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.

Unhealthy food outlets and outdoor advertisements in urban South African primary school students' food environments.

Children's exposure to outlets selling, and outdoor advertisements marketing, unhealthy foods is an important risk factor for obesity. Yet few policies address the food retail and/or outdoor advertising environment, and research about children's perceptions is limited, especially in low- and middle-income countries. We used a participatory, multimodal visual/verbal approach to explore urban-dwelling South African primary school students' perceptions of unhealthy food outlets and outdoor advertisements they encountered on their journeys to school. Forty-one grade 7 students aged 11-14 years participated in drawing and/or photography activities and elicitation discussions. A mixed-methods, triangulated analysis involving the content analysis and extraction of data from research artefacts (33 journey to school drawings and 10 food advertisement photo collages) and thematic analysis of discussion transcripts was conducted. Drawings depicted 175 food outlets, two-thirds (64%) of which sold only unhealthy foods and 125 advertisements, most of which marketed unhealthy food. Unbranded, deep-fried foods prepared and sold by informal traders and independent shops were prominent. Informal and independent traders also sold unhealthy branded foods. Advertisements were primarily for unhealthy foods, especially branded, sugar-sweetened beverages. Participants thought extensive advertising bans, regulation of the sale of unhealthy food to children and other measures were needed to promote children's health in urban contexts. The results point to the need for food system-wide approaches that address multiple commercial determinants of health, including 'big food' advertising, unhealthy food sales by informal and independent traders and programs to address socio-economic influences such as poverty, unemployment and parents' poor work conditions.

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).

Watered down: a cross-case political economy analysis of sugar-sweetened beverage taxes in Vanuatu and Fiji.

Taxes on sugar-sweetened beverages (SSBs) in Vanuatu and Fiji are praised for their alignment with the World Health Organization's noncommunicable diseases Best Buy policy recommendations. SSB taxes also intersect with economic, trade and commercial interests as well as complex domestic and international power dynamics. Yet, to date, the role of these broader interests and power dynamics in shaping SSB tax adoption in Vanuatu and Fiji has remained underexamined. Drawing on Bourdieu's forms of capital and triangulating interview (n = 50), document (n = 461) and observational data, this cross-case political economy analysis sought to understand where forms of power reside, how they manifest, and what impact they have on the alignment between SSB tax in Vanuatu and Fiji and national and global goals and priorities. Three interconnected themes emerged from the analysis: the influence of domestic industry actors in a context of shifting fiscal and trade incentives; the pivotal agenda-setting role of pro-tax multisectoral coalitions and the way political instability lent importance to informal policy processes. Findings evidence the varying influence of economic, social, and cultural capitals across the policy cycle and showcase the way in which actors strategically deployed, lost or re-imagined their capitals to secure policy influence. Importantly, cultural capital was essential to leveraging influence across the policy cycle and more inward-facing systems favoured the protection of domestic actors and industries, including their economic capital. From a health perspective, these political forces ultimately culminated in weaker or 'watered down' SSB taxes in both Vanuatu and Fiji.

Use of social marketing to address the global burden of disease: Initiatives and effects

Purpose: To assess the use of social marketing interventions to address public health concerns and provide evidence on the effectiveness of the approach as a preventive tool in public health programming. Method: A scoping review framework was used, and articles published between 2000 and 2015 were included. Social marketing interventions were defined as interventions meeting at least six of the eight National Social Marketing Benchmark criteria adapted by French and Blair-Stevens (2006). Results: Sixty-nine (69) social marketing studies were included in the study. Nutrition, physical health and obesity (24.6%), malaria (20.3%), HIV/AIDS (11.6%), and cancer (10.0%) were the most prominent public health topics where social marketing strategies were employed. On the effectiveness of using social marketing in public health results indicated that the use of electronic medical records (EMR) among medical students increased from 13.8% to 54.7% while alcohol-impaired driving decreased from 85.0% to 65.0%, and child’s sugar-sweetened beverages intake reduced from 82.2% to 68.8%. The protective effect of ITN use to prevent malaria yielded OR=0.46 (95% CI: 0.30, 0.71, p=0.236). Limitations: The lack of high-quality data from the evaluation of social marketing interventions poses a major challenge and this needs to be addressed. Originality/value: Though the social marketing framework has gained widespread use in addressing and preventing some public health crises, the use of the framework seems limited to certain health topics, such as malaria and physical activities, nutrition, and obesity.

