion: While there is limited evidence that total carbohydrates and GI and GL of the diet are related to health outcomes, the evidence suggests that high intakes of added and free sugars are related to detrimental health effects. In addition, with increasing intake of added and free sugars, there is less room for healthy foods and micronutrients, which is especially important for those with low energy intake, such as children.

Assessing sugar-sweetened beverage consumption in early pregnancy using a substance abuse framework

Sugar-sweetened beverages (SSB) are previously reported to jeopardize maternal fetal health, most well-known for gestational diabetes, childhood obesity, and cognitive impairment. Although warnings and diet recommendations urge pregnant women to consume less SSB, there is no noticeable difference in their behavior. How and why reproductive women change their SSB consumption patterns were not investigated previously. Our study aims to investigate beverage consumption patterns and how these patterns change in pregnancy in the context of substance use disorder (SUD). We invited all pregnant women visiting the clinic to answer a structured 20-min questionnaire every trimester during the regular antennal visit. At the end of the study, 337 pregnant women aged over 20 participated. A total of 301 responses entered for final analysis, with a response rate of 89.3%. Our finding showed those with high DSM-5-TR scores reduced SSB intake after becoming pregnant, while those with mild or low DSM-5-TR scores increased SSB intake after becoming pregnant. The top 3 factors related to their SSB consumption were “use despite of known health hazard (n = 133)”, “increased desire to drink (n = 88)”, and “excessive time spent on seeking SSB (n = 85)”. The least reported factors were in the domains of social impairment (ranging from n = 3 to n = 26), pharmacologic effects (i.e., tolerance (n = 24) and withdrawal (n = 70). When participants reduced SSB consumption after becoming pregnant, their choice of beverages largely shifted to sugarless beverage but not much plain water. The result provided new insights in deciphering pregnant women’s psychomotor factors for SSB intake, which served as useful references for making clinical or even public health recommendations.

Chrononutrition behaviors, sugar-sweetened beverage consumption, sleep quality and the association with body mass index among Malaysian women

ABSTRACT The present study aimed to determine the association between chrononutrition behaviors, sugar-sweetened beverage intake, and sleep quality among Malaysian women. A cross-sectional study using a validated, self-administered Chrononutrition Profile Questionnaire, Beverage Questionnaire and Sleep Quality Index were conducted among 934 Malaysian women. Multinomial logistic regression was performed to obtain odds ratios of being overweight/underweight and to test the association with poor sleep quality. 40% of Malaysian women were either overweight or obese and 65.4% had poor sleep quality. We found that breakfast skipping (OR: 4.101; CI: 2.378–7.070), poor evening eating (OR: 4.073; CI: 1.631–10.186), and eating the largest meal at night (OR: 6.970; CI: 1.944–24.994) increased the odds of being underweight. On the other hand, the daily consumption of 100% fruit juices (OR: 1.668; CI: 1.058–1.731), daily consumption of sweetened coffee or tea (OR: 1.707; CI: 1.162–2.508) and consumption of diet soft drinks by 6 times or fewer (OR: 1.484; CI: 1.066–2.064) are associated with increased odds of being overweight. However, when adjusted, only poor evening latency (AOR: 16.638; CI: 1.986–139.383) revealed an increased odd of being underweight. The highest odds predicting poor sleep quality were found for eating the largest meal during dinner (OR: 3.696; CI: 1.967–6.945) and (AOR: 2.194; CI: 1.119–4.304) when adjusted. Hence, the result indicates that multifactorial impacts on women’s body weight and recommendations to adjust chrononutrition and sugar-sweetened beverages intake in lifestyle must be done carefully considering other parameters together.

Substitution of sugar-sweetened beverages with non-caloric alternatives and weight change: A systematic review of randomized trials and meta-analysis.

Intake of sugar-sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar-sweetened beverages with non-caloric beverages results in long-term reduction in body weight. The objective of this study is to explore if a long-term reduction in body weight can be achieved by replacing an existing intake of sugar-sweetened beverages with non-caloric beverages. Systematic review and meta-analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a "substitution" design were included, that is, studies where subjects substituted an existing intake of sugar-sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow-up of weight change were included. Six trials with a total of 1729 participants were included in the meta-analysis. Replacing an existing intake of sugar-sweetened beverages with a non-caloric beverage resulted in a long-term BMI reduction of 0.31 kg/m2 compared with the sugar-sweetened beverage-group (95% CI; 0.17-0.44). One study with 1 year's intervention and 2 years follow-up showed a regression towards baseline BMI after the intervention had ended. Replacing an existing use of sugar-sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long-term 0.31 kg/m2 reduction in BMI equivalent to 0.5-1 kg in children and adults, respectively, as long as the interventions lasted.

