Sugar-sweetened Beverages Research Articles

Associations of food group intakes with serum carbon isotope ratio values in youth: results from two prospective pediatric cohort studies

BackgroundThe carbon isotope ratio (CIR) is a candidate biomarker for sugar sweetened beverage (SSB) intake in the U.S. However, research specific to youth, who differ in their physiology and dietary patterns compared to adults, is lacking. ObjectivesWe evaluated longitudinal associations of SSB intakes across childhood/adolescence with serum CIR. We also explored the relationship between other dietary intakes and serum CIR. MethodsData were from participants in two longitudinal, pediatric cohorts in Colorado: Exploring Perinatal Outcomes among CHildren Study (EPOCH) (visits at median 10 and 16 y, n=150) and Healthy Start Study (visits at median 5 and 9 y, n=166). Serum CIR was measured using isotope ratio mass spectrometry. Diet was assessed by food frequency questionnaires (EPOCH) or 24-hour diet recalls (Healthy Start). We assessed associations of longitudinal dietary intakes (log2-transformed, standardized) with serum CIR using linear mixed models adjusted for age, sex, and energy intake, and associations of change values between visits using linear regression models. ResultsIn linear mixed models, higher SSB intake across visits was associated with higher serum CIR in both cohorts (β [95% CI]: 0.11[0.06,0.15] in EPOCH and 0.14[0.07,0.21] in Healthy Start). Higher meat intake and a higher dietary animal protein ratio were also positively associated with serum CIR in both cohorts (β [95% CI]: 0.08[0.05,0.12] and 0.18[0.13,0.23] in EPOCH; 0.08[0.01,0.16] and 0.28[0.21,0.35] in Healthy Start). In change analyses, there were positive associations for changes in the dietary animal protein ratio between visits with changes in serum CIR in both cohorts, but not for changes in SSB intake. ConclusionsOur findings support serum CIR as a potential biomarker of SSB intake in youth cross-sectionally; however, there was not a strong link between change values over longer-term follow-up. Meat/animal protein intake was also consistently and, at times, more strongly associated with serum CIR.

Socioeconomic mobility, metabolic health, and diet: mediation via subjective socioeconomic status.

Socioeconomic mobility, i.e., changing socioeconomic status (SES) between adolescence and adulthood, may impact health through changing resources, social status, and health-related behaviors. This analysis examined whether subjective SES contributes to associations of mobility with metabolic health (BMIand metabolic syndrome) and unhealthy diets (fast-food consumptionand sugar-sweetened beverage [SSB] consumption). National Longitudinal Study of Adolescent to Adult Health data were used (n = 4132). Mobility was defined as the difference between adolescent (collected 1994-1995, ages 11-19 years) and adult (collected 2016-2018, ages 33-43 years) SES. Linear and logistic regressions examined associations of mobility with metabolic and dietary outcomes and mediation by subjective SES. Substantial upward mobility was associated with lower risk of high SSB consumption compared with stable disadvantaged SES (risk difference: -0.10 [95% CI: -0.16 to -0.041]). Subjective SES mediated associations of upward, but not downward, mobility with risks of developing metabolic syndrome, high fast-food consumption, and high SSB consumption; upward mobility was associated with higher subjective SES and lower risks of poor metabolic and dietary outcomes. The finding that subjective SES contributed to associations between upward mobility and better health may inform development of interventions designed to promote healthier diets and reduce socioeconomic disparities in metabolic health.

Supply- and demand-side drivers of the change in the sugar density of food purchased between 2015 and 2018 in Great Britain.

