Sugar Intake Research Articles

Infant diet quality index predicts nutrients of concern and ultra-processed food intake in low-income U.S. children

BackgroundDiet quality during infancy can influence nutrient intake and ultra-processed foods (UPF) consumption throughout later childhood. ObjectiveThis study investigated the predictive validity of Infant Diet Quality Index (IDQI) scores from 0-1 years of age and consumption of select nutrients and UPFs at different time points in low-income children ages 2-5 years. MethodsDietary surveys and 24-hour dietary recalls collected between ages 0-12 months from 2,613 Special Supplemental Women, Infants, and Children (WIC) Infant Toddler Feeding Practices Study-2 (ITFPS-2) participants were used to assess infant diet quality by final IDQI score ranging from 0 (non-adherence to dietary guidelines) to 1 (complete adherence to guidelines). Single 24-hour recalls collected across multiple time points per child between ages 2 and 5 years were used to determine nutrient intakes: vitamin B12 (μg), vitamin D (μg), calcium (mg), iron (mg), zinc (mg), potassium (mg), saturated fat (g), and dietary fiber (g), added sugars (g). Likewise, Nova was used to classify foods (to estimate the percentage of energy from foods) by level of industrial processing at each point in time across ages 2-5. Survey-weighted regression analyses estimated associations between total IDQI score and nutrient intake and percentage of energy consumption from each Nova food group at each age between 2-5 years. ResultsIDQI scores based on diet quality from 0-1 years of age were positively associated with children’s dietary fiber and potassium intake at ages 2-5. Additionally, IDQI was negatively associated with added sugar intake. No associations were observed between IDQI and saturated fat consumption. IDQI scores at age 1 were positively associated with the percentage of energy attributed to unprocessed/minimally processed foods (20% to 23%) and negatively associated with UPF consumption at ages 2-5 (-24% to -29%). ConclusionIDQI predicts intake of select nutrients and UPF consumption among low-income U.S. children ages 2-5. Clinical Trial RegistrationFeeding My Baby – A National WIC Study, NCT02031978, https://clinicaltrials.gov/study/NCT02031978. De-identified individual participant data from the WIC ITFPS-2 study is publicly available through USDA Ag Data Commons.

Parental norms and attitudes in Relation to Children’s sugar consumption − A mediation analysis of the “Are You Too Sweet?” intervention study

Parental influence on children’s dietary behaviour makes parents an obvious target for prevention strategies with nutritional foci. Mediation analysis is considered a valuable tool for understanding the underlying mechanisms of influence in intervention studies aimed at implementing behaviour change strategies.The present study used data from the multi-component cluster-randomised intervention “Are You Too Sweet?” with 153 Danish children (5–7 years) to explore mediating effects and role of parental determinants on added sugar intake in children.A pre-and post-intervention questionnaire evaluated parental knowledge, practices, self-efficacy, norms, and attitudes. Children’s dietary intake was estimated from a seven-day dietary record. Associations between children’s added sugar intake and parental responses and changes in responses following the intervention were evaluated using linear mixed models. Exploring potential behaviour change pathways of the intervention was done using mediation analyses.Children’s reduction in added sugar consumption was partly mediated by changes in parental norms and attitudes regarding limiting sugar-rich foods and drinks to special occasions. Parental knowledge of guidelines on the intake of sugar-rich discretionary foods and drinks increased as an intervention effect but did not demonstrate a mediating effect. No significant changes or mediating effects were found in parental self-efficacy or practices.The findings highlight parental norms and attitudes regarding restricting sugar-rich foods and drinks to special occasions as modifiable and a mediator for reducing added sugar intake in the “Are You Too Sweet?” intervention study.Trial registration: Retrospectively registered at ISRCTN: ISRCTN10409779.

Analysis of factors associated with public attitudes towards salt reduction: a multicountry cross-sectional survey

ObjectiveThis paper provides an in-depth examination of public attitudes towards salt reduction across seven culturally diverse countries: the USA, the UK, France, Japan, Indonesia, Thailand, and Brazil.DesignCross-sectional regression analysis with...

