Sugar-sweetened Beverages Research Articles

Childhood obesity and sugar-sweetened beverages in Río Negro: Burden of disease and expected impact of Law no. 27642 on the Promotion of Healthy Eating.

Introduction. The highest levels of childhood overweight and obesity in Latin America correspond to Argentina; this condition increases the risk of obesity, type 2 diabetes, cardiovascular and cerebrovascular diseases, and other conditions in adulthood. More than 25% of childhood and adolescent obesity are attributable to the consumption of sugar-sweetened beverages (SSBs). Our objective was to assess the disease and financial burden of SSB consumption among children and adolescents in Río Negro, the morbidity and mortality in adulthood, and the impact of reducing sugar consumption via the implementation of Law no. 27642 on the Promotion of Healthy Eating. Population and methods. We used a mathematical simulation model with a comparative risk assessment approach in the Río Negro population aged 0 to 17 years. The burden of obesity attributable to SSB consumption in the short and long term and direct medical costs were assessed. Results. The average consumption of SSBs was 348 mL/day; the prevalence of overweight and obesity was 16.6% and 11.6%, respectively. There were over 6600 cases of overweight in children and adolescents; while in adulthood, there were over 17 500 cases of overweight, 34 deaths attributable to SSBs, 3200 cases of diabetes, and over 4230 other health events. Direct medical costs were estimated at ARS 250 000 000 attributable to SSB consumption. Conclusion. The implementation of a comprehensive policy as established by Law no. 27642 on the Promotion of Healthy Eating in Río Negro would decrease 24% of overweight cases, morbidity, mortality, and associated medical costs.

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. 2024;114(12):1344-1353. https://doi.org/10.2105/AJPH.2024.307855).

Countermarketing Versus Health Education Messages About Sugar-Sweetened Beverages: An Online Randomized Controlled Trial of US Adults.

Objectives. To test whether countermarketing messages for sugary drinks lead to lower intentions to consume sugary drinks and less perceived weight stigma than health education messages. Methods. In August 2023, we conducted an online randomized controlled trial with US adults (n = 2169). We assessed the effect of countermarketing messages, health education messages, and neutral control messages on intentions to consume sugary drinks and perceived weight stigma. Results. Both countermarketing messages (Cohen d = -0.20) and health education messages (d = -0.35) led to lower intentions to consume sugary drinks than control messages (Ps < .001). However, both types of messages elicited more perceived weight stigma than control messages (ds = 0.87 and 1.29, respectively; Ps < .001). Countermarketing messages were less effective than health education messages at lowering intentions to consume sugary drinks (d for countermarketing vs health education = 0.14) but also elicited less perceived weight stigma than health education messages (d = -0.39; Ps < .01). Conclusions. Countermarketing messages show promise for reducing sugary drink consumption while eliciting less weight stigma than health education messages, though they may need to be refined further to minimize weight stigma and maximize effectiveness. Clinical Trial Number. ClinicalTrials.gov NCT05953194. (Am J Public Health. 2024;114(12):1354-1364. https://doi.org/10.2105/AJPH.2024.307853).

Comparative effects of different beverages on weight loss in adults: a systematic review and network meta-analysis of randomized trials.

There is a lack of clarity on the comparative effects of different beverages on weight loss in adults. This study aimed at quantifying and ranking the effects of different beverages on weight loss. We searched PubMed, Scopus, and Web of Science up to January 2023. We included randomized trials evaluating the comparative effects of two or more beverages, or compared a beverage against a control group (water, no intervention), for weight loss in adults. We conducted a random-effects network meta-analysis (NMA) with a Bayesian framework to estimate mean difference [MD] and 95% credible interval [CrI]. In total, 78 randomized trials with 4168 participants were eligible. Low/no-calorie sweetened beverages (LNCSB) was effective for weight loss compared with water (MD: -0.79 kg, 95% CrI: -1.35, -0.18), milk (MD: -0.80 kg, 95% CrI: -1.59, -0.01), fruit juice (MD: -0.83 kg, 95% CrI: -1.47, -0.13), sugar-sweetened beverages (SSB) (MD: -1.08 kg, 95% CrI: -1.65, -0.50), and no intervention (MD: -1.19 kg, 95% CrI: -1.93, -0.41). However, in sensitivity analyses, no significant effect was seen in trials with a low risk of bias and those that implemented calorie restriction. LNCSB drinking was effective for waist circumference reduction compared with water (MD: -1.85 cm, 95% CrI: -3.47, -0.22). The certainty of evidence from most comparisons was rated low. This study suggested evidence of low certainty that intake of LNCSBs can result in a small weight loss when used as a substitute for other beverages. Considering the low certainty of evidence, more research is needed to compare the effects of different beverages on body weight. Not applicable, but the protocol of this systematic review was registered at PROSPERO (registration number: CRD42023407937).

