Child Sugar-sweetened Beverage Intake 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.

Staff Knowledge, Attitudes, and Beliefs About Child Sugar-Sweetened Beverage Intake and Acceptability of a Pediatric Clinic-Based Beverage Screener.

Beverages are the leading source of sugar in children's diets and a modifiable risk factor for adverse health conditions. Electronic health record-based screeners could facilitate health systems' efforts to reduce child consumption of sugary beverages. Before implementing a sugar-sweetened beverage screener in the electronic health record within academic healthcare system, 228 pediatric and family medicine clinic staff completed an online educational training to familiarize them with the screener and its rationale. Pretraining and posttraining surveys were used to examine the association between staff knowledge of sugar-sweetened beverages and the acceptability of the screening workflow. Respondents displayed high levels of pretraining knowledge about health consequences of added sugar intake, but lower levels of pediatric beverage guideline knowledge. Knowledge improved from pretraining to posttraining surveys, with high acceptability of the screening process. Staff compliance with sugar-sweetened beverage screening was examined using electronic health record data. During the 6 months after screener implementation, 47% of eligible pediatric patients were screened, with some variation in compliance by age group and practice type. This study demonstrated that engaging nursing and frontline staff to screen pediatric patients for behavioral determinants of health is feasible. Ongoing outreach and refreshers may improve sustainability.

Associations Between Parent Diet Quality and Child Sugar Sweetened Beverage Intake in Latinx Families Living in an Emerging Community

ObjectivesHispanic children have the highest rates of obesity among children in the US and sugar sweetened beverages (SSBs) intake is of concern. It has been established that parent diet is associated with child dietary outcomes. This association has been understudied in the context of Latinx families, particularly those living in emerging Latinx communities (areas with a small yet growing population) where culturally appropriate foods may not be readily available. This analysis aims to determine the relationship between parent diet quality and parent reported child consumption of SSBs. MethodsWe analyzed baseline data for parent/child (age 2–11 years) pairs (n = 53) from the “Raices” study, a 6-month intervention for improving social support, healthcare accessibility, physical activity, and nutrition behaviors among Latinx living in Allegheny county, Pennsylvania. Mothers were selected as primary caregivers. In cases where no maternal data was available, the father was used. A multinomial regression was used with parent diet quality (Starting the Conversation [SCT] 8-item questionnaire, range 0–16, higher scores representing poorer diet quality) as the independent variable and parent reported child SSB intake (modified 2010 NYPANS questionnaire) as the dependent variable with child age, child BMI category, parent age, and parent education as covariates. ResultsNearly 40% of parents (mean age = 37.9 ± 5.9 years; 98.1% female; 56.6% college educated; mean STC score = 5.9 ± 2.7; mean time living in US = 8.8 ± 6.8 years) reported their children (mean age = 6.1 ± 2.6 years; 64.2% female; 71.7% normal weight) consume ≥ 2 SSBs/day. The odds of a child consuming 0 SSB/day or 1 SSB/day compared with ≥ 2 SSBs/day was not significantly predicted by parent diet quality (0/d: OR = 0.74, 95% CI = 0.50, 1.09; 1/d: OR = 1.02, 95% CI = 0.78, 1.34), while controlling for child age, child BMI, parent age and parent education. ConclusionsParent diet quality was not associated with parent reported child SSB intake in this sample of Latinx families living in an emerging community. Future research should continue to explore determinants of food choice in Latinx children. Funding SourcesCenters for Medicare & Medicaid Services, HHS, 1HOCMS331535-01-00.

Five-Year Trends in Sugar-Sweetened Beverage Consumption Among Mothers, Teenagers, Children From SNAP-Ed Eligible Households Indicate Increased Intake Among Children

Abstract Objectives Previously we reported improved dietary intake from 2015 to 2017 for fruits and vegetables, water, and Healthy Eating Index-2015 scores for mothers, teenagers, and children from households eligible for Supplemental Nutrition Education Program-Education (SNAP-Ed). Sugar-sweetened beverage (SSBs) consumption was unchanged during this three-year period across age groups. Our objective was to now examine trends in SSB intake with data from 2018 and 2019. Methods Cross-sectional surveys of mothers and their teenager or child were conducted from 2015 to 2019. Respondents were randomly sampled from households with reported incomes ≤185% of the federal poverty level. A study introduction letter in English or Spanish was sent to sampled households. Next, bilingual staff confirmed by phone household eligibility, the youngest mother (or caregiver), and one teenager (12 to 17 years) or child (5 to 11 years). During the subsequent interviews, staff administered the Automated Self-administered 24-Hour Dietary Assessment Tool (ASA24) in English or Spanish. The quantity and size of each reported food or beverage item was determined by asking mothers to reference pictures in a portion-size booklet or measuring cups or spoons previously mailed to each household. The procedures were replicated to obtain 24-hour dietary information from the teenager or child. Daily SSB intake was converted to ounces and regressed on year of survey with the covariates age, education for mothers, and gender for children. Significance of difference between means was adjusted by Bonferroni. Results Participants over the five-year period were 22,827 mothers, 5855 teenagers, and 10,778 children. Most (64.2%, 69.2%, and 67.9%) survey participants were Latinx. The trend for SSB intake for children was significant, with ounces per day increasing from 5.7 in 2017 to 7.3 in 2018 and 7.9 in 2019 (P = 0.0055). Conclusions A previous study found that, despite improvements across dietary behaviors, SSB intake was unchanged among mothers and children from SNAP-Ed eligible households. This follow-up study adds two years of data and findings indicate that children's SSB intake has increased. Findings suggest a need for interventions and policy work addressing children's SSB intake. Funding Sources California Department of Social Services.