The UK government launched a two-component sugar-reduction programme in 2016, one component is the taxation of sugar-sweetened beverages, the Soft Drinks Industry Levy, and the second is a voluntary sugar reduction programme for products contributing most to children's sugar intakes. These policies provided incentives both for industry to change the products they sell and for people to change their food and beverage choices through a 'signalling' effect that has raised awareness of excess sugar intakes in the population. In this study, we aimed to identify the relative contributions of the supply- and demand-side drivers of changes in the sugar density of food and beverages purchased in Great Britain. While we found that both supply- and demand-side drivers contributed to decreasing the sugar density of beverage purchases (reformulation led to a 19 % reduction, product renewal 14 %, and consumer switching between products 8 %), for food products it was mostly supply-side drivers (reformulation and product renewal). Reformulation contributed consistently to a decrease in the sugar density of purchases across households, whereas changes in consumer choices were generally in the opposite direction, offsetting benefits of reformulation. We studied the social gradient of sugar density reduction for breakfast cereals, achieved mostly by reformulation, and found increased reductions in sugar purchased by households of lower socio-economic status. Conversely, there was no social gradient for soft drinks. We conclude that taxes and reformulation incentives are complementary and combining them in a programme to improve the nutritional quality of foods increases the probability of improvements in diet quality.

Effectiveness of pictorial-warning intervention to reduce consumption of sugar-sweetened-beverages

Abstract Background & Aims Limited research have looked at pictorial-health-warnings (PHW) for sugar- sweetened beverages (SSB), despite the potential for behaviour change that pictorial warnings on tobacco products hold. This study aimed to examine how visual warnings impacted parents’ decisions to buy SSB for their children. Materials and methods All residents dwelling in the communities and local vendors available were subjected to a ten-week multi-strategy intervention by randomized stepped-wedge controlled trial to support the introduction of PHW labels. Stepped implementation of a two-week PHW intervention was delivered in a randomly selected order at one-week intervals. Follow-up data were collected for all three sectors two weeks following the completion of the PHW intervention in the third sector. The trial outcome was determined by comparing the overall perception change towards SSB among parents between the baseline and follow-up periods for three sectors combined. Secondary outcomes included reactions to the trial labels, attitudes toward SSB, and intentions to serve their child SSB. Results PHW led to a 30 % (-37.12%, -22.37%) reduction in purchases of SSB, along with lower intentions to serve SSB to children, higher thoughtfulness about the harms of SSB, more perceived control of healthy eating decisions, stronger negative emotional reactions, lower perceived healthfulness of SSB for their child, and greater injunctive norms to limit SSB for their child (all p < 0.05). No differences by sector or within sector were found between pre and post-intervention in the appeal of SSB or perceived tastiness of SSB (all p > 0.05). Nearly 53% of participants reported being more in control of making healthy eating decisions. Conclusions Warnings on SSB are a promising policy approach to reduce sugary drink purchasing. This evidence will support the health service adoption of implementation strategies to support PHW labels across the entire country. Key messages • Warnings on SSB are a promising policy approach to reduce sugary drink purchasing. • Support the health service adoption of implementation strategies to support PHW labels across the entire country.

Investigating the diverse role of ultra-processed foods on cardiometabolic multimorbidity: Highlights from the ATTICA prospective study (2002-2022)

Abstract Background/Introduction The role of ultra-processed foods (UPF) on multimorbidity is currently unknown with limited research implying the existence of complex associations among the diverse UPF categories. Purpose The aim of the present work was to investigate the association of total and subgroup intake of UPF with cardiometabolic multimorbidity, after twenty years of observation, in a Mediterranean region. Methods In 2001-2002, n=3,042 free-of-cardiovascular disease (CVD) men and women from Attica, Greece, were recruited. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. The NOVA Food Classification system was used to assign the food products as UPF using a standard methodology. The food products assigned as UPF were further grouped as "bread and cereals", "spreads and sauces", "sweets and desserts", "artificially and sugar-sweetened beverages", "processed meat products" and "savory snacks". Cardiometabolic multimorbidity was defined as the co-occurrence of two cardiometabolic diseases i.e., type 2 diabetes and CVD within a 20-year follow-up period in a sample of n=1,846 participants with available data. Results The median consumption level of UPFs was 26.6 (16.3) servings/week contributing to around 40% of participants total daily energy intake. Over the 20–year follow–up period, n=231 cases of cardiometabolic multimorbidity were recorded. Ranking from 1st tertile (lower intake– 11.8 mean servings/week) to 2nd tertile (23.3 mean servings/week) and 3rd tertile (44.7 mean servings/week) regarding the consumption level of UPF, 20-year cardiometabolic multimorbidity was 9.5%, 13.4% and 14.7% respectively. Multi-adjusted analysis revealed that one standard deviation (SD) increase in UPF intake (servings/week) or in contribution of UPFs to total energy intake (% total energy intake) was associated with 26% [Odds ratio (OR)=1.26, 95% Confidence Interval (95%CI) (1.17–1.85)] and 29% higher risk of cardiometabolic multimorbidity [OR=1.29, 95%CI (1.08–1.69)]. Among UPF subgroups, only in case of artificial and sugar-sweetened beverages [OR=1.06, 95%CI (1.02–1.13)] as well as spreads and sauces [OR=1.06, 95%CI (1.02–1.13)] a positive association was observed. In case of breads and cereals an inverse association was observed [OR=0.95, 95%CI (0.92–0.98)]. In the rest categories even if a positive trend was observed (all ORs>1) significance was not reached (all p-values<0.05). Conclusion A dose-response relationship between UPF consumption and elevated risk of cardiometabolic multimorbidity was emerged. However, the diverse categorization of UPFs accompanied by the contradicting associations revealed herein among the different subcategories of UPFs could imply the need to return to the evaluation of foods more on the basis of their nutritional role and less on the basis of their degree of processing. The nation context accompanied by specific dietary habits should also be taken into consideration.

