Low Sugar-sweetened Beverages Research Articles

Association of Sugar-Sweetened Beverage Frequency with Adiposity: Evidence from the "Children of 1997" Birth Cohort.

Background: Observationally, sugar-sweetened beverage (SSB) consumption is associated with adiposity in Western children but could be confounded. We examined the association of SSB frequency with adiposity in the non-Western setting of Hong Kong. Methods: We examined the associations of SSB consumption frequency at 11 and 13 years assessed by using a food frequency questionnaire with subsequent body mass index (BMI) z-score and overweight/obesity up to 18 years using generalized estimating equations, and with waist circumference, waist-to-hip ratio, and body fat percentage at 16–19 years using linear regression in a population-representative Chinese birth cohort “Children of 1997” (n = 3628). Results: At 11 and 13 years, 6.8% and 8.2% of children respectively consumed SSB daily. Neither SSB frequency at 11 nor at 13 years was associated with subsequent BMI z-score or overweight/obesity up to 18 years, or with waist circumference, waist-to-hip ratio, or body fat percentage at 16–19 years adjusted for age, sex, socioeconomic position, health status, physical activity and other food consumption, although bias to the null from under-reporting cannot be eliminated. Conclusion: Although we cannot definitively exclude a small association of SSB frequency with adiposity, lack of association of SSB frequency with adiposity in a non-Western setting with low SSB consumption suggests that the role of SSB in adiposity appears to be minor.

The Relationship between Self-Reported Exposure to Sugar-Sweetened Beverage Promotions and Intake: Cross-Sectional Analysis of the 2017 International Food Policy Study.

Sugar-sweetened beverage (SSB) consumption is independently associated with several non-communicable diseases, so policymakers are increasingly implementing measures, such as marketing regulation, to reduce intake. To help understand how such measures work, this study examined the association between SSB consumption and self-reported exposure to SSB promotions, both overall and by type of promotion, and whether these relationships vary between the UK, USA, Canada, Mexico, and Australia. Cross-sectional analysis of the online 2017 International Food Policy Study was performed (n = 15,515). Participants were grouped into 5265 (34%) non-, 5117 (33%) low-, and 5133 (33%) high-SSB consumers. Multinomial logistic regression models examined whether SSB consumption varied by exposure to total SSB promotion and by type: traditional, digital, recreational environment, and functional environment. Multiplicative interactions were included to investigate international variations. An additional unit of total self-reported SSB promotion exposure increased the likelihood of participants being low SSB consumers (relative risk ratio (RRR) = 1.08, 95% confidence interval (CI) = 1.06–1.10) and high SSB consumers (RRR = 1.13, 95% CI = 1.11–1.16). Only exposure to traditional and digital promotion increased the likelihood of participants being SSB consumers, though this may be explained by degree of exposure, which was not measured in this study. Some evidence illustrated international variation in these relationships.

Abstract P3032: Low-Salt and Minimal Sugar-Sweetened Beverage Intake May Not Improve Hypertension Control

Objective: Sugar-sweetened beverage (SSB) (high fructose corn syrup and sucrose) consumption positively associates with obesity, cardiovascular disease, and hypertension (HTN). High fructose intake may aggravate HTN, an effect enhanced by greater sodium intake. Thus, high SSB may increase difficult-to-control BP (BPD). Methods: SSB consumption in the Systolic Blood Pressure Intervention Trial (SPRINT) was evaluated in 61 subjects with a validated instrument and converted to grams of fructose per day. Demographics and 24-hour sodium excretion were collected. The BPD group had SBP >140 mmHg or >120 mmHg for intensive group participants, or BP at “goal” for the trial group and more than median number of agents in each group in study as a whole. The “BP Easy” group (BPE; n=25) group comprised the remainder of subjects. Mean BP from two visits before SPRINT termination established the study BP; descriptive variables were summarized; and a Wilcoxon rank sum test was used to compare SSB consumption between groups. Results: Cohort characteristics are shown in Table 1. BPD and BPE median fructose intakes were 11.25 g/d (IQR, 5.5 to 17.92) and 11.9 g/day (IQR 2.9 to 36.71; P =0.577), respectively. BPD and BPE median 24hr urine sodium excretion were 108.4 mmol (IQR 89.5-152.5) and 121.1 (102-137; P=0.16), respectively. Conclusions: A highly selected group of older subjects had low SSB (fructose) intake, yet a proportion that consumed less sodium and fructose manifested difficult to control BP. Further study of this sub-population is critical to better understanding difficult to control BP.