Consumption of Sugar-Sweetened Beverages by Polish Young Adults: A Preliminary Study on the Importance of Sugar Tax Familiarity and Health Effects

Consumption of sugar-sweetened beverages (SSBs) contributes to the risk of developing overweight and obesity in children and adults. Thus, reducing free sugar is a globally recognized public health priority. The implementation of a sugar tax is one way of achieving this goal. This study aimed to investigate the relationship between familiarity with the sugar tax and its importance in reducing obesity, the perceived health consequences of SSBs, situations and reasons for consumption, and the frequency of SSB consumption. A cross-sectional study was conducted in May 2022 among 216 Polish adults (age 18–45). Hierarchical cluster analysis was used to identify three homogeneous clusters with regard to the perceived health consequences of consuming SSBs. A logistic regression model was used to verify the relationship between the frequency of SSB consumption (dependent variable) and other variables. Respondents with higher familiarity with the sugar tax (OR: 0.594; 95% CI: 0.42–0.85) and those in the “Unaware of disease” (OR: 0.437; 95% CI: 0.18–0.94) and “Disease-conscious” (OR: 0.484; 95% CI: 0.24–0.97) clusters were less likely to consume SSBs at least once per week than those in the “Moderately disease-conscious” cluster. Both the place of SSB consumption (i.e., restaurant—OR: 1.847; 95% CI: 1.14–3.64, work or university—OR: 3.217; 95% CI: 1.51–6.88, family home—OR: 2.877; 95% CI: 1.50–5.53) as well as a preference for their taste (OR: 4.54; 95% CI: 1.66–12.45) increased the chance of consuming SSBs at least once a week. In conclusion, it is necessary to continue educating the public about the health consequences of SSB consumption. The use of legislative measures (i.e., sugar tax) also contributes to reducing SSB consumption and can thus counteract the increasing obesity rate.

Sugar-sweetened beverage consumption in Thailand: Determinants and variation across socioeconomic status

ObjectivesReducing consumption of sugar-sweetened beverages (SSBs) is a primary public health goal in Thailand, but information on the characteristics of SSB consumers remains limited. This study aims to gain knowledge about the characteristics of SSB consumers in Thailand. Study designSecondary analysis of survey data. MethodsThe study used data from the Health Behaviour of Population Survey conducted by Thailand's National Statistics Office between February and May 2021. SSB consumption was sourced from a survey question about the consumption of prepackaged sugar-sweetened non-alcoholic beverages. The influence of demographic, socioeconomic, behavioural, habitual, and health factors on mean daily intake and daily consumption was assessed using a two-part model and logistic regression analysis, respectively. Decomposition analysis was conducted to understand how the impact of these factors affecting SSB consumption varied across socioeconomic groups. ResultsFrequent SSB consumers exhibited various unhealthy behaviours, including smoking, unhealthy food consumption, low physical activity, and making food selections driven by appetitive motivations. Although higher socioeconomic status was associated with greater consumption of SSBs, it stabilised at elevated income levels. Increased SSB consumption in higher socioeconomic groups was linked to mixed eating habits, being overweight, and occasional drinking, while in lower socioeconomic groups, it was associated with unhealthy behaviours like smoking, regular alcohol drinking, appetitive food choices, and low physical activity. ConclusionsSSB consumption in Thailand is multifactorial, varying by socioeconomic status. These insights are crucial for policy formation aimed at reducing SSB consumption in the country. Policymakers should explore interventions that address overall unhealthy behaviours alongside those targeting overconsumption of SSBs.

Abstract 4142765: Plant-based Diet And Risk of Cardiovascular Disease in Patients with Prediabetes And Diabetes

Introduction/Background: The role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear. Research Questions/Hypothesis: We aimed to evaluate the associations of plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with cardiovascular disease (CVD) risk and explore potential contributing factors among people with prediabetes and diabetes. Methods/Approach: A total of 18,145 participants with prediabetes and 7,922 with diabetes were enrolled from the UK Biobank and followed until the end of 2020. We calculated the PDI, hPDI, and uPDI based on 18 major food groups including plant-based foods and animal-based foods and applied Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk related to PDI, hPDI, and uPDI. Results/Data: A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 VS. T1=1.14, 95% CI=1.03–1.27, P trend=0.012) and those with diabetes (HRT3 VS. T1=1.16, 95% CI=1.03–1.31, P trend=0.016), but not for PDI (P trend=0.621) or hPDI (P trend=0.914) (Table 1). High sugar-sweetened beverages (SSB) intake accounted for 16.7% of the uPDI-CVD association, whereas low intake of whole grain accounted for 26.9% of the association among patients with diabetes. Elevated cystatin C levels explained the largest proportion of the association between uPDI and CVD risk among individuals with prediabetes (18.1%, 95% CI=7.1%–39.1%) and diabetes (32.8%, 95% CI=11.5%–64.6%) (Table 2). Conclusions: Adherence to an unhealthy plant-based diet is associated with a higher CVD risk in people with prediabetes or diabetes, which may be partially attributed to low consumption of whole grains, high intake of SSB, and high blood cystatin C level.