‘If you’re serious about losing weight, why are you drinking all those Cokes?’: a critical discourse analysis of interviews on sugar-sweetened beverages amongst residents of a middle to upper class neighborhood in Winnipeg, Manitoba

ABSTRACT Sugar-sweetened beverages (SSB) have been identified as a health policy target, due to their associations with weight gain. However, fatness or ‘obesity’ is associated with stigma, and for ‘obese’ children, mother blame; thus, SSB policies must be evaluated for their potential to reinforce existing forms of stigma. The purpose of this study was to explore discourses mobilized in discussion of SSB consumption and purchasing amongst residents of a middle-upper class neighborhood in Winnipeg, Canada. We conducted a critical discourse analysis of qualitative interviews from 2019, with English-speaking, adult participants using purposive sampling. Eighteen participants were recruited; fifteen were women, all self-identified as white and spoke about (grand)parenting. Considerations of weight stigmatization informed analysis. Participants utilized a personal responsibility discourse to determine the acceptability of SSB purchasing and consumption. Negative emotions, or judgements, shaped discussion of regular SSB consumption, consumption by higher-weight individuals, or consumption in specific contexts, which were unacceptable. Parental responsibility was a discourse applied to children’s SSB intake and elicited judgmental language, particularly among mothers. The discourses utilized by dominant social groups are stigmatizing, particularly when directed towards higher-weight individuals, leading to maternal blame. Therefore, the impact of SSB policies on stigma, including weight-based stigma, should be carefully considered prior to implementation.

Is the Consumption of Added Sugar from Common Beverages Associated with the Presence of Attention Deficit Hyperactivity Disorder Symptoms in Thai Medical Students?

Attention deficit hyperactivity disorder (ADHD) significantly affects the well-being of medical students in various aspects. Sugar-sweetened beverages (SSBs) pose a potential risk of ADHD. Our study aimed to determine the prevalence of ADHD symptoms and the association between consumption of added sugar in common beverages and ADHD symptoms in Thai medical students. An online cross-sectional survey was conducted among medical students at Chiang Mai University from May 2022 to April 2023. The consumption of added sugar from common beverages in Thailand was assessed using the Thai Adolescence Sugar Sweetened Beverage Intake (THASSI) questionnaire. An Adult ADHD Self-Report Scale (ASRS) score ≥ 3 identified the presence of ADHD symptoms. Multivariable logistic regression was used for the analysis. Of 441 participants, 29.9% had ADHD symptoms. Daily consumption of added sugar from beverages higher than 25 g/day showed an increased risk of ADHD symptoms (adjusted odds ratio (OR) 1.80, 95%CI 1.15 to 2.84, p = 0.011). The same trend was observed when using the sex-specific cutoff points (adjusted OR 1.73, 95%CI 1.10 to 2.73, p = 0.018). Higher consumption of added sugar from beverages may increase the risk of ADHD symptoms in Thai medical students. This finding supports the implementation of health policies that promote healthy consumption behaviors among medical students.

Parental Feeding Styles and Risk of a New Carious Lesion in Preschool Children: A Longitudinal Study.

Parents may influence children's intake of sweets and sugar-sweetened beverages through their feeding styles. This study prospectively assessed the association between parental feeding styles and caries risk in preschool children. In November and December 2021, we recruited 1181 preschool children aged 3-4 years in Guangzhou, China, and then conducted a follow-up visit after 15 months. The children were examined for dental caries, and their parents answered the Chinese version of the Parental Feeding Style Questionnaire. Data were analyzed using logistic regression analysis. At baseline, 'control over eating' was found to be negatively associated with early childhood caries (OR = 0.60, 95%CI = 0.44, 0.83). After 15 months, no significant association between baseline parental feeding styles and the risk of a new carious lesion was found. When considering changes in parental feeding styles between the baseline and the follow-up visit, we found children with increasing scores on 'instrumental feeding' during the 15 months had a higher risk of a new carious lesion (OR = 1.91, 95%CI = 1.18, 3.12). However, children with always-intermediate scores (OR = 0.51, 95%CI = 0.30, 0.86), always-high scores (OR = 0.42, 95%CI = 0.23, 0.77), or increasing scores (OR = 0.50, 95%CI = 0.31, 0.83) on 'control over eating' had a lower risk of a new carious lesion. Our study highlighted the influence of parental feeding styles on caries risk in preschool children.

Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D’LITE Study): A Randomized Controlled Trial

BackgroundMobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. ObjectiveThe objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DesignA secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) was conducted, with participants recruited from October 2017 to September 2019. Participants/settingCommunity-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. InterventionParticipants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Main outcome measuresDietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Statistical AnalysesBetween-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. ResultsThere was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. ConclusionFor adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.

Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.

Parenting practices are associated with adolescent food choices during independent eating occasions.

Frequency of independent eating occasions (iEOs) has been linked to intake of unhealthy foods and overweight/obesity among adolescents. Parenting practices involving modeling healthy food intake and making healthy foods available have been associated with healthy food intake among adolescents, however, little is known about these associations during iEOs. To determine whether parenting practices involving structure (monitoring, availability, modeling, and expectations), lack of structure (indulgence), and autonomy support reported by adolescents or parents were associated with adolescent iEO intake of junk foods, sugar-sweetened beverages (SSBs), sugary foods, and fruit and vegetables. Cross-sectional study measuring parenting practices and adolescent iEO food choices via an online survey and adapted food frequency questionnaire. Parent/adolescent dyads (n = 622) completed surveys (November-December 2021) using a national Qualtrics panel database. Adolescents were 11-14 years and had iEOs at least weekly. Primary measures included parent- and adolescent-reported frequency of food parenting practices and adolescent-reported iEO intake of junk foods, sugary foods, SSBs, and fruits and vegetables. Multivariable linear regression models were used to examine associations between parenting practices and iEO intake of foods/beverages, adjusting for adolescent's age, sex, race and ethnicity, iEO frequency, parent's education and marital status, and household food security status. Bonferroni multiple comparison corrections were conducted. More than half of parents were female (66%) and 35-64 years (58%). Adolescents/parents identified as White/Caucasian (44%/42%), Black/African American (28%/27%), Asian (21%/23%), and Hispanic ethnicity (42%/42%). Positive associations were observed among adolescent-reported and parent-reported autonomy support, monitoring, indulgence and expectations parenting practices and adolescent-reported daily iEO intake frequencies of junk foods, sugary foods, and fruits and vegetables (p < 0.001). Structural and autonomy support parenting practices were positively associated with both healthy and unhealthy iEO food intake by adolescents. Interventions to improve adolescent iEO intake could promote positive practices associated with healthy food consumption.

A National Analysis of Fruit and Vegetable Intake in Response to Sugar-sweetened Beverage Intake

A National Analysis of Fruit and Vegetable Intake in Response to Sugar-sweetened Beverage Intake

Decreasing consumption of sugar-sweetened beverages and Raising tap water consumption through Interventions based on Nutrition and sustainability for Kids: study protocol of the “DRINK” cluster randomised controlled trial

BackgroundEffectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age).MethodsForty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child’s beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires.DiscussionMulticomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024–2025.Trial registrationISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state.

There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

Evaluation of food security status, psychological well-being, and stress on BMI and diet-related behaviors among a sample of college students

ObjectivesThe purpose of this study was to evaluate food insecurity on body mass index (BMI) and diet-related behaviors among college students and whether psychological well-being (PWB) and stress levels mediate this relationship. Study designThis was a cross-sectional study. MethodsData from 1439 students from the American College Health Association National College Health Assessment III (Fall 2020) were used. Food security status was evaluated by the USDA Six-Item Short Form. PWB was measured using the Diener Flourishing Scale. Diet-related behaviors included the average servings of fruits, vegetables, and sugar-sweetened beverages consumed per day. Stress was measured by self-reported levels. Regression model analysis evaluated the influence of food security status, PWB, and stress levels on BMI. PWB and stress were also tested as mediators in the relationship between food insecurity and BMI. ResultsAmong our sample of college students, 44.54% (n = 641) were food insecure, and 55.46% (n = 798) were food secure. Multiple regression analysis showed that higher food insecurity, older age, full-time enrollment status, and fifth-year student status were positively associated with a higher BMI score (P < 0.05). Results from mediation models revealed that PWB, but not stress, mediated the relationship between food security and BMI among Black/African American students. Regarding diet-related behaviors, high stress levels mediated the relationship between food insecurity and sugar-sweetened beverage intake among students. ConclusionsFood insecurity appears to influence BMI in college students. This relationship seems to be mediated by disrupted PWB and a higher intake of sugar-sweetened beverages due to stress.

Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income

BackgroundExisting evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents’ soft drink intake through potential mediators.MethodsData from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas.ResultsHigher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents’ higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income.ConclusionsOur study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

Validity and Reproducibility of Food Group-Based Food Frequency Questionnaires in Assessing Sugar-Sweetened Beverage Consumption Habits among Chinese Middle-School Students.