Total, Relative, and Added Sugar Intakes Are Positively Associated with Depression, Poor Mental Health, and Mental Health Medication Use in Female, but Not Male, Young Adults

Total, Relative, and Added Sugar Intakes Are Positively Associated with Depression, Poor Mental Health, and Mental Health Medication Use in Female, but Not Male, Young Adults

Carbon isotope ratio is not a viable candidate biomarker for total added sugar intake

Carbon isotope ratio is not a viable candidate biomarker for total added sugar intake

Food consumption and adherence to dietary guidelines among Jordanian children and adolescents

Background Early-life food consumption patterns may affect children’s health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood. Aims To evaluate Jordanian children and adolescents’ energy and macronutrient intake and how closely they adhere to dietary recommendations. Methods This cross-sectional study used data from Jordan’s Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines. Results The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake. Conclusion The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Validity and reliability of the Sustainable HEalthy Diet (SHED) index by comparison with EAT-Lancet diet, Mediterranean diet in Turkish adults.

Food consumption and diet are strongly associated with sustainability. The Sustainable HEalthy Diet index was developed to measure the nutritional, environmental, and sociocultural components of sustainable diets and healthy eating patterns. However, a methodological approach has yet to be proposed for Turkish adults. This study aimed to determine the validity and reliability of the SHED index in Turkish adults. Data were collected from 558 healthy adults using a web-based questionnaire. Internal consistency reliability was evaluated using Cronbach's alpha coefficient, and repeatability was evaluated using the test-retest method. Construct validity was investigated using the EAT-Lancet diet and the Mediterranean Diet Adherence Screener (MEDAS), and the adapted SHED index structures' accordance was evaluated with confirmatory factor analysis. Good reliability and repeatability were found (r = 0.758 and 0.795, respectively). A higher SHED index score was related to a greater intake of grains, fruits, and vegetables and a lower intake of meat, eggs, and dairy compared to EAT-Lancet diet food groups. A higher SHED index score was associated with a lower saturated fat and added sugar intake. While the SHED index was associated with greater adherence to the Mediterranean diet (r = 0.334, p < 0.001), it was negatively associated with non-alcoholic and diet non-alcoholic beverage consumption (r = -0.257 and -0.264, respectively; p < 0.001). The SHED index showed good validity and reliability in Turkish adults. Our results suggest that the SHED index can be used in epidemiological and intervention studies because it allows the measurement of diets in terms of health and sustainability to propose adaptations accordingly.

Factors Driving Individuals’ Attitudes toward Sugar and Sweet-Tasting Foods: An Analysis within the Scope of Theory of Planned Behavior

Public health authorities are undertaking initiatives aimed at reducing sugar intake because it is linked to detrimental health outcomes. Individuals’ attitudes and intentions toward sugar can be significant factors affecting intake. Therefore, we here aimed to evaluate individuals’ attitudes and intentions toward sugar intake by combining the theory of planned behavior with different frameworks. Accordingly, we developed an online questionnaire and reached 940 participants. We observed that subjective norms (β = −0.140; p &lt; 0.001) and perceived behavioral control (β = −0.138; p &lt; 0.001) as defined in the theory of planned behavior significantly affected attitude. Subsequently, examining the effect of attitude (β = −0.209; p = 0.018) and intention (β = 0.717; p &lt; 0.001) on sugar intake showed that intention had a positive effect, whereas attitude had no significant effect. Mediation analysis showed that attitude influenced sugar intake through intention (β = −0.286; p = 0.001). Furthermore, we determined that components including habits, perceived understanding, perceived nonautonomy, negativity, and apathy can affect attitude toward sugar intake (p &lt; 0.001). Analyzing the effects of sociodemographic factors revealed that sugar intake was lower in individuals with food allergies (p &lt; 0.05). In conclusion, these findings suggest that the theory of planned behavior, when combined with different frameworks, can be effective in predicting sugar intake and individuals’ intentions.

Assessing Knowledge, Attitudes and Behaviours toward Salt and Sugar Consumption in the Central Division of Fiji

Objectives: This study aimed to assess salt and sugar-related knowledge, attitudes and behaviours (KAB) of adults in the Central Division of Fiji. Methods: A randomised stratified sample of 700 adults were selected. Questions on salt and sugar-related KABs were developed. The survey took place from March to June 2022. For analyses, population and sample weights were applied, and differences between predefined subgroups (sex, age, ethnicity and area) were compared using weighted chi-square tests. Results: 534 adults participated (response rate 76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognised that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, almost 40% reported adding salt or salty sauces when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) adding sugar to drinks daily. Conclusions: Despite having positive knowledge and attitudes, many people reported behaviours likely to contribute to excess salt and sugar intake, highlighting the need for interventions that support behaviour change and the creation of healthier food environments.

