Low Sugar-sweetened Beverages Research Articles

Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study.

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

Association of childhood food consumption and dietary pattern with cardiometabolic risk factors and metabolomics in late adolescence: prospective evidence from ‘Children of 1997’ birth cohort

BackgroundHealthy diet might protect against cardiometabolic diseases, but uncertainty exists about its definition and role in adolescence.MethodIn a subset of Hong Kong’s ‘Children of 1997’ birth cohort (n=2844 out of...

A systematic review of interventions to improve the diet of children

Abstract Aim The purpose of this systematic review was to evaluate robust interventions across seven eating practice outcomes and to consider potential modifiers, including parental involvement, intervention setting, and quality of food practice evaluation. Methods The search procedure reflected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web of Science, PsychInfo, PubMed, and Elton B. Stephens Company (EBSCO) (2004–2019) were searched for studies that aimed to change children’s (2 to 12 years old) diet (one or more eating practice components: fruit, vegetables, whole grains, lower saturated fat, lower sugar-sweetened beverages (SSBs), intake of dairy, diet quality). Of 2316 papers, 22 met inclusion criteria. Results Fruits (n = 12) and vegetables (n = 15) were the most frequent outcomes. Half of fruit-targeted, two-thirds of vegetable-targeted, half of fruit/vegetable-targeted, eight of nine SSB-targeted, and one of two whole grain-targeted outcomes showed significant improvements. The actual food intake change was modest in most cases. Eighteen interventions included parents, although the four that did not also reported significant outcomes. Most studies were conducted in schools, early childcare, or after-school programs (n = 13) with significant improvements in most settings. Only about half of the studies involving children &lt; 10 years used proxy reporting/direct observation. Eight studies included no reliability, validity, or citation for the method of dietary measurement. Conclusion Robust studies continue to focus on one or two foods, parental involvement may be beneficial depending on the intervention, and more research is needed to establish best practices across all settings.

Combination of sugar-sweetened beverage consumption, screen-based sedentary time, and sleep duration and their association with South Korean adolescents' mental health.

This study examines the combinations of sugar-sweetened beverage (SSB) consumption, screen-based sedentary time, and sleep duration and their association with adolescents' depressive symptoms and suicidal ideation. This research followed a crosssectional study design. Secondary data analysis was conducted on the data collected from 21,046 high school students who had participated in the 17th Korea Youth Risk Behavior Web-Based Survey in 2021. A complex sampling analysis, including descriptive and logistic regression analyses, was conducted in SPSS Statistics 26.0. The combination of low SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. In addition, a combination of medium/high SSB consumption, appropriate/excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. Finally, the combination of high SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in suicidal ideation. The findings demonstrate that healthcare providers should develop and conduct family-and school-based programs to restrict SSB consumption, screen-based sedentary behaviors, and sleep duration to improve adolescents' mental health.

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults.

This study aimed at analyzing the association between stages of change, consumption of food markers, and self-efficacy in the adoption of healthy eating practices, adjusted by nutritional knowledge, among Brazilian adolescents and young adults. A cross-sectional analysis was conducted with 347 individuals from schools in the Federal District, Brazil. They completed a self-administered questionnaire covering: consumption of food markers, stage of change, self-efficacy in the adoption of healthy eating practices, and nutritional knowledge. Adjusted logistic regression was conducted. Participants in pre-contemplation (OR = 0.22), contemplation (OR = 0.19), decision (OR = 0.13) and action (OR = 0.40) stages have less chance to have healthy eating than those in maintenance, including fruits and vegetables [pre-contemplation (OR = 0.23), contemplation (OR = 0.19), and decision (OR = 0.09)]. Adolescents and young adults in pre-contemplation (OR = 0.29) and contemplation (OR = 0.37) had lower chances of having low consumption of sugar-sweetened beverages compared to those in maintenance (p < 0.05). Adolescents and young adults in pre-contemplation (OR = 0.38) and contemplation (OR = 0.36) were less likely to have high self-efficacy scores than those in maintenance (p < 0.05). Higher score of self-efficacy was associated with a lower chance of having a high consumption of sugar-sweetened beverages (OR = 1.02; p = 0.032). Regardless of nutritional knowledge, individuals in the earlier stages of change are less likely to have an adequate consumption of healthy foods markers, including fruits and vegetables, and low sugar-sweetened beverages consumption. They are also less likely to have high self-efficacy scores than those in maintenance. Nutritional interventions to focus on enhancing self-efficacy among adolescents and young adults in earlier stages of change to improve dietary habits.