Association of breastfeeding and early exposure to sugar-sweetened beverages with obesity prevalence in offspring born to mothers with and without gestational diabetes mellitus.

The relationship of gestational diabetes mellitus (GDM), exclusive breastfeeding (EBF), and sugar-sweetened beverages (SSBs) on obesity prevalence in children has rarely been evaluated. This study examined the association of GDM status, EBF, and SSB with obesity prevalence in children (1-5 y). Data are from the 2014 Los Angeles County WIC Survey, which included 3707 mothers and their children (1-5 y). Compared with GDM offspring who were not EBF, GDM offspring who were EBF had lower odds of obesity, as did non-GDM offspring who were and were not EBF. Compared with GDM offspring with high-concurrent SSB intake (>3 servings/d) and no EBF, GDM offspring with high SSB intake and EBF did not have lower odds of obesity, whereas those with GDM, low SSB (≤1 serving/d), and EBF had lower odds of obesity. Using non-GDM, EBF, and low SSB as referent, non-GDM offspring who were not EBF, with either high or low SSB, had approximately a fourfold increase in odds of obesity. In GDM offspring, EBF is only associated with lower obesity levels if later SSB intake is also low, whereas EBF is protective against obesity in non-GDM offspring regardless of high or low later SSBs intake.

Association of Breastfeeding and Sugar-Sweetened Beverage Consumption with Obesity Prevalence in Offspring Born to Mothers with and Without Gestational Diabetes Mellitus (P11-098-19)

ObjectivesPrenatal and early life factors such as Gestational Diabetes Mellitus (GDM), exclusive breastfeeding (EBF), and early exposure to sugar-sweetened beverages (SSBs) may contribute to obesity in children. The relationship of EBF and SSBs with obesity prevalence in children exposed to GDM has rarely been evaluated. This study examined the association of EBF and early SSBs consumption with obesity prevalence in children (1-5y) born to mothers with and without GDM. MethodsThis study used data from the 2014 Los Angeles County Women, Infants, and Children(WIC) Survey, which included 3,707 mothers and their children (1-5y). Infants (1-2y) with weight-for-height ≥ 97.7thpercentile were classified as subjects with high weight-for-length and children (2-5y) were classified as subjects with obesity if their BMI-for-age was ≥ 95thpercentile. ResultsThe individual and combination interaction effects of GDM, SSBs intake, and EBF on obesity prevalence were all significant (P < 0.05). Compared to GDM offspring, with low SSBs intake, and who were EBF (referent), those who were GDM, with high SSBs intake and who were EBF had approximately a five-fold increase in odds of obesity (OR = 4.77, 95%CI 1.55-8.60, P = 0.03). Compared to the GDM referent group, GDM offspring who were not EBF with low and high SSBs intake had 4.3- and 4.4-times higher odds of obesity, respectively (OR = 4.33, 95%CI 1.42- 8.07, P = 0.01; OR = 4.38, 95%CI 1.39- 8.16, P = 0.01). Using non-GDM, EBF and low SSBs as referent, those who were not EBF, with either high or low SSBs had approximately a 4-fold increase in odds of obesity (OR = 3.62, 95%CI: 2.16-6.05, P < 0.0001; OR = 3.83, 95%CI: 2.26-6.48, P < 0.0001). Compared to the non-GDM referent group, those who were EBF and had high SSBs intake had 77% higher odds of obesity (OR = 1.77, 95%CI 0.93-3.37, P = 0.001). ConclusionsIn non-GDM offspring, EBF was protective against odds of obesity in both high and low SSBs consumers. In GDM offspring, EBF was only protective against obesity when SSBs intake was low. Surprisingly, GDM offspring who were EBF and had high SSBs consumption had a 4- to 5-fold increase in odds of obesity compared to those not EBF with either low or high SSBs intake. These results suggest that interventions should focus on the combined protective effects of EBF and low SSBs intake, particularly in GDM offspring. Funding SourcesFirst 5 LA.