Portion Size Norms of Discretionary Foods and Eating Settings: A Repeated Cross-Sectional Study

Background: The increase in serving sizes of energy-dense nutrient-poor discretionary foods over time, with attractively presented large servings and package sizes, has led to portion distortion and a new ‘normal’ for serving sizes. Little data exists on the variations of portion size norms of discretionary foods across settings. This study aimed to examine the differences in the range of normal portion sizes of commonly consumed foods between home and out-of-home settings (coffee shops, restaurants). Methods: A repeated cross-sectional design was used, with nine selected discretionary foods and beverages included in a validated online image-series questionnaire. Participants completed the questionnaire at two time points to report their normal portion sizes in home and out-of-home settings. Quantile regression models were used to examine differences in the range of normal portion sizes (17th to 83rd percentile, representing the majority of the study population) between settings. Results: A final sample of 295 participants was included in the analysis (51% females, mean age 40 ± 14 years). The ranges of normal portion sizes did not differ by settings for all test foods except for sugar-sweetened beverages (SSB) tested in both containers and glassware. SSB showed smaller normal portion sizes at home compared to fast food restaurants (in a bottle/can and in a glass/cup; p < 0.001). Conclusions: These findings suggest that the portion size norms of many discretionary foods are mostly consistent in home and out-of-home settings. As the typical serving sizes available to consumers in the out-of-home settings are large, it is essential to establish practical serving size guidelines directed at the food industry to increase the availability of smaller size options and empower consumers towards better portion control.

Factors Related to the Consumption of Sugar-Sweetened Beverages (SSBs) Among High School Students at SMA Negeri 68 Jakarta in 2024

Indonesia ranked third in Southeast Asia for Sugar-Sweetened Beverages (SSBs) consumption in 2022, with a consumption rate of 20.23 liters/person/year. According to Riskesdas in 2018, 61.3% of the Indonesian population consumed more than once a day and 47.5% in 2023. This study aims to understand the patterns and levels of SSB consumption among various factors in students of SMA Negeri 68 Jakarta in 2024. This cross-sectional study was conducted from April to May 2024 with 134 respondents using questionnaires and interviews for 24-hour food recall and SQ-FFQ. Univariate analysis showed that 12.69% of respondents had high SSB consumption. Bivariate analysis indicated a significant relationship between the availability of SSBs at home (p-value = <0.001; OR = 20.000) and peer influence (p-value = 0.018; OR = 4.588) with SSB consumption. After knowing the research results, it is hoped that students can realize the importance of limiting SSB consumption and spread awareness to their immediate environment, while families are advised to limit the availability of SSBs at home by reading nutritional labels before purchasing, understanding the impacts of sugary drinks, and learning the latest facts about sugary drinks.