The Associations between Depression and Sugar Consumption Are Mediated by Emotional Eating and Craving Control in Multi-Ethnic Young Adults.

Individuals with mental health conditions such as depression are vulnerable to poor dietary habits, potentially due to the maladaptive eating behaviors often used to regulate negative emotion. However, the specific dietary components most associated with depression, as well as the mediating roles of emotion regulation and other eating behaviors, remains ambiguous in young adults. For this cross-sectional evaluation, a total of 151 (86 F, 65 M; BMI: 22.0 ± 5.1 kg/m2; age: 21.4 ± 2.5 y) multi-ethnic participants (50 White, 36 Black, 60 Asian, and 5 White Hispanic) completed a digital 24-h dietary recall and self-reported measures of depressive symptoms, emotional regulation, and eating behaviors. LASSO regression was used to identify the dietary variables most associated with each subscale and to remove extraneous dietary variables, and multiple regression and mediation analyses were conducted for the remaining variables. Out of >100 dietary factors included, only added sugar in the combined sample (p = 0.043), and relative sugar in females (p = 0.045), were retained and positively associated with depressive symptoms. However, the relationships between depression and added and relative sugar intake were mediated by craving control and emotional eating, respectively. Individuals with higher added sugar intake (p = 0.012-0.037), and females with higher relative sugar intake (p = 0.029-0.033), had significantly higher odds of risk for major depression disorder and the use of mental health medications. Added and relative sugar intake are significantly associated with depressive symptoms in young adults, but these relationships may be mediated by facets of emotional dysregulation, such as emotional eating and craving control.

Adherence to the nutritional recommendations according to diabetes status in Korean adults: a cross-sectional study

BackgroundNutritional therapy plays a crucial role in diabetes management. Assessing adherence to nutritional recommendations is critical for evaluating whether the current status of nutrition education is appropriate. This study aimed to evaluate adherence to nutritional recommendations according to diabetes status using data from the Korean National Health and Nutrition Examination Survey from 2016 to 2019.MethodsA total of 2,793 participants (55.4% male) were evaluated regarding their adherence to nutritional recommendations. The “aware” group comprised people who had been clinically diagnosed by a physician. The “treated” group comprised people receiving anti-diabetic medications. The “control” group comprised people who achieved an HbA1c level < 6.5%. The “educated” group comprised people who had received nutrition education or counseling at various locations.ResultsAmong the 1,918 individuals in the “aware” group, only 243 (8.7%) had received nutrition education. Adherence to nutritional recommendations was generally low, with people with diabetes showing slightly higher adherence to total energy intake (59.6% vs. 55.3%) and total sugar intake (88.0% vs. 84.5%) than people without diabetes. However, adherence to total carbohydrate intake was poor in both the treated and educated groups (34.3% and 26.0%, respectively) compared to the untreated and non-educated groups (44.4% and 36.0%, respectively).ConclusionsThese findings indicate inadequate nutritional management for people with diabetes in Korea. Nutrition education should be effectively strengthened to achieve nutritional goals.

The trajectories of free sugar intake during childhood, their main sources and its association with socio-economic factors: generation XXI birth cohort.

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries (n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children's sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year2 until 13 years. At all ages, the main food source was sweets. Some item's consumption declined (sweets 25-21 % and yoghurts 22-7 %) as children grew older. Inversely, soft drink intake increased (9-18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal-SES was associated with lower children's FS intake: occupational status (β = -3·5; 95 % CI: -4·97, -1·94), years of education (β = -3·7; 95 % CI: -4·93, -2·40) and household income (β = -4·9; 95 % CI: -6·50, -3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term β = -1·04; CI 95 % (-1·50, -0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children's FS intake was always higher when their mothers had a lower SES.

Evolution of critical nutrients (salt, sugars and saturated fats) in Spanish foods and beverages in the last 25 years

Non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, etc.) are the leading cause of death worldwide, accounting for 71 % of global deaths. The risk factors for all of them are closely linked to lifestyle and in particular to diet. For this reason, public health policies in European Union countries, in line with World Health Organization (WHO) recommendations, include in their priority measures actions aimed at promoting healthier food environments. One of these measures are policies for the reformulation of processed foods to reduce critical nutrients: salt, saturated fats, trans fats and added sugars. In Spain, as part of the NAOS Strategy, food reformulation measures have been implemented since 2008. Of all of them, the Plan de Colaboración para la Mejora de la Composición de Alimentos y Bebidas y otras Medidas 2020 stands out, which has led to a reduction in the content of salt, sugar, saturated and total fat in foods belonging to 57 subcategories marketed by the main food manufacturing and marketing companies from 2016 to 2021. Despite this, to date no population-based study has been conducted to test the impact of the measure on the diet of the Spanish population. The present article, by way of example, shows results of the theoretical estimation of total sugar intake in the pre-reformulation period (2016) and post-reformulation period (2024) based on the consumption of beverages in Spain. Data highlight that reformulation policies could have positive effects that need to be evaluated in representative studies of the Spanish population assessing the overall diet, in order to solidly confirm their positive effects on the population's diet.