The Health and Economic Impact of Using a Sugar Sweetened Beverage Tax to Fund Fruit and Vegetable Subsidies in New York City: A Modeling Study.

Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.

Clusters of lifestyle behaviours and their associations with socio-demographic characteristics in Dutch toddlers

PurposeThis study aimed to identify clusters of lifestyle behaviours in toddlers and assess associations with socio-demographic characteristics.MethodsWe used data from the Dutch National Food Consumption Survey 2012–2016 and included 646 children aged 1–3 years. Based on 24-h dietary recalls and a questionnaire, a two-step cluster analysis was conducted to identify clusters in the intake of fruit, vegetables, sugar-sweetened beverages and unhealthy snacks, physical activity and screen time. Logistic regression models assessed associations between socio-demographic characteristics and cluster allocation.ResultsThree clusters emerged from the data. The ‘relatively healthy cluster’ demonstrated a high intake of fruit and vegetables, low sugar-sweetened beverage and unhealthy snack intake and low screen time. The ‘active snacking cluster’ was characterised by high unhealthy snack intake and high physical activity, and the ‘sedentary sweet beverage cluster’ by high intake of sugar-sweetened beverages and high screen time. Children aged 1 year were most likely to be allocated to the ‘relatively healthy cluster’. Compared to children of parents with a high education level, children of parents with a low or middle education level were less likely to be in the ‘relatively healthy cluster’, but more likely to be in the ‘sedentary sweet beverage cluster’.ConclusionClusters of lifestyle behaviours can be distinguished already in children aged 1–3 years. To promote healthy lifestyle behaviour, efforts may focus on maintaining healthy behaviour in 1-year-olds and more on switching towards healthy behaviour in 2- and 3-year-olds.

The influence of social norms in the context of reducing sugar-sweetened beverages consumption

ObjectivesThis study aimed to examine the factors associated with low sugar-sweetened beverage (SSB) consumption and intention to avoid these products as well as investigate the role of different types of social norms in the adoption of this behaviour. Study designThis study reports the results of a secondary data analysis from a cross-sectional telephone survey. MethodsA total of 1000 adults were randomly recruited in the province of Québec, Canada, using a random-digit dialling procedure. Eligibility criteria were to be aged between 18 and 64 years; able to answer a questionnaire in French or English; and to reside in the province of Québec. SSB consumption, social norms and variables from the theory of planned behaviour were assessed by means of a questionnaire. Logistic regression analyses were conducted to examine factors associated with behaviour and intention. ResultsConsuming <1 SSB per day was significantly associated with intention, perceived behavioural control, and risk perception about tooth decay. Descriptive (perceived prevalence in the close surroundings of one person) and perceived societal norms (perceived broad societal approval/disapproval of the behaviour) were associated with behaviour. All theory of planned behaviour variables (including injunctive norm) and risk perception pertaining to chronic diseases predicted intention to avoid the consumption of ≥1 SSB per day. Sex, age, income, and risk perception pertaining to chronic diseases were associated with perceived societal disapproval of SSB consumption. ConclusionsThis study confirms the importance of social norms in the prediction of SSB consumption but also highlights the need to address motivation and capacities in public health interventions to reduce SSB consumption.

Are intentions to change, policy awareness, or health knowledge related to changes in dietary intake following a sugar-sweetened beverage tax in South Africa? A before-and-after study