Harnessing SSB tax for health and economic prosperity: A Path to sustainable growth

This study explores the implementation of sugar-sweetened beverages (SSB) excise taxes as a policy tool to address public health challenges related to excessive sugar consumption in Indonesia. With rising rates of diabetes and obesity, SSB taxes have been widely adopted globally, yielding positive outcomes such as reduced consumption and increased government revenue. This research synthesizes global evidence through a scoping review and examines how an SSB excise tax could be structured to fit Indonesia’s unique socio-economic context. The findings suggest that a tiered tax based on sugar content would be most effective in curbing consumption while encouraging the beverage industry to innovate healthier alternatives. Revenue generated from the tax, estimated to reach IDR 9.68 trillion annually, could be directed toward public health initiatives, particularly for preventing and managing non-communicable diseases. The study also recommends complementary public health campaigns to raise awareness of the risks associated with sugar consumption. Effective collaboration between the Directorate General of Taxes and the Ministry of Health is crucial for successfully implementing and monitoring the policy. The introduction of SSB excise taxes in Indonesia represents a strategic opportunity to enhance public health, generate substantial government revenue, and support long-term sustainable development.

Modelling the potential impact of a tax on fruit juice in South Africa: implications for the primary prevention of type 2 diabetes and health financing

BackgroundSouth Africa is experiencing a persistent growth in non-communicable diseases. Diabetes is among the top ten causes of mortality, especially among women, which is partly driven by high levels of added sugar consumption and obesity. To reduce obesity rates and the incidence of diabetes, South Africa introduced a tax on sugar sweetened beverages (also known as the Health Promotion Levy (HPL)) in 2018. The tax is applicable to sugar-sweetened beverages but excludes 100% fruit juice. The government is currently considering extending the tax to include fruit juices. This study models the potential health and economic impact of taxing fruit juices at 20% of the retail price of one liter.MethodsTo analyze the distributional impact of the tax, this study uses extended cost-effectiveness analysis methodology. Data on price elasticities, healthcare cost, income, fruit juice consumption were sourced from the literature and representative national surveys. The potential impact of the tax on diabetes incidence, prevalence, mortality, and financial benefits were estimated for each income group (lowest, quintile 1 to highest, quintile 5).FindingsWe estimate that a 20% tax on fruit juice would avert 156,640 incident cases of type 2 diabetes mellitus over 20 years, with most disease averted occurring among the first- and fifth-income groups. Averted deaths from diabetes would average 2,000 deaths per quintile (for quintiles 1 to 4) and about 2,800 in quintile 5. The improved health resulting from averted incidence and deaths will reduce overall healthcare expenditure by R7.5 billion over 20 years, of which R2.3 billion will occur in the fifth quintile. The South African government will also save about R300 million in subsidizing diabetes-related healthcare cost as a result of prevention; and would raise R8.6 billion in tax revenues per annum. Out-of-pocket expenditure savings will be R303 million and a financial risk protection (money-metric value of insurance) of R4.6 billion over the 20-year period.ConclusionWe conclude that an HPL that significantly raises the retail price of fruit juices would reduce consumption and diabetes-related morbidity and mortality. The tax will also provide significant financial benefits in the form of reduced healthcare costs for both government and households as well as providing financial risk protection to individuals. Health taxes are win-win policies that improve population health and generate revenue for governments to fund public health services delivery and thus improve overall health financing activities of the government. Therefore, population level disease prevention measures such as health taxes are important for achieving universal health coverage.

Association Between Diet and Mental Health Outcomes in a Sample of 13,887 Adolescents in Canada.