Associations of sugary beverage intake with type 2 diabetes and the role of physical activity: a prospective cohort study

BackgroundHigher consumption of sugary beverages (SB) has been associated with type 2 diabetes (T2D), but whether these associations are modified by physical activity remains unclear. This study aimed to examine the associations of SB intake, including sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and natural juices (NJ) with the risk of incident T2D, and the potential role of physical activity.MethodsWe included 153,862 diabetes-free participants in the UK Biobank who completed both the International Physical Activity Questionnaire at recruitment (2006–2010) and at least one 24-h dietary recall questionnaire in 2009–2012. We assessed the associations of each SB with the risk of incident T2D using Cox proportional hazard models, and explored the interactions between each SB and physical activity.ResultsDuring a median follow-up of 11.8 years, 6631 participants developed incident T2D. Participants consuming more SSB and ASB (comparing > 2 to 0 unit/d) had a higher hazard of T2D (hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 1.05–1.31 for SSB; 1.54, 1.37–1.74 for ASB), while medium intake of NJ showed an inverse association (HR> 0–1 vs. 0 unit/d: 0.87, 95% CI: 0.82–0.92; HR> 1–2 vs. 0 unit/d: 0.88, 95% CI: 0.81–0.97) with incident T2D. No significant interactions between physical activity and SSB/ASB were found (P-interaction=0.204 for SSB, 0.926 for ASB), but the protective association of medium NJ intake with T2D was stronger among participants with higher level of physical activity (P-interaction = 0.043).ConclusionsHigher intake of SSB and ASB was related to higher risks of T2D. Medium NJ intake was associated with a lower risk of T2D, particularly among individuals with higher physical activity level. These findings emphasized the importance of healthy beverage intake and adequate physical activity in diabetes prevention.

Reduced rank regression dietary patterns and dyslipidemia in Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents (ERICA).

Evidence on the harmful effects of diet on serum lipids in adolescence has not been consistent. The present study sought to establish which dietary patterns are associated with biomarkers of dyslipidemia. Data from 36,217 Brazilian adolescents participating in the Study of Cardiovascular Risk in Adolescents were evaluated. Dietary patterns were identified using the reduced rank regression analysis. Linear regression models were applied to verify the association between dietary pattern scores and the biomarkers of dyslipidemia. The two first dietary patterns identified by reduced rank regression (RRR-DP1 and RRR-DP2) were kept for further analysis. The RRR-DP1 was highly and positively loaded for sweets and red meat and negatively loaded for beans, fruits, vegetables, and rice. The RRR-DP2 was positively loaded for beans and rice and negatively loaded for sugar-sweetened beverages, fruit juices, and sweets. Linear regression models estimated that one standard deviation (SD) increase in the RRR-DP1 score was only associated with a mean increase of 0.29 mg/dL in HDL-cholesterol (95% CI 0.06;0.53), while one SD increase in the RRR-DP2 score was associated with the lower mean of triglycerides (β = -2.24, 95% CI -3.57;-0.91), LDL-c (β = -0.82 95% CI -1.53;-0.12), and total cholesterol (β = -1.30 95% CI -1.94;-0.65). Higher adherence to the dietary patterns positively loaded for red meat and sweets was associated with increased HDL-c levels, while adherence to a more Brazilian traditional dietary pattern (RRR-DP2) was associated with a better lipids profile.

Sugar Sweetened Beverages (SSBs)-Awareness, Intention and Self-Efficacy Among Low-Income Adults in a Tertiary Care Setting

Objective: To assess the awareness, self-efficacy and intention of Sugar Sweetened Beverages (SSBs) among low-income staff members of a tertiary care hospital. Study Design: Cross sectional analytic study. Place and Duration of Study: Tertiary care hospital in Rawalpindi Pakistan, for 4 months, from May to Aug 2022. Methodology: The research was conducted among low-income urban adults of a tertiary care hospital in Rawalpindi Pakistan.A non-probability purposive sampling technique was used to select a sample of 200 participants. After taking informed consent the data was collected using a validated questionnaire to assess the SSB-related awareness, self-efficacy and intention.The association between SSB-related constructs and demographic factors was analyzed by using chi-square test and a p-valueof ≤ 0.05 was considered as significant. Results: The mean age of the participants was 21(SD=2.9). Majority 124(62%) of the participants were male, while almost two third 150(75%) had a higher secondary education. Remarkably participants had good SSBs related awareness 170(85%), selfefficacy 151(75.5%) and intention 177(88.5%). Whereas 60(30%) of the participants rarely using sugary drinks, comprised of 35(58.3%) females and 25(41.7%) males. However, association between these two variables was statistically significant (p=0.001). Association analysis between sociodemographic with SSB-related constructs, reported significant association between awareness with employment status (p-value=0.05) and self-rated health status (p-value=0.001). Conclusion: The current study concluded that despite less education level and monthly income. Majority of the participants consumed sugary drinks once weekly but not daily with good awareness, self-efficacy and intention, whereas no significant association was evident between gender and SSBs related awareness, self-efficacy and intention.

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.

School food policy in secondary schools in England and its impact on adolescents' diets and dental health: the FUEL multiple-methods study.

School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = -2.78 g, 95% confidence interval -4.66 to -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. This trial is registered as ISRCTN68757496. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

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 &amp; 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 &amp;lt; 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 &amp;gt; 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&amp;gt;1) significance was not reached (all p-values&amp;lt;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.

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). 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. 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). 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 = &lt;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.