Association of Modifiable Risk Factors With Dental Caries Among Indigenous and Nonindigenous Children in Australia

Although the prevalence of untreated dental caries among Indigenous Australian children greatly exceeds the prevalence observed among non-Indigenous children, the associations of dental caries with risk factors is considered to be the same. To estimate the association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children using decomposition analysis. Cross-sectional study using data from Australia's National Child Oral Health Study 2012-2014, a nationally representative sample of both Indigenous and non-Indigenous children aged 5 to 14 years. Data analyses were completed in November 2018. Outcomes were the mean number of decayed tooth surfaces in the primary dentition for children aged 5 to 10 years and mean number of decayed tooth surfaces in the permanent dentition for children aged 8 to 14 years. The area-based measure was the school-based Index of Community Socio-Educational Advantage, with individual-level variables including sex, equivalized household income, tooth-brushing frequency, sugar-sweetened beverage (SSB) consumption, time from last dental visit, and residing in an area with water fluoridation. There were 720 Indigenous children aged 5 to 10 years, 14 769 non-Indigenous children aged 5 to 10 years, 738 Indigenous children aged 8 to 14 years, and 15 631 non-Indigenous children aged 8 to 14 years. For area-based inequalities in primary dentition among Indigenous children, two-thirds of the contribution was associated with SSB consumption (65.9%; 95% CI, 65.5%-66.3%), followed by irregular tooth brushing (15.0%; 95% CI, 14.6%-15.5%) and low household income (14.5%; 95% CI, 14.1%-14.8%). Among non-Indigenous children, almost half the contribution was associated with low household income (47.6%; 95% CI, 47.6%-47.7%), followed by SSB consumption (31.0%; 95% CI, 30.9%-31.0%) and residing in an area with nonfluoridated water (9.5%; 95% CI, 9.5%-9.6%). For area-based inequalities in permanent dentition among Indigenous children, 40.0% (95% CI, 39.9%-40.1%) of the contribution was associated with residing in an area with nonfluoridated water, followed by low household income (20.0%; 95% CI, 19.7%-20.0%) and consumption of SSBs (20.0%; 95% CI, 19.9%-20.1%). Among non-Indigenous children, the contribution associated with low household income, SSB consumption, and last dental visit more than a year ago were each 28.6%. The association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children differed substantially. Targets to reduce SSB consumption may reduce oral health inequalities for both groups; however, Indigenous children require additional focus on oral hygiene.

Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth.

Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.

Social Networks and Sugar-Sweetened Beverage Consumption in a Pediatric Urban Academic Practice

Increased sugar-sweetened beverage (SSB) consumption is linked to childhood obesity. The risk of increased SSB consumption is multifactorial. Limited studies have examined children’s SSB consumption and social networks. In order to examine the association between SSB consumption and SSB preferences of a child’s social network, a cross-sectional survey was administered to patients aged 8–17 years from June to September 2016. In a questionnaire, subjects completed a beverage consumption recall, identified people important to them along with each person’s favorite beverage, and answered questions about habits, environment, and attitudes. Subjects with higher SSB consumption (>16 fl oz) were compared to subjects with lower SSB consumption (≤16 fl oz). 202 surveyed: 55% female, 53% Hispanic, 45% Black, 28% overweight or obese. Children drank an average of 3 cups/day of SSBs, range of 0–15 cups/day. Social networks included caregiver, relative, and friend. Subjects with higher SSB consumption (n = 96) were compared to those with lower SSB consumption (n = 106). We found children with higher SSB consumption had higher odds of reporting a higher number of people in their immediate social networks who prefer SSB, adjusted for habits, environment, and attitudes (aOR 1.41; 95% CI: 1.02–1.99; p < 0.05). Children are more likely to have higher SSB consumption if they list people in their immediate social network who prefer SSB as their favorite drink. Further research is required to explore the influence of social networks on health behaviors of children.