The high prevalence of mental disorders among adolescents calls for community-based and population-level prevention strategies. Diet is an important intervention target for primary prevention of mental disorders among adolescents. We used data from a large longitudinal study of Canadian adolescents (aged 14-18 y) to examine prospective associations between diet and mental health outcomes. We estimated the effect of diet (ie, consumption of vegetables and fruit and sugar-sweetened beverages [SSBs]) at baseline on depressive symptoms, anxiety symptoms, and psychological well-being (measured by the Center for Epidemiologic Studies Depression Scale-Revised, Generalized Anxiety Disorder 7 scale, and Flourishing Scale, respectively) and at 1-year follow-up in a sample of 13,887 Canadian secondary school students who participated in the 2017-2018 and 2018-2019 cycles of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary (COMPASS) behavior study. We applied linear mixed-effects methods informed by a directed acyclic graph. Sensitivity analyses assessed the robustness of the effect estimates to unmeasured confounding variables. Baseline SSB consumption was associated with greater severity of depressive (β = 0.04; 95% CI, 0.01-0.06) and anxiety (β = 0.02; 95% CI, 0-0.05) symptoms, particularly among male students, and poorer psychological well-being (β = -0.03; 95% CI, -0.05 to -0.01) at follow-up. Baseline vegetables and fruit consumption was positively associated with psychological well-being (β = 0.06; 95% CI, 0.03-0.10) but not other mental health outcomes at follow-up. Our results support the notion that diet should be part of comprehensive mental health prevention and promotion interventions to reduce the prevalence of mental health disorders among adolescents.

Behavioral Correlates of Caregiver-Reported Oral Health of Children with Cleft Lip and/or Cleft Palate Ages 14 to 48 Months: An Observational Study.

To identify behaviors associated with poor caregiver-reported oral health in a population of young children with cleft palate with or without cleft lip (CP ± L). Observational cross-sectional study. U.S. Cleft Outcomes Research NETwork (CORNET) Consortium Eight hundred thirty-four caregivers of US children with CP ± L ages 14 to 48 months who provided demographic and medical information and answered 8 items on oral health behaviors (eg, sugar-sweetened beverage intake frequency, having a regular source of dental care, toothbrushing, and fluoride exposure). Caregiver-reported oral health status of the child (poor/fair vs good/very good). Logistic regression models were used to generate confounder-adjusted odds ratios (OR) and evaluate associations between oral health behaviors and caregiver-reported oral health status of the child. The mean age of children was 25.5 ± 7.5 months, 82.7% were white, and 24.1% were Hispanic/Latino. About 16.7% of caregivers reported their child's oral health as fair/poor. Children consuming 2+ servings of juice and/or sugar-sweetened beverages daily (OR: 2.18; 95% confidence interval [CI]: 1.2, 4.0; P = 0.011), those drinking bottled water (OR: 1.75; 95% CI: 1.0, 3.1; P = 0.049), and those consuming 1+ servings of meal replacement drinks daily (OR: 2.86; 95% CI: 1.2, 6.5; P = 0.015) had increased odds of fair/poor caregiver-reported child oral health. Sugar-sweetened beverages and meal replacement drinks, as well as bottled water intake, were associated with poorer caregiver-reported oral health for children with CP ± L. Future research should focus on ways to improve beverage-related behaviors in children with CP ± L to prevent dental diseases and promote oral health.

Cost-effectiveness of tax policies on promoting sustainable diets in Iran: a modeling study.

Implementation of food taxes may promote sustainable diets in a society. This study estimates the potential short-term impacts of taxes on sugar and sweets (SAS), sugar sweetened beverages (SSB) and hydrogenated oil and animal fats (HOAF) in Iran through a social cost-effectiveness analysis. In this study, three tax scenarios were evaluated, including a 25% tax on SASs, a 30% tax on SSBs, and a 30% tax on HOAFs. The data from Iran's 2019-2020 Household Income and Expenditure Survey (HIES) were utilized, and a simulated population of 1 million individuals aged over 25 years was analyzed. Population impact fraction (PIF) was calculated to estimate the averted number of cases and Disability-Adjusted Life Years (DALYs) under each policy scenario. Additionally, the study assessed water and carbon footprints, as well as all associated costs. Cost-effectiveness was evaluated through incremental cost-effectiveness ratios (ICER) and comparison with WHO-recommended thresholds. Implementation of taxes on SASs and HOAFs resulted in reductions of 1.09 and 1.08% in water footprint, as well as 0.47 and 1.05% in carbon footprint, respectively. In terms of population health, the interventions resulted in averting 343.92 DALYs (95% UI = 318.62-369.36) for the SSB tax and 1219.01 DALYs (95% UI = 1123.05-1315.77) for the tax on HOAFs. Additionally, the tax on SASs averted 1028.09 DALYs (95% UI = 947.16-1,109). All scenarios were deemed cost-effective based on the WHO threshold for ICER, with values of 0.26 billion Rials/DALY, 0.54 billion Rials/DALY, and 0.17 billion Rials/DALY, respectively. The studied tax scenarios could generate substantial health gains and be cost-effective in Iran. It is recommended that policymakers consider implementing such price policies to promote healthy and sustainable diets.