Examining the network dynamics of daily movement and dietary behaviors among college students: A diary study.

Promoting individuals' overall health and well-being is important, and understanding the interconnections between daily movement and dietary behaviors may provide insights for developing effective health behavior interventions. In the current study, we therefore adopted a network approach to investigate the complex relationships among movement and dietary behaviors within a daily diary study. Data were collected from 101 college students over a 28-day period, assessing movement (i.e., physical exercise and sedentary behavior) and dietary (i.e., overeating, sugar-sweetened beverage intake, and snack consumption) behaviors. We employed a multilevel vector autoregressive model to analyze the within-person (temporal and contemporaneous) and between-person networks of movement and dietary behaviors. Our findings unveiled a negative association between physical exercise and sedentary behavior at both contemporaneous and between-person levels, while the interconnections among dietary behaviors displayed nuanced variations across different levels. We also found intricate relationships between movement and dietary behaviors, with sedentary behavior and sugar-sweetened beverage intake emerging as central nodes in the behavior networks. This exploratory study underscores the complex interconnections of daily health behaviors, particularly highlighting the potential roles of sedentary behavior and sugar-sweetened beverage intake in multiple behavior interventions. These preliminary findings have yet to be validated through theory-driven studies with experimental designs.

The impact of culturally-informed messages to reduce sugar-sweetened beverage consumption: An experiment among Black women in the United States.

Sugar-sweetened beverage (i.e., sugary drink) consumption is associated with chronic health issues that disproportionately affect Black women. Culturally-informed (CI) health campaigns may be more effective among Black women than campaigns designed for general audiences. This study assesses the effects of a CI campaign on consumption intentions, comparing these effects to general audience and control campaigns. We conducted an online between-persons randomized experiment with a national convenience sample of 502 Black women in February 2023. Participants were randomly assigned to view a CI, general audience, or control campaign. Outcomes were intentions to decrease sugary drink consumption (primary outcome; range 1-7), knowledge of (range 0-4) and perceived susceptibility to health harms (range 1-5) and sharing intentions (range 0-3). The CI campaign had significantly higher perceived cultural relevance (M = 4.61) than the general audience (M = 3.64) or control (M = 3.66; p's<0.05) campaigns. Consumption intentions did not differ by campaign condition (F = 0.03, p>0.05). There was no main effect of campaign condition on knowledge or perceived susceptibility (p's>0.05), though findings were moderated by body size. Based on body size, women reported less perceived susceptibility or knowledge when exposed to the CI campaign, compared to either the control or general audience campaign. Sharing intentions did not differ by campaign condition. Future research should continue to examine the role of refining message content over a longer duration to understand whether the anticipated impact of CI messages can be achieved in the context of sugary drink consumption among Black women.

Making Sense of the Relationship Between Ultra-Processed Foods, Obesity, and Other Chronic Diseases

Ultra-processed foods (UPFs) is a food category within the NOVA system. The key feature of UPFs are foods that have been highly processed and contain various additives, especially those that are industrially produced. It is claimed that UPFs are inherently unhealthy. The classification system is highly controversial. This paper critically evaluates the evidence. In stark contrast to conventional systems for food classification, the NOVA system disregards the nutritional values of foods. As a result, many foods generally considered to be healthy are included as UPFs, whereas many unhealthy foods are excluded. Epidemiological studies, mainly prospective cohort studies, have consistently reported an association between the intake of UPFs and risk of obesity, cardiovascular disease (CVD), type 2 diabetes, common mental disorders (especially depression), and all-cause mortality. A similar association has been reported for cancer and hypertension, but the supporting evidence is weaker. The most plausible explanation for this is that the associations are largely due to a limited number of unhealthy foods, such as processed meat and sugar-sweetened beverages. Studies of the relationship between UPFs and obesity present a different picture. There is much evidence that suggests that UPFs play a major causal role in obesity. The high contents of fat, sugar, carbohydrates, and sodium commonly present in UPFs makes these foods hyperpalatable. In addition, UPFs typically have a high energy density. As a result of these two features of UPFs, most people consume an excessive energy intake when presented with UPFs. Because UPFs include a wide range of foods, many of which are healthy, it is likely that while many UPFs are obesogenic, many others are not.