BackgroundIn April 2018, South Africa implemented the Health Promotion Levy (HPL), one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100mL). The objectives of this study were to examine whether the psychological constructs tax awareness, SSB knowledge, SSB risk perception, and intentions to reduce SSB intake were associated with taxed beverage intake, whether they changed from pre- to post-tax, and whether they modified the effect of the HPL.MethodsWe collected single day 24-hour dietary recalls surveyed from repeat cross-sectional surveys of adults aged 18–39 years in Langa, South Africa. Participants were recruited in February-March 2018 (pre-tax, N = 2,481) and February-March 2019 (post-tax, N = 2,507) using door-to-door sampling. Surveys measured tax awareness, SSB knowledge, SSB risk perception, and intention to reduce SSB intake. SSB intake was estimated using a two-part model. To examine changes over time, logistic regression models were used for binary outcomes (tax awareness and intention to reduce SSB consumption) and linear regression models for continuous outcomes (SSB knowledge SSB risk perceptions). Effect modification was tested using interaction terms for each psychological construct with time.ResultsNo constructs were associated with SSB intake at baseline. At post-tax, the predicted probability to consume taxed beverages was 33.5% (95% CI 28.5–38.5%) for those who expressed an intention to reduce SSB intake compared to 45.9% (95% CI 43.7–48.1%) for those who did not. Among consumers, intending to reduce SSB intake was associated with 55 (95% CI 28 to 82) kcal/capita/day less SSBs consumed. Tax awareness, SSB knowledge, and SSB risk perception increased by a small amount from pre- to post-tax. Intentions to reduce SSB intake was lower in the post-tax period. The tax effect on SSB intake was modified by SSB knowledge and intention to reduce SSB intake, with higher levels of each associated with lower SSB intake.ConclusionAfter the South African SSB tax was implemented, SSB knowledge and risk perception increased slightly, tax awareness remained low, and only SSB knowledge and behavioral intention to change were significantly associated with taxed beverage intake among participants recruited from a low-income South African township.

Sugar-Sweetened and Artificially Sweetened Beverages Consumption and Risk of Cardiovascular Health

IntroductionSugar-sweetened and artificially sweetened beverages are routinely consumed worldwide. Given their popularity, there has been much debate about the effect that these beverages have on cardiovascular health. We sought to determine the exact relationship between sugar-sweetened and artificially sweetened beverages consumption on cardiovascular health. MethodsAll studies that reported an association between sugar-sweetened/artificially sweetened beverages consumption and cardiovascular health were extracted from database inception to September 2022 using keywords from several databases. We used the DerSimonian & Laird random-effects method for the analysis. ResultsOf the total 16 prospective studies, 1,405,375 individuals were followed for a median follow-up of 14.8 years. Compared with low sugar-sweetened and artificially sweetened beverage consumption, a higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (hazard ratio [HR] of 1.27, 95% confidence interval [CI] of 1.16-1.40 and risk ratios of 1.16, 95% CI of 1.02-1.33). Similarly, compared with low artificially sweetened beverages consumption, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.32, 95% CI of 1.12-1.57). Likewise, compared with low sugar-sweetened beverages consumption, a higher consumption of sugar-sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.21, 95% CI of 1.07-1.37 and risk ratios of 1.22, 95% CI of 1.09-1.35). ConclusionsIncreasing consumption of sugar-sweetened and artificially sweetened beverages may be correlated with an increased risk of developing cardiovascular/vascular complications and mortality, albeit without causality of cardiovascular/vascular morbidity.

The Association between the Consumption of Sugar-Sweetened Beverages and Metabolic Syndrome Components in Young Rural Adults in South Africa

Background: Metabolic syndrome (MetS) is the key risk factor for cardiovascular disease (CVD) development. However, lifestyle habits including high consumption of sugar-sweetened beverages (SSBs) contribute to its onset. The current study was aimed at investigating the association between SSBs consumption and MetS components among young adults aged 22 to 30 years. Methods: This was a cross-sectional study where a total of 596 young adults (307 females and 287 males) participated. Blood pressure, biochemical assessment, and anthropometric measurements were taken following protocols. A validated 24 h recall questionnaire and food manuals were used to collect SSBs data. Binary logistic regression was applied to determine the association between SSBs consumption and MetS components. Results: In males, high SSBs consumption increased the risk of high fasting blood glucose (FBG) (p &lt; 0.05). In females, high and low SSBs consumption decreased the risk of reduced high-density lipoprotein cholesterol (HDL-C), whereas only high SSBs consumption was associated with decreased risk of high triglycerides (TG) (p &lt; 0.05). In conclusion, high TG, reduced HDL-C and high FBG was significantly associated with high consumption of SSBs. Longitudinal studies are recommended to further investigate the extent to which SSBs influences components of MetS.

The Association Between Frequent Sugar-Sweetened Beverage Intake and Sleep Duration in School Children: A Cross-Sectional Study.