Total sugar content of pre-packaged beverages available in Saudi Arabia

Beverages are a major source of sugar; therefore, efforts to reduce sugar consumption focus on limiting sugary drinks. This is a descriptive observational analysis study of pre-packaged beverages. The analysis covered 12 beverage categories and 28 types of commonly available sugars in beverages. The beverages' median total sugar was determined and assessed based on the World Health Organization (WHO) recommended upper limit of sugar intake and the multiple traffic light labeling (MTL) criteria. Different analyses were performed including frequencies and median to determine the categories with high sugar content and non-parametric tests to compare the median of the total sugar among categories. The median total sugar content of the 1400 analyzed beverages was 11 g 100 mL-1; fruit juices and soft drinks had the highest median of total sugar (12 – 11 g 100 mL-1). The top sugar terms found are White sugar, Sucrose, High-fructose corn syrup, and Glucose syrup. The median total sugar in our study amounts to 20 % of the WHO upper limit recommendation, and 46.22 % of the beverages received a ‘red’ label for sugar content per 100 mL based on the MTL criteria. Sugar content in the pre-packaged beverages is high compared to the recommended daily limit of sugar.

Dietary Shifts since COVID-19: A Study of Racial Differences.

The COVID-19 pandemic has fundamentally changed the quality and quantity of people's food consumption. This study aimed to explore the dietary shifts among different racial groups resulting from the COVID-19 pandemic, focusing on changes in consumption across various food categories. This cross-sectional study included a sample of 10,050 urban residents aged 40-100 years across the United States. Dietary patterns among African American, Asian, Hispanic, and White populations were assessed before and since the pandemic (retrospective condition) using the Dietary Screening Tool (DST). The DST investigates consumption trends in food groups aligned with the MyPlate guidelines, plus fat, sugar, and sweet (FSS) intake and processed meats. This study found significant shifts in food consumption patterns among racial groups since COVID-19. The data indicate that African American individuals largely reduced their consumption of several food groups compared to White individuals, with a 43% decrease in processed meats, 42% in dairy, 36% in lean protein, 21% in fruit, 17% in grains, and 15% in FSS, although their vegetable consumption did not significantly decrease. African American individuals also consumed 66% less processed meat, 57% less dairy, and 30% less lean protein in comparison to Asian individuals. Hispanic individuals also showed a tendency to reduce their consumption more than White individuals, with a 34% decrease in dairy, 28% in vegetables, and 24% in fruit. In contrast, Asian individuals consumed 37% less FSS and 34% less grains than White individuals. Additionally, when compared to Asian individuals, Hispanic individuals consumed 49% less dairy and 47% less processed meat. The findings also revealed that African American individuals were the most nutritionally vulnerable group since the pandemic. Specifically, they were 38% and 35% more likely to be considered at nutritional risk than Asians and White participants, respectively. These findings illuminate the considerable dietary shifts induced by the COVID-19 pandemic and emphasize the critical need to address the racial disparities in nutritional vulnerability and public health policy.

THE RELATIONSHIP BETWEEN SIMPLE SUGAR INTAKE AND THE ABDOMINAL CIRCUMFERENCE OF PSSK STUDENTS

The abdominal circumference is dependent upon various factors, one of it is the simple sugar intake. Hence, research has been conducted in order to determine the effects of simple sugar intake on the abdominal circumference because there is an increase in people who have a large abdominal circumference in the past years, mainly due to increase in simple sugar intake. The research was conducted using a descriptive design with a cross-sectional analytical research method amongst the Medical Students of Udayana University by providing questionnaires. For the majority of the students, the simple sugar intake appears to be in the mid-range. There are 15 students, whose intake is more than the mid-range and 14 student whose intake below the mid-range. For majority of students, the abdominal circumference appears to be around the mid-range, 65.8cm to 92.8cm. There are 8 students whose abdominal circumference is more than the mid-range and another 8 students whose abdominal circumference is below the mid-range. The Pearson chi-square test value is 25.772 with an asymptotic significance 2 tailed (often referred to as “p”, short for probability) value of 0.018. Since this p-value is below 0.05, it means there is a significant or valid relationship between the two variables as expected.In conclusion, there is a significant relationship and moderate correlation between the intake of simple sugars and abdominal circumference amongst the PSSK UNUD students

Maternal dietary patterns and offspring behavioral problems.