Level of Neighborhood Deprivation Predicts Fruit &amp; Vegetable and Sugar-Sweetened Beverage Intake in Children Aged 12–24 Months

Abstract Objectives The first USDA Dietary Guidelines for Americans for children under 2 were released in December, 2020, and recommend a diverse diet rich in fruits and vegetables (FV), whole grains and lean protein and avoidance of sugar-sweetened beverages (SSB). We analyzed data for children 12–24 months enrolled in the CDC-funded PREVAIL Cohort in Cincinnati, OH to assess adherence to FV and SSB recommendations by the socioeconomic position (SEP) of their neighborhoods. Methods Diet was assessed using a validated food frequency questionnaire and daily servings of FV and SSB were calculated. Home addresses were geocoded and merged with the Deprivation Index, a validated measure of census tract-level SEP, with residence then classified as being High SEP (least deprived), Low SEP (most deprived) or the middle quartiles of deprivation score. Comparisons of FV and SSB intake were made using logistic or Poisson regression and generalized estimating equations (GEE). Results Dietary data was available for N = 207 children from research visits at 12 (n = 155), 18 (n = 196), and 24 (n = 171) months. Residents in High SEP neighborhoods were 86% white with a median household income of ≥$50,000; residents of Low SEP neighborhoods were 86% Black with a median income of ≤$25,000. Children in High SEP consumed the most and those in Low SEP the least FV per day (mos. 12, 18, 24: High: 3.8, 3.8, 4.5; Low: 2.1, 2.7, 3.2; all P &amp;lt; 0.05). While only 16.8% of children consumed any SSB at month 12, Low SEP children were 13.4 times more likely to consume any SSB than High SEP (37.8% vs 4.4%, P = 0.001). At month 24, 27.4% of High SEP children consumed any SSB and 7.8% consumed SSB at least once daily compared to 58.4% and 27.8%, respectively, in Low SEP children (P &amp;lt; 0.05). In univariate GEE models, children in Low SEP neighborhoods averaged 1/3 fewer FV but 4.6-times more SSB (all P &amp;lt; 0.01) compared to children in High SEP neighborhoods. The middle quartiles of deprivation index were intermediate in their FV and SSB intake. Conclusions In the PREVAIL Cohort, children in more deprived neighborhoods consumed significantly fewer fruits and vegetables and more sugar-sweetened beverages than those in more affluent neighborhoods. Efforts to improve diet quality should focus on promoting and enabling healthy food and beverage consumption in low SEP neighborhoods. Funding Sources Centers for Disease Control and Prevention.

Associations of mothers' source of feeding information with longitudinal trajectories of sugar-sweetened beverage intake, 100% juice intake and adiposity in early childhood.

There remains a need to understand how information sources can promote young children's healthy beverage consumption and prevent obesity. To examine associations of mothers' primary feeding information source with children's sugar-sweetened beverage (SSB) intake, 100% juice intake and adiposity between ages 3 and 7 years. We analyzed data from a prospective cohort study (n = 371 children; 13 visits). Mothers reported their primary feeding information source at baseline and completed child 3-day dietary records each visit. Child adiposity indicators were calculated from repeated height/weight measurements and dual-energy X-ray absorptiometry. Longitudinal models examined beverage intakes and adiposity over time by source. Primary feeding information sources included doctors (48.2%), mothers (17.5%), grandmothers (13.5%), other healthcare professionals (11.3%) and other family/friends (9.4%). Children's juice intake with age differed by source (P interaction = 0.03), with steepest and slightest intake decreases in the doctor (-19.7% each year; 95% CI: -23.7%, -15.5%) and grandmother (-5.0%; -14.5%, 5.5%) subgroups, respectively. Children's SSB intake did not differ by source, but increased annually by 7.1% (4.5%, 9.8%) overall. The grandmother subgroup had the greatest child adiposity over time. Mothers' primary feeding information source may have important, yet heterogeneous, influences on young children's beverage intakes and adiposity over time. Consistent evidence-based messages are likely needed.