The Consumption of Non-Sugar Sweetened and Ready-to-Drink Beverages as Emerging Types of Beverages in Shanghai

Background: The Chinese beverage industry is experiencing rapid growth, particularly in the popularity of non-sugar sweetened beverages (NSSs) and ready-to-drink beverages (RSBs). This study aimed to assess current consumption patterns and determinants of various beverage types among retail visitors. Methods: A total of 44 observation points, including 22 supermarkets and 22 convenience stores, were randomly selected across Shanghai. At each location, at least 100 individuals were recruited to participate. Data were collected using an electronic self-administered questionnaire. Results: The consumption rates of total beverages, sugar-sweetened beverages, NSSs, and RSBs were 57.70%, 56.94%, 19.60%, and 29.50%, respectively; the median consumption amounts among the drinking population were 162.57 mL/day, 137.98 mL/day, 32.85 mL/day, and 32.85 mL/day, respectively. The consumption proportions of NSSs and RSBs ranked 2nd and 3rd. The multifactorial analyses showed that people aged 6–18 years consumed more beverages (p < 0.05). Males were more likely to consume sugar-sweetened beverages and NSSs, but females were more likely to consume RSBs (p < 0.05). Higher educated people and bachelors were more likely to consume beverages (p < 0.05). Conclusions: The emerging beverage categories, NSSs and RSBs, warrant attention due to their significant consumption rates. Tailored intervention strategies should be considered for demographic groups varying by age, gender, and educational attainment.

An Instrumental Analysis of the Triad Association Between Sugar-Sweetened Beverages, Screen Time, and Dental Caries in Adolescents

Background: Previous studies reported screen time in association with unhealthy dietary behaviors, such as excessive intake of sugar-sweetened beverages leading to dental caries. Thus, we aimed to explore the association between screen time on mobile devices and dental caries experience in adolescents, as well as whether sugar-sweetened beverages would mediate the association. Methods: We analyzed 24,374 junior and senior high school students of age 12 to 17 years from the 2021 “Surveillance for common diseases and health risk factors among students” Project in Jiangsu Province of China. Dental caries experience was determined by the designated dentists. Screen time and consumption of sugar-sweetened beverages were self-reported and treated as a priori risk. We employed an instrumental variable (IV) approach for the current cross-sectional setting. We used the lasso technique to shortlist covariates from a range of confounding factors. Binary logistic regression or ordered logistic regression was performed where appropriate to explore the associations of screen time on mobile devices with dental caries and sugar-sweetened beverages. Results: The prevalence rate of dental caries was 38.4% in the study population. In comparison with <2 h/d screen time on mobile devices, extended screen time (≥2 h/d) was associated with higher dental caries risk (coefficient: 1.27, 95%; confidence interval: 0.80–1.75). Mediation analysis suggested that sugar-sweetened beverage intake might be an independent risk factor for dental caries, instead of the mediator between screen time on mobile devices and dental caries. None of the interaction terms under investigation was statistically significant. Conclusions: Exposure to mobile device screens and sugar-sweetened beverages was associated with dental caries in adolescents. These findings highlighted the importance of increasing awareness of potential risks owing to mobile device usage and sugar-sweetened beverages and the necessity to develop appropriate intervention strategies for school-aged adolescents.

The association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary habits: a large-scale cross-sectional study.