A diet high in sugar-sweetened beverage and low in fruits and vegetables is associated with adiposity and a pro-inflammatory adipokine profile.

Diet, obesity and adipokines play important roles in diabetes and CVD; yet, limited studies have assessed the relationship between diet and multiple adipokines. This cross-sectional study assessed associations between diet, adiposity and adipokines in Mexican Americans. The cohort included 1128 participants (age 34·7±8·2 years, BMI 29·5±5·9 kg/m2, 73·2 % female). Dietary intake was assessed by 12-month food frequency questionnaire. Adiposity was measured by BMI, total percentage body fat and percentage trunk fat using dual-energy X-ray absorptiometry. Adiponectin, apelin, C-reactive protein (CRP), dipeptidyl peptidase-4 (DPP-IV), IL-1β, IL-1ra, IL-6, IL-18, leptin, lipocalin, monocyte chemo-attractant protein-1 (MCP-1), resistin, secreted frizzled protein 4 (SFRP-4), SFRP-5, TNF-α and visfatin were assayed with multiplex kits or ELISA. Joint multivariate associations between diet, adiposity and adipokines were analysed using canonical correlations adjusted for age, sex, energy intake and kinship. The median (interquartile range) energy intake was 9514 (7314, 11912) kJ/d. Overall, 55 % of total intake was accounted for by carbohydrates (24 % from sugar). A total of 66 % of the shared variation between diet and adiposity, and 34 % of diet and adipokines were explained by the top canonical correlation. The diet component was most represented by sugar-sweetened beverages (SSB), fruit and vegetables. Participants consuming a diet high in SSB and low in fruits and vegetables had higher adiposity, CRP, leptin, and MCP-1, but lower SFRP-5 than participants with high fruit and vegetable and low SSB intake. In Mexican Americans, diets high in SSB but low in fruits and vegetables contribute to adiposity and a pro-inflammatory adipokine profile.

Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: Results from the Harvard pooling project of diet and coronary disease

Background Sugar-sweetened beverage (SSB) intake is associated with metabolic disorders. The reduction of SSB intake has been promoted to prevent death and disability from chronic diseases. However, a lower SSB intake requires substitution by other fluids to maintain hydration. We investigated the association between SSB intake and the risk of coronary events and death, and assessed if substitution of coffee, tea, milk, fruit juice and artificially-sweetened beverages (ASB) for SSBs is associated with a reduced risk of coronary events and death. Methods This was a follow-up study in which data from six cohort studies were pooled. Results During the mean 5–10 years follow-up, 4248 coronary events and 1630 coronary death occurred among 284.345 individuals; 355 mL daily increase of SSB intake was associated with an increased risk of coronary events (HR: 1.08; 95% CI: 1.02, 1.14) and possibly coronary death (HR: 1.05; 95% CI: 0.96, 1.16). Substitution analyses suggested that replacing SSBs with coffee (HR: 0.93; 95% CI: 0.87, 1.00) or ASB (HR: 0.89; 95% CI: 0.83, 0.97), but not with tea (HR: 0.94; 95% CI: 0.87, 1.01), low-fat milk (HR: 0.96; 95% CI: 0.90, 1.03), whole fat milk (HR: 0.95; 95% CI: 0.87, 1.04) or fruit juice (HR: 0.97; 95% CI: 0.85, 1.07) was associated with a lower risk of developing coronary events. No associations were found for coronary death. Conclusion We found that SSB intake is associated with an increased risk of coronary events and possibly coronary death. Our findings also suggest that substituting ASBs or coffee for SSBs lowers the risk of developing CHD events.