Coffee Intake in Brazil Influences the Consumption of Sugar, Sweets, and Beverages

Background/Objectives: Considering the high consumption of coffee in Brazil, this study aimed to investigate the relationship between coffee consumption and the intake of added sugar, non-caloric sweeteners, sugary beverages, and foods. Methods: A modified case-crossover study was conducted using data from the national “Household Budget Survey (POF)” which 38,854 participants. Dietary intake was assessed using 24-h recalls on two non-consecutive days. Days with and without coffee consumption were compared (case-crossover) to evaluating the effects on sugar, sweeteners, sugary foods, sugar-sweetened beverages (SSB), and milk. Results: 87% of Brazilians aged 10 and older consumed coffee on a giving day. The consumption of all food groups decreased as days of coffee consumption increased, except for non-caloric sweeteners and sugar, which increased. In the case-crossover analysis (2192 men and 2580 women), women who consumed coffee on one of the two days showed an increase of 10 g of sugar and of 0.10 mL (2 drops) of sweeteners. For men values were 8 g and 0.05 mL. Also, women reduced sugar-sweetened beverages (−56.8 mL/day), while men reduced milk intake (−25.9 mL/day). Conclusions: Coffee consumption was associated with increased intake of sugar and non-caloric sweeteners and lower intake of sweets, SSB, and milk. Reducing sweets and SSB is beneficial but increasing sweeteners and reducing milk are not. Potential strategies include encouraging the use of milk in coffee instead of sugar and sweeteners, as well as reducing the size of sugar sachets, which in Brazil typically range from 5 g to 8 g.

The Impact of a Water Promotion and Access Intervention on Elementary School Students in the Presence of Food Insecurity.

School-based interventions encouraging children to replace sugar-sweetened beverages (SSBs) with water show promise for reducing child overweight. However, students with child food insecurity (CFI) may not respond to nutrition interventions like children who are food-secure. The Water First cluster randomized trial found that school water access and promotion prevented child overweight and increased water intake. This secondary analysis used mixed-effects regression to evaluate the interaction between the Water First intervention and food insecurity, measured using the Child Food Security Assessment, on child weight status (anthropometric measurements) and dietary intake (student 24-hour recalls). Eighteen elementary schools (serving ≤ 50% children from low-income households), in which drinking water had not been previously promoted, in the San Francisco Bay Area. Students in fourth-grade classes (n=1056). Food insecurity interacted with the intervention. Among students with no CFI, the intervention group had a lower prevalence of obesity from baseline to 7 months (-0.04, confidence interval [CI] -0.08 to 0.01) compared to no CFI controls (0.01, CI -0.01 to 0.04) (p=0.04). Among students with high CFI, the intervention group had a pronounced increase in the volume of water consumed between baseline and 7 months (86.2%, CI 21.7 to 185.0%) compared to high CFI controls (-13.6%, CI -45.3 to 36.6%) (p=0.02). Addressing food insecurity in the design of water promotion interventions may enhance the benefit to children, reducing the prevalence of obesity.

The divergent association of diet intake, parental education, and nutrition policy with childhood overweight and obesity from low- to high-income countries: A meta-analysis.