Mental health problems often begin in early childhood and could predict psychiatric and behavioral outcomes. Prenatal factors such as maternal nutrition have an impact on neurodevelopment. This study aims to investigate the association between maternal dietary patterns and emotional and behavioral problems in 4-year-old children. Within a cohort of 205 mother-child pairs, three maternal dietary patterns were identified: 'Sweet and Superfluous', 'Fish and Vegetables' and 'Meat and Cereals'. Child behavior was evaluated by means of the Child Behavior Checklist 1.5-5 (CBCL 1.5-5), the Teacher's Report Form 1.5-5 (TRF 1.5-5), and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P). Multivariable analysis determined associations between maternal dietary patterns and their children's behavior. Maternal adherence to the 'Sweet and Superfluous' pattern was positively associated with externalizing and depressive problems in children. The 'Meat and Cereals' pattern was linked to a higher risk for attention, hyperactivity and depressive problems as somatic complaints. Conversely, the 'Fish and Vegetables' pattern was associated with a reduced risk of hyperactivity problems. All these associations were more pronounced in girls than in boys. Maternal diet during pregnancy is associated with the emotional and behavioral development of children at 4 years of age. Previous research on prenatal dietary patterns and children's behavior is inconclusive. In our study, children of mothers who had higher intakes of sugar and processed foods during pregnancy were more likely to have emotional and behavioral problems at age 4, especially girls. A high-quality diet characterized by fish and vegetable consumption during pregnancy was associated with reduced anxiety and hyperactivity problems in girls. Our findings highlight the importance of prenatal nutrition for child neurodevelopment.

Objective Analysis of Traditional Chinese Medicine Syndrome Differentiation of Patients With Diabetes and Prediabetes: Protocol for a Nonrandomized, Exploratory, Observational Case-Control Study Using Digitalized Traditional Chinese Medicine Diagnostic Tools.

Diabetes and prediabetes are diagnosed differentially by Western and Chinese medicine. While Western medicine uses objective laboratory analysis of biochemical parameters to define the severity of diabetes and prediabetes, Chinese medicine uses a comprehensive approach that integrates observation, inquiry, pulse palpation, and tongue diagnosis. The medical information collected is then categorized into different syndromes. However, traditional methods of pulse and tongue diagnoses used to determine syndrome differentiation are highly subjective and skill dependent. This study aims to identify the gap in conventional traditional Chinese medicine (TCM) diagnostic techniques for syndrome differentiation analysis using contemporary diagnostic devices. We devised a protocol for a nonrandomized, exploratory, observational case-control study with equal allocations in 5 arms to investigate the syndrome differentiation of diabetes and prediabetes. We hypothesize that the TCM syndrome differentiation of diabetes and prediabetes in the tropical climate may differ from that defined based on the Chinese demographic. We also speculate that the high-frequency spectral energy may reflect a difference in pulse wave intensity and density between the healthy and diabetes groups. A total of 250 eligible participants will be equally assigned to 1 of 5 arms (healthy or subhealthy, prediabetes, diabetes, prediabetes with hypertension and dyslipidemia, and diabetes with hypertension and dyslipidemia). Participants aged 21-75 years, of any sex or race, and have been diagnosed with diabetes (fasting plasma glucose [FPG] of 7 mmol/L, or 2-hour plasma glucose [2hPG] of 11.1 mmol/L) or prediabetes (impaired FPG of 6.1-6.9 mmol/L, or impaired glucose tolerance with an 2hPG of 7.8-11 mmol/L) will be included. The Health Evaluation Questionnaire, Physical Activity Questionnaire, sugar intake assessment, Constitution in Chinese Medicine Questionnaire, radial pulse diagnosis, and tongue diagnosis will be performed in a single visit. ANOVA for continuous data and chi-square tests of independence will be used for categorical data assessments, with a level of P<.05 considered significant. The recruitment is in progress. We anticipate that the study will conclude in June 2025. As of July 15, 2024, we have enrolled 140 individuals. To the best of our knowledge, this is the first study to use contemporary TCM diagnostic instruments to map expert and empirical knowledge of TCM to its scientific equivalents for the purpose of evaluating the syndrome differentiation of diabetes. We designed this protocol with the exploratory goal to examine objectively the syndrome differentiation of patients with diabetes and those with prediabetes using TCM diagnostic technologies. The data collected and evaluated under standardized conditions using these contemporary diagnostic devices will exhibit a higher degree of stability, hence yielding dependable and unbiased results for syndrome differentiation. Thus, our findings may potentially increase the accuracy of identification, diagnosis, treatment, and prevention of diabetes and prediabetes through a system of targeted treatment. ClinicalTrials.gov NCT05563090; https://clinicaltrials.gov/ct2/show/NCT05563090. DERR1-10.2196/56024.