Effect of the Smart Moms intervention on targeted mediators of change in child sugar-sweetened beverage intake

ObjectiveFew parent-targeted interventions have examined the mechanisms of action by which the intervention changes child behavior. The purpose of this study was to test the theoretical and behavioral mediators of the Smart Moms intervention on changes in child sugar-sweetened beverage and juice (SSB/juice) consumption. Study designThis is a secondary mediation analysis of data from a 6-month randomized controlled trial (N = 51 mother-child dyads) of a mobile phone–based program to reduce child SSB/juice intake compared with a waitlist control group. MethodsLinear mixed models compared changes in intervention targets from baseline to 3 months between treatment groups. Intervention targets that changed significantly between groups were tested in a multiple mediation model to evaluate their significance as mediators of change in child SSB/juice at 6 months. ResultsMaternal beverage consumption but no other behavioral or theoretical intervention targets mediated the effect of the intervention on the reduction in child SSB/juice at 6 months. There were few mediators of the intervention on child SSB/juice change. ConclusionGreater longitudinal research is needed to understand predictors of child dietary changes to inform future intervention efforts. In addition, a greater focus on the measurement of theoretical constructs in family-based child obesity prevention research is needed.

Parental Concerns about Child and Adolescent Caffeinated Sugar-Sweetened Beverage Intake and Perceived Barriers to Reducing Consumption.

Sugar-sweetened beverage (SSB) consumption contributes to obesity and chronic disease. SSB intake in children and adolescents remains well above recommendations and reducing intake is challenging. In addition to high sugar content, SSBs are the predominant source of caffeine among youth. However, whether caffeine in SSBs presents unique barriers to reducing consumption is unknown. Herein, we examine parental concerns about child caffeinated-SSB (CSSB) intake and describe parent-reported barriers to lowering their child’s consumption. In-depth qualitative interviews were conducted with 21 parents of children and adolescents 8–17 years of age. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded using Nvivo™, and key themes were identified. Most parents expressed concern about child CSSB consumption, primarily with regard to dietary (e.g., excess sugar), health (e.g., obesity, diabetes) and/or behavioral (e.g., hyperactivity) consequences of frequent intake. Several key barriers to CSSB restriction were reported, encompassing six emergent themes: widespread availability and accessibility; child non-compliance when asked not to drink CSSBs; peer and cultural influences; negative child response to CSSB restriction; family eating behaviors; and, child preferences for CSSBs versus other beverages. Consideration of these barriers, along with the development of novel approaches to address these challenges, will likely bolster success in interventions aimed at reducing CSSB intake among children and adolescents.

Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors.

CITATION: Morgan, E. H., et al. 2017. Caregiver involvement in interventions for improving children’s dietary intake and physical activity behaviors. Cochrane Database of Systematic Reviews, 2:1-19, Art. CD012547, doi:10.1002/14651858.CD012547.

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.

Decreasing sugar-sweetened beverage intake in children: a systematic review and meta-analysis

Decreasing sugar-sweetened beverage intake in children: a systematic review and meta-analysis

Impact of interventions to reduce sugar-sweetened beverage intake in children and adults: a protocol for a systematic review and meta-analysis

BackgroundSugar-sweetened beverages (SSBs) have been stressed as relevant targets of public health interventions considering the negative outcomes derived from their excessive intake. Though the evidence from published literature grows to support a cause-and-effect association of SSBs with obesity and other diseases, little is known on the effectiveness that strategies alone or as part of multi-component programmes have had to influence this particular dietary behaviour across all ages. Therefore, this review and meta-analysis aim to evaluate the effect that interventions have had to decrease their consumption or increase water intake in children and adults so as to guide the design of future programmes and inform policy making.MethodsIncluded studies in this review will be randomised controlled trials and quasi-experimental interventions (with a control group) that have reported baseline and post-intervention intakes of SSBs or water and that have been published from 1990 in any language. A thorough search will be performed in MEDLINE, EMBASE, Scopus, Web of Science, Cochrane’s central register of controlled trials, and the Global Health Library. Two independent reviewers will conduct initial screening of potentially included articles and will later extract data to analyse domains of intervention design and delivery (with emphasis on behaviour change techniques used as rationale), as well as results in changes on consumption patterns and behavioural determinants. Internal and external validity of each study will also be appraised. A meta-analysis will be performed if a sufficient number of studies are available, and if not, a narrative review will be conducted instead.DiscussionThe results from this review aim to strengthen public health initiatives tackling obesity through improvements in non-alcoholic drinking patterns. As a subject of growing attention globally, this review will help determine which strategies available are the most effective in different contexts. Knowledge gained from this work will also aid resource allocation in future research and government agendas.Systematic review registrationPROSPERO: CRD42014013436.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0008-4) contains supplementary material, which is available to authorized users.