Previous systematic review has shown that individuals with more comprehensive dietary knowledge tend to engage in healthier eating patterns among American or European population. However, research on the association between dietary knowledge based on the Chinese Dietary Guidelines and healthy dietary behaviors, particularly among adolescents and college students in China, is lacking. This study aimed to examine the association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary behaviors among adolescents and college students in China. A cross-sectional study was conducted in China in August and October 2023. The study involved 527 adolescents and 11,856 college students. A convenience and cluster sampling methodology was employed to select one or two grades from 33 different university majors. The dietary behaviors of college students were evaluated by assessing their consumption of nine food groups: water, eggs, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. The dietary behaviors of adolescents were evaluated by assessing their consumption of five food groups: fast food, salty snack foods, fruits, vegetables, and soft drinks and sugared fruit beverages. The participants' dietary knowledge was assessed using the Chinese Dietary Guidelines. The relationship between dietary knowledge and behaviors was examined using a multivariate logistic regression analysis. The questionnaire response rate was 100.0%. Multivariate logistic regression analysis revealed a significant positive association between dietary knowledge and the likelihood of exhibiting diverse dietary behaviors among college students. After adjusting for gender, age, family income, place of residence, and parents' education levels, the results demonstrated a positive association between dietary knowledge and adherence to 4-8 eating habits among college students. In contrast, similar association was not observed among adolescent. This study revealed a significant association between dietary knowledge based on the Guidelines and adherence to healthy dietary behaviors among college students in China. That is to say, the higher the level of dietary knowledge based on the Guidelines among college students, the healthier the dietary behaviors they tend to adopt in their daily lives. These findings indicate the necessity of developing educational interventions based on the Guidelines to enhance dietary knowledge among individuals with limited dietary knowledge. Such interventions could facilitate the acquisition of essential health-related knowledge and strengthen motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials in order to establish a causal association between dietary knowledge based on the Guidelines and healthy dietary behaviors.

An Inventory of Proposed and Enacted Sugar-Sweetened Beverage Policies at the State, Local, and Tribal Levels in the United States, 2014‒2023.

Objectives. To inventory and describe trends in proposal and enactment of US sugar-sweetened beverage (SSB) policies at state, local, and Tribal levels, 2014-2023. Methods. We systematically searched 6 policy databases in 2021 (updated May 2023) using SSB-related search terms, identifying additional policies through snowball and online searches and a survey of food-policy experts. We reviewed 10 821 policies for inclusion and quantitatively coded included policies. Results. The inventory included 400 (321 unique [i.e., excluding companion]) policies meeting criteria: 335 (256 unique) state-, 63 local-, and 2 Tribal-level policies. From 2014 to 2023, 11% of unique state-, 92% of local-, and 100% of Tribal-level proposed policies were enacted. Across jurisdictions, the most frequently proposed policies related to excise taxes, restaurant children's meals, nutrition standards, and the Supplemental Nutrition Assistance Program, while the largest proportions of enacted policies related to restaurant children's meals, nutrition standards, education, and procurement. More policies were proposed and enacted in California and New York than other states, and in 2017 (proposed) and 2016 (enacted). Conclusions. This comprehensive inventory of US SSB policies provides information to inform future SSB policy development and diffusion. (Am J Public Health. Published online ahead of print October 17, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307855).

Effectiveness of Universal Community Engagement Childhood Obesity Interventions at Improving Weight-Related and Behavioral Outcomes among Children and Adolescents: A Systematic Review and Meta-Analysis

Background: Universal community engagement interventions can address childhood obesity. Objectives: This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents. Methods: Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I2 statistics and Cochran’s Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively. Results: Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children’s standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = −0.02, 95%CI = [−0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children’s dietary choices and activity levels. Only the meta-analysis on children’s daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = −0.25, 95%CI = [−0.38, −0.13], Z = 3.98, p < 0.0001) at immediate post-intervention. Conclusions: Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement.

Modeling and empirical evidence of the impact of implementation of sugar sweetened-beverages tax to reduce non-communicable diseases prevalence: a systematic review.