Symptoms of Attention Deficit Hyperactivity Disorder and Oral Health Problems among Children in Spain

Introduction: The aim of this study was to explore the association between symptoms of attention deficit hyperactivity disorder (ADHD) and oral health in a representative sample of the Spanish population aged 6–14 years. We also examined the contribution of several sociodemographic and behavioral determinants of children/adolescents and their family environment. Methods: A cross-sectional study involving 3,402 subjects aged between 6 and 14 years from the Spanish National Health Survey. The presence of ADHD symptoms was determined using the self-reported hyperactivity/inattention subscale of the Strength and Difficulties Questionnaire. Oral health was assessed using five indicators: caries, extraction, restorations, gingival bleeding, and the presence of teeth in poor condition (e.g., broken or misaligned). Logistic regressions were used to examine the association between the presence of ADHD symptoms and oral health indicators. These models were adjusted for sociodemographic factors, lifestyle variables, and oral hygiene behaviors relating to both the children and their parents. Results: Compared to children without ADHD symptoms, children with ADHD symptoms had a higher risk of caries (fully adjusted odds ratio: 2.16; 95% confidence interval: 1.66–2.82), extraction (1.42; 1.09–1.85), restoration (1.47; 1.19–1.82) and gingival bleeding (1.64; 1.11–2.41). The increased risk of caries was maintained when the analyses were restricted to middle/high social class families and children with low sugar intake, good oral hygiene behaviors and regular dental visits. Conclusions: Children with ADHD symptoms in Spain had worse oral health indicators than those without ADHD symptoms. Our results suggest that the association of ADHD symptoms with caries was independent of socioeconomic level, cariogenic diet, frequency of toothbrushing, and dental visits.

Testing the causal relationship of fat and sugar intake with depression and cortisol: a Mendelian Randomisation study

Unhealthy diets high in fat and sugar content may have an impact on psychological health and increase the risk of Major Depressive Disorder (MDD) and stress levels. On the other hand, MDD and stress might be related to food choices and intake. However, it is not clear whether diet, and specifically fat and sugar intake, is causally related to stress and MDD, and whether this relationship may be bi-directional. This study utilised Mendelian Randomisation (MR) to investigate the causal nature of the relationship of fat and sugar intake with MDD and cortisol (as a proxy of stress), and to shed light on the direction of this relationship. Summary-level data for all exposure and outcome variables were obtained from large-scale, non-overlapping GWASs in individuals of European ancestry. Bidirectional analyses were performed: one with macronutrients as exposures and one with MDD/cortisol as exposures. Random-effects inverse-variance weighted regression was used as the primary analytic method for genetic instruments with at least two single nucleotide polymorphisms (SNPs) available (and individual Wald ratio was used when only one SNP was available). Higher levels of genetically predicted relative sugar intake were causally associated with lower MDD risk, for both genome-wide significant p-value threshold of p < 1 × 10−8, (OR = 0.553, 95% CI: 0.395-0.775) and relaxed p-value threshold of p < 1 × 10−6 (OR = 0.786, 95% CI: 0.630–0.981). No reverse causality was detected in the opposite direction as MDD was not associated with sugar consumption. The associations observed for all the other pairs of variables were weak and imprecise. A number of limitations was present in the study, such as low-SNP based heritability for some exposures, inability to prove whether variants were correlated with unmeasured confounders and self-reporting of MDD data. Lifestyle and/or pharmacological interventions targeting sugar-related physiological mechanisms may help to reduce depressive symptoms. However, more research is necessary on short- and long-term effects of sugar on the risk of MDD. Additionally, future studies should investigate whether the amount and type of sugar consumed may underlie the impact of sugar on mood and stress levels.