BackgroundHigher consumption of sugar-sweetened beverages (SSBs) maybe association with children's sleep pattern. However, few studies have considered this association in Asia, especially in school children. This study investigated the relationship between children's consumption frequency of such beverages and their sleep duration.MethodsParticipants aged 6–12 years were analyzed from two survey data in 2012 and 2013–2016 Nutrition and Health Surveys in Taiwan. A total of 2,628 participants were included in the analysis (2012, N = 1,267; 2013–2016, N = 1,361). Beverages weekly consumption were divided into low and high intake groups by medians cut-off points. The sleep variables were the sleep duration at night (including school days and weekends) and sleep debt. After controlling the confounders, the correlation between sugar-sweetened beverage consumption and sleep duration was examined using multinomial logistic regression analysis.ResultsThe students slept for an average of 8.8 h on school days and 9.7 h on weekends. Relative to the low SSB intake group, the high intake group exhibited shorter sleep durations on school days (P < 0.001), greater sleep debt (P = 0.049). In logistic regression, high intake group were more likely to sleep for <8.5 h on school days (OR = 1.67, P = 0.002) and exhibit >2 h of sleep debt than low intake group (OR = 1.41, P = 0.022).ConclusionsChildren who had consumed sugar-sweetened beverages frequently slept for shorter durations at night on school days and exhibited greater sleep debt. The causal relationship was not clear. Nonetheless, these two factors are important in promoting children health.

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

BackgroundDietary factors like sugar-sweetened beverage (SSB) consumption are known to influence disease course in a variety of illnesses; however, long-term outcomes are not well documented for inflammatory bowel disease. ObjectiveDoes high consumption of SSBs lead to high healthcare utilization (ie, hospitalizations and emergency department visits), inflammation, and disease severity in patients with inflammatory bowel disease? DesignA prospective cohort study was conducted from 2015 to 2019. Patients enrolled in the discovery study cohort were followed for 3 years, whereas patients in the validation cohort were followed for 2 years. They underwent nutrition assessment and received routine care. Dietary intakes of SSBs and fiber were quantified by a validated, self-reported questionnaire. Participants/settingFor the discovery study cohort, 1133 adult patients were recruited from the University of Pittsburgh Medical Center Digestive Disease Clinic in Pittsburgh, PA. Eligible patients had a preexisting diagnosis of Crohn’s disease or ulcerative colitis and had at least annual follow-up at this tertiary referral center. High SSB consumption was defined as 7 or more SSBs per week. Moderate was defined as > 2 but < 7 SSBs per week. Low SSB consumption was defined as 2 or fewer SSBs per week. Main outcome measuresPrimary outcome was time to hospitalization and emergency department visits. Secondary outcomes assessed laboratory markers of disease severity and inflammation. Tertiary outcomes assessed time to hospitalization and emergency department visits in a subsequent independent cohort of patients. Statistical analysis performedMultivariable logistic regression, Kaplan-Meier, and Cox proportional hazards modeling ResultsThe discovery cohort included of 1,133 adult patients with inflammatory bowel disease (58% women, 70% with Chron’s disease, 30% with ulcerative colitis, median age 46 years). Low SSB consumption, moderate SSB consumption, and high SSB consumption occurred in 57%, 17%, and 26% in the discovery cohort, respectively. Among patients without active disease at enrollment, high SSB consumption was associated with decreased time to hospitalization and emergency department visits when compared with low SSB consumption (hazard ratio 1.55, 95% CI 1.06 to 2.27; and hazard ratio 1.53, 95% CI 1.10 to 2.13). In terms of disease severity and inflammatory biomarkers, high SSB consumption was associated with increase odds of elevated erythrocyte sedimentation rate (odds ratio 2.04, 95% CI 1.31 to 3.18), elevated C-reactive protein level (odds ratio 1.60, 95% CI, 1.07-2.37), eosinophilia (odds ratio 1.88, 95% CI 1.06 to 3.335), and monocytosis (odds ratio 1.81, 95% CI 1.18 to 2.79) when compared with low SSB consumption after adjusting for baseline differences. Lastly, the validation cohort produced similar results to our primary outcome (ie, high SSB consumption was associated with decreased time to hospitalization and emergency department visits when compared with low SSB consumption). ConclusionsHigh SSB consumption was associated with decreased time to hospitalization and emergency department visits. Furthermore, high SSB consumption is associated with disease severity biomarkers and inflammation. Prospective studies assessing the therapeutic influence of nutrition counseling and decreased SSB consumption on long-term inflammatory bowel disease clinical course are warranted.