The surge in non-communicable diseases (NCDs) has been linked to excessive sugar-sweetened beverage (SSB) consumption. In response, the World Health Organization advocates for SSB taxes as a preventive measure. This study conducts a systematic literature review, encompassing simulation modeling and empirical evidence, to evaluate the effectiveness of SSB taxes in diminishing NCD prevalence. A systematic search from August 2002 to August 2022, utilizing databases like ScienceDirect, PubMed, Google Scholar, Wiley Online Library, Springer, and ResearchGate, identified 29 relevant articles worldwide following PRISMA 2020. The Critical Appraisal Skill Programme (CASP) 2018 tool was employed for economic evaluation. Among the selected articles, 22 utilized simulation models in group of countries such as South Africa, the US, the UK, Asia (Philippines, India, Indonesia, Thailand), Australia, and Europe (Germany), while seven were based on US and UK evidence. Simulation modeling consistently demonstrated that SSB taxes significantly reduced NCD incidence, prevalence, and mortality, also bolstering government revenue. Tax rates in simulations ranged from 10 to 25%. However, empirical evidence indicated a limited impact, primarily due to low tax rates. Notably, a UK-specific tax led to a 2.7% reduction in SSB sugar purchases and 40.2% higher purchases of no-levy drinks. The findings suggest that while simulation models demonstrate the potential effectiveness of SSB taxes in reducing NCDs, empirical evidence reveals there is no significant effect of the SSB tax, Based on the study conducted in this study, the SSB tax is not effective in reducing the prevalence of NCDs due to consumer preferences that have not changed. , likely due to the implementation of lower tax rates and failure to fulfill the assumption of subtitution product, physical activity, and so on. The study highlights that SSB tax is not effective in reducing the prevalence of NCDs due to consumer preference that have not change. Multi-actions are needed to support the sustainability of the implementation of the SSB tax, including education and promotion of healthy lifestyles and encouragement to reformulate SSB products by industry.

Associations between exposure to advertising of foods high in fats, salt and sugar and purchase of energy and nutrients: a cross-sectional study.

To assess associations between self-reported advertising exposure to foods high in fats, salt and sugar and household purchases of energy, nutrients and specific product categories. A cross-sectional design was used. Advertising exposure data were gathered using a questionnaire administered to the main shopper of each household, and purchase data from supermarkets and other stores for these households were accessed for a 4-week period during February 2019. Households in London and the North of England. Representative households (N 1289) from the Kantar Fast Moving Consumer Goods Panel. Main shoppers were predominantly female (71 %), with a mean age of 54 years (±13). Linear regression models identified that exposure to foods high in fats, salt and sugar advertising through traditional mediums (including broadcast and print), but not digital, transport, recreational or functional mediums, was associated with greater purchases of energy (9779 kcal; 95 % CI 3515, 16 043), protein (416 g; 95 % CI 161, 671), carbohydrate (1164 g; 95 % CI 368, 1886) and sugar (514 g; 95 % CI 187, 841). Generalised linear models showed that individuals who reported exposure to sugary drink advertising were more likely to purchase sugary drinks (1·16; 95 % CI 2·94, 4·99) but did not purchase more energy or nutrients from sugary drinks. There was no evidence of associations between exposure to advertising for sugary cereals or sweet snacks and purchases from these categories. There was a strong influence of traditional advertising and sugar-sweetened beverage advertising on household food and drink purchases, thus supporting the need for advertising restrictions across traditional formats and for sugary drinks specifically.

Indigenous knowledge and sugar sweetened beverages: Qualitative adaptations towards chronic disease prevention and intervention

Sugar sweetened beverages (SSB) are a concern for Indigenous populations and are associated with multiple chronic diseases. To address this concern, we culturally tailored and tested the feasibility of an evidence-based SSB-reducing curriculum. The modified curriculum was designed for Indigenous men and is thematically based on traditional values, ancestral teachings, and community strengths while promoting healthy lifestyles. A community-based participatory research (CBPR) approach was used to develop an interview guide using an Indigenous-centered theoretical framework. Two Indigenous content experts conducted both individual and focus group interviews (n = 14) with urban community leaders and athletes. Two Indigenous qualitative scientists analyzed the data with the support of an inter-tribal community advisory board. Results included imagery utilization, the importance of water, marketing, taste, and building routine. These findings guided the development of 6-month Indigenous focused SSB intervention consisting of 12 in-person intervention sessions and 27 short messaging service (SMS) messages.