Gain-Framed Messages Were Related to Higher Motivation Scores for Sugar-Sweetened Beverage Parenting Practices than Loss-Framed Messages.

Parents play an important role in promoting healthy beverage intake among children. Message-framing approaches, where outcomes are described as positive (gain) or negative (loss) results, can be used to encourage parenting practices that promote healthy beverage intakes. This study tested the effectiveness of message framing on motivation for parenting practices targeting reductions in child sugar-sweetened beverage (SSB) intake (controlling availability, role modeling) and dispositional factors moderating effectiveness. Parents (n = 380) completed a survey to assess motivation after viewing gain- and loss-framed messages to engage in parenting practices, usual beverage intake, and home beverage availability. Paired t-tests were used to examine differences in motivation scores after viewing gain- vs. loss-framed messages for all parents and by subgroups according to low vs. high SSB intake and home availability, and weight status. Gain- versus loss-framed messages were related to higher motivation scores for both parenting practices for all parents (n = 380, p < 0.01) and most subgroups. No differences were observed by message frame for parents in low home SSB availability or normal and overweight BMI subgroups for controlling availability. Gain- versus loss-framed messages were related to higher motivation scores, therefore gain-framed messages are recommended for parent interventions intended to decrease child intake of SSBs.

Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study.

BackgroundLimited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk.ObjectiveThe purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children.MethodsMothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother’s fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward’s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings.ResultsOf the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward’s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion).ConclusionsFindings may have implications in tailoring future obesity prevention interventions among families with young children.

The δ13C Value of Fingerstick Blood Is a Valid, Reliable, and Sensitive Biomarker of Sugar-Sweetened Beverage Intake in Children and Adolescents

Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults. The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents. Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity. Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively). The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388.

Determinants of Sugar-Sweetened Beverage Consumption among Low-Income Children: Are There Differences by Race/Ethnicity, Age, and Sex?

BackgroundUnderstanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions. ObjectiveOur aim was to identify child and parent lifestyle and household demographic factors predictive of high SSB consumption frequency in children from low-income, ethnically diverse communities that may help inform public health interventions. DesignWe used a cross-sectional telephone household survey. Participants/settingParticipants were 717 boys and 686 girls aged 3 to 18 years old from the New Jersey Childhood Obesity Study living in five low-income cities (Camden, New Brunswick, Newark, Trenton, and Vineland). The adult most knowledgeable about household food shopping completed a questionnaire over the telephone inquiring about their and their child’s dietary and physical activity habits, and household-, parent-, and child-level demographics. Main outcome measuresChild’s SSB consumption frequency was measured. Statistical analysis performedMultivariate ordered logit models were designed to investigate a variety of variables hypothesized to affect the frequency of SSB consumption. Exploratory stratified analyses by race, sex, and age were also conducted. ResultsEight percent of our study participants never consumed SSBs, 45% consumed SSBs at least once per day, and 23% consumed twice or more per day. SSB consumption was higher among children 12 to 18 years vs 3 to 5 years (P<0.0001), of non-Hispanic black vs non-Hispanic white race/ethnicity (P=0.010), who were moderate fast food consumers vs never consumers (P=0.003), and those whose parents were high vs low SSB consumers (P<0.0001). Living in a non–English-speaking household (P=0.030), having a parent with a college or higher education vs less than high school (P=0.003), and having breakfast 6 to 7 days/wk vs never to 2 days/wk or less were associated with lower SSB consumption (P=0.001). ConclusionsWe identified a number of household-, parent-, and child-level predictors of SSB consumption, which varied by race, sex, and age, useful for building customized interventions targeting certain behaviors in ethnically diverse, low-income children.