Sugar- and artificially-sweetened beverages and the risks of chronic kidney disease: a systematic review and dose-response meta-analysis.

Consumption of sugar or artificially-sweetened beverages (SASBs) has been linked to albuminuria, decline in kidney function, and risk of chronic kidney disease (CKD). However, the results are controversial. We therefore aim to evaluate the effects of sugar or artificially-sweetened beverage consumption on CKD risk. Original observational studies reporting relative risks (RRs) with 95% confidence intervals (CIs) for the association between sugar or artificially-sweetened beverage consumption and impaired renal function or CKD risk in adults were identified using a systematic search of PubMed and EMBASE from inception to 20 February, 2019. Random effects model was applied to derive summary RRs and 95% CIs. Linear and non-linear dose-response relationships were estimated using data from sugar or artificially-sweetened beverage consumption categories in each study. The summary RR of CKD for high versus low sugar-sweetened beverage consumption was 1.30 (95% CI 0.88-1.94) according to six included studies with a total of 25,455 participants, while the pooled RR of CKD for high versus low artificially sweetened beverage consumption was 1.40 (95% CI 0.65-3.02) according to three studies with a total of 19,995 participants. For dose-response analysis, a significant, increased risk of CKD was observed with the sugar or artificially-sweetened beverage consumption above seven servings per week (P < 0.001). Our study found a positive association between consumption of sugar or artificially-sweetened beverage consumption and CKD, though it did not reach statistical significance. However, the dose-response results suggest that more than seven servings per week should be avoided.

Stakeholder views on the potential impact of a sugar-sweetened beverages tax on the budgets, dietary intake, and health of lower and higher socioeconomic groups in the Netherlands

BackgroundSocioeconomic inequalities in overweight and obesity exist in many European countries. A sugar-sweetened beverages (SSB) tax may contribute to a reduction of these inequalities. However, in the Netherlands, the government decided to not (yet) introduce an SSB tax, although the government has acknowledged its potential to be pro-equity. Understanding how various stakeholder groups perceive the potential effects of an SSB tax on different socioeconomic groups may provide useful insights into equity-related considerations in the debate whether or not to implement an SSB tax. This study aims to gain insight into the perceptions of stakeholder groups in the Netherlands on (1) the effects of an SSB tax on the budgets of lower and higher socioeconomic groups and (2) the impact of an SSB tax on socioeconomic inequalities in dietary intake and health.MethodsSemi-structured interviews were conducted in 2019 with 27 participants from various stakeholder groups in the Netherlands (i.e. health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties). Data were analyzed using a thematic content approach.ResultsParticipants from all stakeholder groups indicated that an SSB tax would have a larger impact on the budgets of lower socioeconomic groups. Participants from nearly all stakeholder groups (except trade associations) mentioned that an SSB tax could have greater health benefits among lower socioeconomic groups as these often have a higher SSB consumption and are more likely to be overweight or obese. Some participants mentioned that an SSB tax may have no or adverse health effects among lower socioeconomic groups (e.g. compensation of lower SSB consumption with other unhealthy behaviours). Some participants emphasised that an SSB tax should only be introduced when accompanied by other interventions (e.g. offering healthy alternatives), to make it easier for lower socioeconomic groups to lower their SSB consumption in response to an SSB tax, and to prevent adverse health effects.ConclusionsParticipants believed an SSB tax could contribute to a reduction in socioeconomic inequalities in dietary intake and health. However, additional interventions facilitating the reduction of SSB consumption in lower socioeconomic groups were recommended.

Latent Profiles of Health Behaviors in Rural Children with Overweight and Obesity.

The objectives were to identify profiles of school-age children with overweight and obesity (OW/OB) from rural counties based on patterns of diet, activity, and sleep, to examine demographic predictors, and to examine whether profiles were differentially associated with psychosocial functioning. Participants included 163 children (Mage = 9.8) and parents. Children wore accelerometers to assess physical activity and sleep duration. Consumption of fruits and vegetables (F/V) and sugar-sweetened beverages (SSB) was assessed with a food frequency questionnaire. Self-report of emotional, social, and academic health-related quality of life (HRQOL), peer victimization, social skills, and social problem behaviors was collected, as well as parent-report of HRQOL. Latent variable mixture modeling (LVMM) was conducted. Sleep did not significantly contribute to profile differentiation and was removed. Four profiles emerged: (a) Low F/V + Low SSB + Low activity, (b) Low F/V + Low SSB + Moderate activity, (c) High F/V + High SSB + Low activity, and (d) Moderate F/V + Moderate SSB + High activity. Older children were more likely to be in profile 1. After controlling for child age, parents of children in profile 1 reported significantly lower child social HRQOL than parents of children in profiles 2 and 4. Children in profile 4 reported experiencing significantly lower victimization than those in profile 3. There are subgroups of rural children with OW/OB that engage in various combinations of healthy and unhealthy behaviors. LVMM has the potential to inform future interventions and identify needs of groups of children with OW/OB.