Assessing the intake of sugar-sweetened beverages (SSBs) is crucial for reducing obesity; however, a simple but relatively accurate method for determining added sugar consumption among school adolescents is lacking. The aim of this study was to evaluate the reproducibility and validity of a food group-based food frequency questionnaire (FG-FFQ) for SSBs in assessing SSB consumption and added sugar among middle-school students. A total of 242 school students completed the FG-FFQs twice and four discontinuous 24-h dietary records (24HDR) over a three-month period. A weighted average approach was used to obtain the average sugar content in the sugary drink food group (FG). Correlation coefficient, weighted kappa statistic, misclassification analysis, and Bland-Altman plot were used to evaluate the validity and reproducibility of the FG-FFQ. Linear regression was utilized to obtain the calibration formulas. The average content of added sugar in sugary drink FG was 8.1 g/100 mL. SSB consumption frequency, consumption amount, and added sugar had correlation coefficients of 0.81, 0.87, and 0.87, respectively, in the validity analysis (p < 0.05). The majority of scatter plots were covered by 95% confidence intervals in the Bland-Altman bias analysis. The intra-class correlation coefficient of SSB consumption frequency and Spearman correlation coefficient of SSB consumption amount and added sugar were 0.74, 0.81, and 0.90, respectively, in the reproducibility analysis (p < 0.05). Results produced by the FG-FFQ calibration formula were more comparable to 24HDR. The FG-FFQ for SSB consumption showed acceptable validity and reproducibility, making it a viable instrument for epidemiological studies on sugary drinks in adolescents.

Dental caries incidence and associated factors in young adults.

To assess the caries incidence from late adolescence to early adulthood and to identify the factors associated with caries incidence. This is a secondary analysis of longitudinal caries data of young adults aged 17-23 from the Iowa Fluoride Study cohort. The inclusion criteria required completion of dental exams at both ages 17 and 23 and having cumulative exposure (AUC) variables data for at least 8 out of the 11 time periods between ages 17 and 23. Mean imputation was used to handle the missing explanatory variable data. Multiple linear regressions were conducted using a generalized linear model to assess the effects of sociodemographic and behavioral/dietary variables on the age 17-23 adjusted cavitated caries (D2+ MFS) increment (AdjCI17-23 ). Multicollinearity was assessed using the variance inflation factor (VIF) and the final model was selected based on the Akaike Information Criterion (AIC) using backward selection and the net effects calculated. The mean AdjCI17-23 was 2.08 (SD = 4.02). The net effects (main effect plus interactions) of higher composite socioeconomic status, higher combined daily fluoride intake, higher frequency of milk intake, lower amount of sugar-sweetened beverages intake, and lower age 17 dental caries counts were associated with lower mean AdjCI17-23 . The incidence of caries from age 17 to 23 in this study was low. This study suggests and reinforces the need to continue to advocate for caries preventive strategies such as fluoride use, encouraging milk intake, and reducing sugar-sweetened beverage intakes.

Characteristics Associated With Purchasing Sugar-Sweetened Beverages and Bottled Water Among US Households, 2015

BackgroundFrequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. ObjectiveThis study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. DesignThis study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. Participants/settingsA total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. Explanatory variablesThe included demographic and socioeconomic variables were household head’s age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households’ residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. Main outcome measuresAnnual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. Statistical analysisUnadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana’s household projection factors. ResultsNearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. ConclusionsThese findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status.

Perceptions of Health, Body Size, and Nutritional Risk Factors for Obesity in People with HIV in South Africa.

Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and body mass index (BMI). We categorized participants into six BMI groups: 18.5-22kg/m2, 22-25kg/m2, 25-27.5kg/m2, 27.5-30kg/m2, 30-35kg/m2, and ≥ 35kg/m2 and stratified them by HIV serostatus. Our outcomes were self-reported (1) body size and (2) health status among all participants, and intake of (3) chips and (4) sugar-sweetened beverages(SSB) in PWH. We described these metrics and used multivariable regression to evaluate the relationship between the nutritional behaviors and BMI ≥ 25kg/m2 in PWH only, adjusting for age, sex, educational attainment, and household wealth quintile. Of 6138 participants, 1163 (19.7%) were PWH. Among PWH, < 10% with a BMI 25-30kg/m2, < 20% with a BMI 30-35kg/m2 and < 50% with a BMI ≥ 35kg/m2 self-reported as overweight or obese. PWH reported being in poor health at higher rates than those without HIV at each BMI category except ≥ 35kg/m2. In adjusted models, SSB consumption was associated with BMI ≥ 25kg/m2 (1.13 [1.01-1.25], t-statistic = 2.14, p = 0.033) in PWH. Perceptions of body size may challenge efforts to prevent weight gain in PWH in South Africa. SSB intake reduction should be further explored as a modifiable risk factor for obesity.