Sugar‐Sweetened Beverage Consumption in Young Adults: Understanding Eating Occasion Contextual Factors

Background/ObjectivesYoung adulthood represents an influential transitional period, marked by poor dietary habits and excess weight gain. Sugar‐sweetened beverages (SSBs) are a major source of excess caloric intake among young adults, yet little is known about the correlates of SSB consumption. This study examines the correlates of SSB consumption including eating occasion contextual factors, using real‐time assessment of young adults' eating occasions (EOs).MethodsData were collected during the Measuring Meals in Everyday Life (MEALS) study (n=557, adults 18–30 years). Participants reported all foods and beverages consumed over 3–4 non‐consecutive days using a food diary recorded via a Smartphone app. Contextual characteristics such as eating location, purchase location, presence of others and activities while eating were documented in the app at each EO. Information on sociodemographic factors and health behaviours were collected via an online questionnaire. An “eating occasion” was defined as an occasion when any food or beverage was ingested, while a “sugar‐sweetened beverage occasion” was defined as any EO where a SSB was consumed (with or without other items). SSB consumers were categorised as low or high SSB consumers based on the median frequency of consumption. Associations for individual level and EO level characteristics with level of SSB consumption were analysed using multivariate logistic regression, accounting for the clustered nature of the data.ResultsOverall, 30% of participants consumed SSBs. Most SSBs were consumed: either alone (43%) or with family/partner (42%); at home (50%), and while undertaking screen‐based activities (46%). Most SSBs consumed were purchased from the supermarket/grocery store (58%). Compared to non‐consumers, SSB consumers had a significantly higher BMI (mean [SD]: 23.1 [5.7] v 21.8 [3.9], P&lt;0.001). Being a current/past smoker, being overweight/obese and participating in screen‐based activities were associated with being a high SSB consumer (P&lt;0.01). After adjustment for covariates, smoking status (OR [95% CI]=5.69 [1.98,16.31]; P&lt;0.01) and weight status (2.31 [1.06,5.01]; P&lt;0.05) remained significantly associated with high SSB consumption.ConclusionsAlmost a third of young adults in this study consumed SSBs and most SSBs were consumed alone or with family/partner, at home and while undertaking screen‐based activities. However, individual factors, rather than EO contextual factors, were more strongly associated with being a high SSB consumer. Future research is needed to explore how SSB occasions differ from other beverage consumption occasions in relation to their accompanying foods and contextual characteristics.Support or Funding InformationAustralian Research Council, Victorian Health Promotion Foundation, National Health and Medical Research Council

Associations among sugar sweetened beverage intake, visceral fat, and cortisol awakening response in minority youth

ContextAbdominal adiposity has long been associated with excess caloric intake possibly resulting from increased psychosocial stress and associated cortisol dysfunction. However, the relationship of sugar-sweetened beverage (SSB) intake specifically with cortisol variability and visceral adipose tissue (VAT) is unknown. ObjectiveTo examine the relationships between SSB intake, VAT, and cortisol response in minority youth. DesignA cross-sectional analysis. SettingThe University of Southern California. Participants60 overweight/obese Non-Hispanic Black and Hispanic adolescents ages 14–18years. Main outcome measuresVAT via Magnet Resonance Imaging (MRI), cortisol awakening response (CAR) via multiple salivary samples, and SSB intake via multiple 24-hour diet recalls. SSB intake was divided into the following: low SSB consumers (<1 servings per day), medium SSB consumers (≥1–<2 servings per day), high SSB consumers (≥2 servings per day). Analysis of covariance were run with VAT and CAR as dependent variables and SSB intake categories (independent variable) with the following a priori covariates: sex, Tanner stage, ethnicity, caloric intake, and body mass index. ResultsThe high SSB intake group exhibited a 7% higher VAT compared to the low SSB intake group (β=0.25, CI:(0.03, 0.33), p=0.02). CAR was associated with VAT (β=0.31, CI:(0.01,0.23), p=0.02). The high SSB intake group exhibited 22% higher CAR compared to the low SSB intake group (β=0.30, CI:(0.02,0.48), p=0.04). ConclusionThis is the first study exploring the relationship between SSB, VAT, and CAR. SSB consumption appears to be independently associated greater abdominal adiposity and higher morning cortisol variability in overweight and obese minority youth. This study highlights potential targets for interventions specifically to reduce SSB intake in a minority youth population.

Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis.

Soft drink consumption is associated with adverse health behaviours that predispose to adverse cardiovascular risk factor profiles; however, it is unclear whether their intake independently leads to an increased risk of cardiovascular events and mortality. We conducted a systematic review and meta-analysis to evaluate this. Medline and EMBASE were searched in July 2015 for studies that considered soft drink intake and risk of mortality, myocardial infarction (MI) or stroke. Pooled risk ratios (RRs) for adverse outcomes were calculated using inverse variance with a random effects model, and heterogeneity was assessed using the I2 statistic. A total of seven prospective cohort studies with 308,420 participants (age range 34-75 years) were included in the review. The pooled results suggest a greater risk of stroke (RR 1.13, 95% CI 1.02-1.24), and MI (RR 1.22, 95% CI 1.14-1.30), but not vascular events with incremental increase in sugar-sweetened beverage (SSB) consumption. With incremental increase in artificially sweetened beverage (ASB) consumption, there was a greater risk of stroke (RR 1.08, 95% CI 1.03-1.14), but not vascular events or MI. In the evaluation of high vs. low SSB, there was a greater risk of MI (RR 1.19, 95% CI 1.09-1.31) but not stroke, vascular events or mortality. For ASB, there was a significantly greater risk of stroke (RR 1.14, 95% CI 1.04-1.26) and vascular events (RR 1.44, 95% CI 1.02-2.03) but not MI or mortality. Our results suggest an association between consumption of sugar-sweetened and ASBs and cardiovascular risk, although consumption may be a surrogate for adverse health behaviours.

Abstract 17285: Frequent Consumption of Meals Prepared at Home and Risk of Type 2 Diabetes Among American Men and Women

Introduction: The frequency of eating meals prepared at home (MPAH) decreased among Americans over the last 50 years. Eating out has been associated with poor diet quality and weight gain in adolescents and adult. Few studies have examined MPAH frequency in relation to diabetes risk. Hypothesis: Having MPAH is associated with lower risk of Type 2 Diabetes (T2D). Methods: We followed 57,994 women in the Nurses’ Health Study and 41,679 men in the Health Professionals Follow-up Study from 1986 to 2012. Participants were free of diabetes, cardiovascular disease, and cancer at baseline. Weekly frequencies of consuming MPAH were collected at baseline, and summed up as overall MPAH. Results: Participants with more MPAH had higher intake of whole grains, total and low-fat dairy products, fruits, and vegetables, and lower sugar sweetened beverage (SSB) at baseline. However, MPAH turned to be associated with more red meat and low coffee intakes. MPAH was moderately associated with less weight gain during follow-up. Compared to those with 0-6 overall MPAH/week, women with 11-14 MPAH/week had 0.45±0.08kg less weight gain over 8 years, whereas men had 0.41±0.07 kg less weight gain (P&lt;0.001) for the same comparison. During 2.3 million person-years of follow-up, 8959 T2D cases were identified and confirmed in both cohorts. After multivariate adjustment of demographic and lifestyle factors, pooled hazard ratio (95% confidence interval) of T2D were 0.96 (0.90, 1.01), 0.96 (0.87, 1.06), 0.88 (0.83, 0.94) for participants who had 7-8, 9-10, and 11-14 MPAH/week (P for trend&lt;0.001), comparing with those eating 0-6 MPAH/week. Each additional MPAH for lunch was associated with 2% lower risk of T2D, whereas the corresponding value was 4% for dinner (P&lt;0.001 for both). These findings were attenuated when BMI or SSB were further adjusted: the hazard ratio comparing participants with 11-14 MPAH/week to those with 0-6 MPAH/week were 0.95 (0.90, 1.01; P for trend=0.13) with adjusting of BMI, and 0.94 (0.89, 1.00; P for trend=0.09) with adjustment of SSB. Conclusions: These findings suggest that eating more MPAH is associated with a lower risk of T2D overtime, and this relationship may be partly ascribed to less weight gain and lower SSB intake by those who prepare their own meals at home more often.

Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study.

Dietary patterns, physical activity (PA) and sedentary behaviours are some of the main behavioural determinants of obesity; their combined influence in children has been addressed in a limited number of studies. Children (16,228) aged 2-9 years old from eight European countries participated in the baseline survey of the IDEFICS study. A subsample of 11,674 children (50.8% males) were included in the present study. Children's food and beverage consumption (fruit and vegetables (F&V) and sugar-sweetened beverages (SSBs)), PA and sedentary behaviours were assessed via parental questionnaires. Sex-specific cluster analysis was applied to identify behavioural clusters. Analysis of covariance and logistic regression were applied to examine the association between behavioural clusters and body composition indicators (BCIs). Six behavioural clusters were identified (C1-C6) both in boys and girls. In both sexes, clusters characterised by high level of PA (C1 and C3) included a large proportion of older children, whereas clusters characterised by low SSB consumption (C5 and C6) included a large proportion of younger children. Significant associations between derived clusters and BCI were observed only in boys; those boys in the cluster with the highest time spent in sedentary activities and low PA had increased odds of having a body mass index z-score (odds ratio (OR)=1.33; 95% confidence interval (CI)=(1.01, 1.74)) and a waist circumference z-score (OR=1.41; 95%CI=(1.06, 1.86)) greater than one. Clusters characterised by high sedentary behaviour, low F&V and SSB consumption and low PA turned out to be the most obesogenic factors in this sample of European children.

Evidence-based mapping of design heterogeneity prior to meta-analysis: a systematic review and evidence synthesis.

BackgroundAssessment of design heterogeneity conducted prior to meta-analysis is infrequently reported; it is often presented post hoc to explain statistical heterogeneity. However, design heterogeneity determines the mix of included studies and how they are analyzed in a meta-analysis, which in turn can importantly influence the results. The goal of this work is to introduce ways to improve the assessment and reporting of design heterogeneity prior to statistical summarization of epidemiologic studies.MethodsIn this paper, we use an assessment of sugar-sweetened beverages (SSB) and type 2 diabetes (T2D) as an example to show how a technique called ‘evidence mapping’ can be used to organize studies and evaluate design heterogeneity prior to meta-analysis.. Employing a systematic and reproducible approach, we evaluated the following elements across 11 selected cohort studies: variation in definitions of SSB, T2D, and co-variables, design features and population characteristics associated with specific definitions of SSB, and diversity in modeling strategies.ResultsEvidence mapping strategies effectively organized complex data and clearly depicted design heterogeneity. For example, across 11 studies of SSB and T2D, 7 measured diet only once (with 7 to 16 years of disease follow-up), 5 included primarily low SSB consumers, and 3 defined the study variable (SSB) as consumption of either sugar or artificially-sweetened beverages. This exercise also identified diversity in analysis strategies, such as adjustment for 11 to 17 co-variables and a large degree of fluctuation in SSB-T2D risk estimates depending on variables selected for multivariable models (2 to 95% change in the risk estimate from the age-adjusted model).ConclusionsMeta-analysis seeks to understand heterogeneity in addition to computing a summary risk estimate. This strategy effectively documents design heterogeneity, thus improving the practice of meta-analysis by aiding in: 1) protocol and analysis planning, 2) transparent reporting of differences in study designs, and 3) interpretation of pooled estimates. We recommend expanding the practice of meta-analysis reporting to include a table that summarizes design heterogeneity. This would provide readers with more evidence to interpret the summary risk estimates.