Public acceptability of a sugar-sweetened beverages tax and its associated factors in the Netherlands

Abstract Background Public acceptability of a sugar-sweetened beverages (SSBs) tax is important for governments in the decision-making process. Therefore, the aim of the present study was to investigate the level of public acceptability of an SSBs tax and its associated factors. Methods Dutch adults representative of the Dutch population for age, sex, educational level and location (n = 500) completed an online self-administered questionnaire. The acceptability of an SSBs tax was measured on a 7-point Likert scale. Associations between acceptability and sociodemographic factors, body mass index, SSB consumption, and beliefs about effectiveness (9 items, e.g. 'An SSBs tax would reduce people's SSB consumption'), appropriateness (7 items), socioeconomic and economic benefit (5 items), implementation (1 item) and trust (3 items) were assessed using multivariable linear regression analyses. Results Of the participants, 40% supported and 43% opposed an SSBs tax in general. Moreover, 42% supported (43% opposed) an SSBs tax as a strategy to reduce overweight and 55% supported (32% opposed) an SSBs tax if revenue is used for health initiatives. Participants with a low educational level (B=-0.82;95%CI = [-1.31,-0.32]), overweight (B=-0.49;95%CI = [-0.89,-0.09]), moderate or high SSB consumption (B=-0.86;95%CI = [-1.30,-0.43] and B=-1.01;95%CI = [-1.47,-0.56], respectively) and households with adolescents (B=-0.57;95%CI = [-1.09,-0.05]) reported lower acceptability of an SSBs tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P &amp;lt; 0.001). Conclusions Public acceptability of an SSBs tax tends to be higher if revenue is used for health initiatives. Sociodemographic factors, body mass index, SSB consumption and several beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust are associated with acceptability. Key messages It should be considered to include a recommendation to use revenue for health initiatives in global guidelines for SSBs taxes. Targeting population subgroups with low levels of support might be an effective strategy for communication campaigns.

Projected impact of a reduction in sugar-sweetened beverage consumption on diabetes and cardiovascular disease in Argentina: A modeling study.

Sugar-sweetened beverage (SSB) consumption is associated with obesity, diabetes, and hypertension. Argentina is one of the major consumers of SSBs per capita worldwide. Determining the impact of SSB reduction on health will inform policy debates. We used the Cardiovascular Disease Policy Model-Argentina (CVD Policy Model-Argentina), a local adaptation of a well-established computer simulation model that projects cardiovascular and mortality events for the population 35-94 years old, to estimate the impact of reducing SSB consumption on diabetes incidence, cardiovascular events, and mortality in Argentina during the period 2015-2024, using local demographic and consumption data. Given uncertainty regarding the exact amount of SSBs consumed by different age groups, we modeled 2 estimates of baseline consumption (low and high) under 2 different scenarios: a 10% and a 20% decrease in SSB consumption. We also included a range of caloric compensation in the model (0%, 39%, and 100%). We used Monte Carlo simulations to generate 95% uncertainty intervals (UIs) around our primary outcome measures for each intervention scenario. Over the 2015-2024 period, a 10% reduction in SSBs with a caloric compensation of 39% is projected to reduce incident diabetes cases by 13,300 (95% UI 10,800-15,600 [low SSB consumption estimate]) to 27,700 cases (95% UI 22,400-32,400 [high SSB consumption estimate]), i.e., 1.7% and 3.6% fewer cases, respectively, compared to a scenario of no change in SSB consumption. It would also reduce myocardial infarctions by 2,500 (95% UI 2,200-2,800) to 5,100 (95% UI 4,500-5,700) events and all-cause deaths by 2,700 (95% UI 2,200-3,200) to 5,600 (95% UI 4,600-6,600) for "low" and "high" estimates of SSB intake, respectively. A 20% reduction in SSB consumption with 39% caloric compensation is projected to result in 26,200 (95% UI 21,200-30,600) to 53,800 (95% UI 43,900-62,700) fewer cases of diabetes, 4,800 (95% UI 4,200-5,300) to 10,000 (95% UI 8,800-11,200) fewer myocardial infarctions, and 5,200 (95% UI 4,300-6,200) to 11,000 (95% UI 9,100-13,100) fewer deaths. The largest reductions in diabetes and cardiovascular events were observed in the youngest age group modeled (35-44 years) for both men and women; additionally, more events could be avoided in men compared to women in all age groups. The main limitations of our study are the limited availability of SSB consumption data in Argentina and the fact that we were only able to model the possible benefits of the interventions for the population older than 34 years. Our study finds that, even under conservative assumptions, a relatively small reduction in SSB consumption could lead to a substantial decrease in diabetes incidence, cardiovascular events, and mortality in Argentina.

A Systematic Review of Interventions to Improve Diet Quality of Children that Included Parents Versus Those Without Parental Involvement

Abstract Objectives To determine through systematic review whether parental involvement in interventions to improve eating habits of children was more often associated with positive dietary behavior changes as compared to those with no or low involvement. Methods Web of Science, PsychInfo, PubMed, and EBSCO were searched for studies between 2004–2016 that aimed to change children's (2 to 12 years old) diet quality (diet quality; and 1 or more eating behavior component: fruit (F), vegetables (V), whole grains, lower saturated fat, lower sugar-sweetened beverages (SSB), and intake of calcium-rich foods). Preferred Reporting Items for Systematic Reviews and Meta-Analysis were followed for this review. Parental involvement was classified as low, medium, or high involvement. Diet assessment tools were scored for their reliability and validity. The influence of theoretical framework on outcomes was not included in the current review. Results Of 443 papers, data was extracted from 156 randomized controlled trials, and 26 met inclusion criteria. Most studies focused on the intake of F and/or V or SSB. Most with low parental involvement reported no significant dietary change (12 of 15 diet measures in 8 studies). Half with medium/medium-high involvement found significant diet change (4 of 8 measures, 3 studies). More positive diet change resulted with high parental involvement (13 of 18 measures, 11 studies). All studies with no parental involvement reported significant positive changes except 1 (4 studies, 5 measures); 3 studies incorporated exposure to F&amp;V, 1 aimed to lower SSB. Conclusions Increasing level of parental involvement supports dietary behavior change in children. Without parental involvement, repeated F&amp;V exposure also increases intake. Nutrition professionals should engage parents at multiple time points in child dietary interventions to achieve positive dietary changes. Direct F&amp;V exposure is an option if parental involvement is not feasible. Funding Sources This work was supported by the USDA National Institute of Food and Agriculture through Multistate Hatch Capacity Funds supporting the W-3005 research group and respective universities.

Early Introduction of Sugar-Sweetened Beverages and Caries Trajectories from Age 12 to 48 Months

Early exposure to sweet tastes predicts similar food preferences and eating behavior in later life and is associated with childhood obesity. The aim of this study was to explore the associations of early (during the first year of life) and subsequent intake of sugar-sweetened beverages (SSBs) with 4-y caries trajectories among Scottish young children. We used data from 1,111 Scottish children who were followed annually from age 12 to 48 mo (4 sweeps in total). SSB intake was reported by parents in every sweep. SSB intake was broken down into 2 components, the initial SSB intake and the deviation over time from that initial value. Childhood dental caries was clinically determined (including noncavitated and cavitated lesions) every year. The association of SSB intake with baseline decayed, missing, and filled tooth surfaces (dmfs) (intercept) and rate of change in dmfs over time (slope) was examined in 2-level linear mixed-effects models, with repeated observations nested within children. Both the initial SSB intake and the deviation from the initial SSB intake were positively associated with steeper caries trajectories. By sweep 4, the predicted mean dmfs difference was 1.73 between children with low and high initial SSB intake (1 standard deviation below and above the mean) and 1.17 between children with low and high deviation from their initial SSB intake (1 SD below and above the mean). The findings of this prospective study among Scottish young children provide evidence that the introduction of SSBs during the first year of life can put children in a trajectory of high levels of dental caries. They support current recommendations to avoid sugars for very young children and interventions targeting early feeding practices for caries prevention.