It is unclear whether the effects of dietary intake, parental education, and nutrition policy on childhood overweight and obesity is consistent between high-income (HICs) and low- and middle-income (LMICs) countries. The objective of this meta-analysis was to investigate the association of diet, parental education and nutrition policy with childhood overweight and obesity when the economic levels were controlled. PubMed, Web of Science, Embase and Scopus were searched for observational studies published from January 1980 to October 2023 that examined the association of diet, parental education and nutrition policy with childhood overweight and obesity. Meta random effects model stratified by gross national income per capita was used to assess whether the associations were varied by economic levels. From 18 191 identified studies, 154 met the inclusion criteria. Meta-analysis revealed that higher sugar-sweetened beverage intake was a risk factor for childhood overweight and obesity in both HICs and LMICs countries/regions, whereas higher intake of fruit and/or vegetable was a protective factor only in LMICs countries/regions (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.69-0.85). Moreover, lower parental education level increased the risk (OR = 1.46; 95% CI = 1.32-1.61) and nutrition policy implementation decreased the risk (OR = 0.96; 95% CI = 0.91-0.99) of childhood overweight and obesity only in HICs. Fruit and/or vegetable intake, parental education and nutritional policy exert different influences on childhood overweight and obesity in countries with varied economic levels. These findings will enhance the understanding of the complex interplay between these factors and their impact on childhood health.

The Prevalences of Behavioral Problems in Children and adolescents in Chengdu, Sichuan, China and Associated Risk Factors: A Multi-Center Cross-Sectional Study

ABSTRACT This study aimed to investigate the prevalence of behavioral problems in children and adolescents in Chengdu, Sichuan, China and the associated risk factors. A questionnaire survey was conducted with the students and their parents or caregivers from five primary and middle schools to investigate the parent–child relationship, family financial situations, health risk behaviors, and behavioral problems. A total of 8157 questionnaires were distributed, and 7928 (97.19%) valid questionnaires were returned. Among the 7928 valid questionnaires, 3846 were completed by female students and their parents or caregivers, and 4082 were completed by male students and their parents or caregivers. The average age of the surveyed students was 10.62 years. The prevalence rate of behavioral problems in children and adolescents was 13.79%, and the prevalence rate of behavioral problems significantly varied by gender and age. The female students had a higher prevalence rate of behavioral problems than male students (14.6% versus 13.0%). The students aged 12–16 years had a higher prevalence rate of behavioral problems than those aged 6–11 years (16.4% versus 12.2%). A correlation between behavioral problems and weekly pocket money was detected in the children and adolescents. Poor parent–child relationships, excessive screen time for both parents and children, short duration of sleep, and excessive intake of sugar-sweetened beverages could lead to a significant increase to the risk of developing behavioral problems in children and adolescents. Health-risky behaviors in children and adolescents were closely correlated to their behavioral problems. More attention should be paid to encouraging children and adolescents to live healthy lifestyles and tackling their behavioral problems.

The Impact of Sugar Consumption on Eye Health: Implications for Public Health Outcomes in Human Populations

The rising global consumption of sugar, mainly through sugar-sweetened beverages, presents a growing public health concern due to its potential negative impact on eye health. This paper explores the complex relationship between excessive sugar intake and various eye diseases, including diabetic retinopathy, cataracts, and glaucoma, focusing on the biological mechanisms involved, such as metabolic dysregulation, oxidative stress, and inflammation. The paper found that epidemiological evidence has consistently linked high sugar consumption to an increased prevalence of these conditions, highlighting the need for public health interventions to mitigate this risk. The burden of sugar-related eye diseases places significant pressure on healthcare systems, social equity, and economic productivity. Vulnerable populations, including children, the elderly, and those with pre-existing health conditions, face heightened risks. Therefore, addressing these challenges requires a multifaceted approach, incorporating policies to reduce sugar consumption, improve public education on healthy dietary habits, and promote community-based initiatives to reduce the health impact of excessive sugar intake. Recommendations include implementing sugar taxes, improving food labeling, and fostering collaboration between healthcare providers and policymakers to safeguard eye health and enhance public health outcomes. Continued research into the long-term effects of sugar on eye health is essential for refining these strategies and ensuring better outcomes for at-risk populations. Accepted: 05/11/2024 Published: 19/11/2024 *Corresponding Author Sylvester Chibueze Izah E-mail: chivestizah@gmail.com Keywords: Sugar consumption, Eye health, Diabetic Retinopathy, Cataracts, Glaucoma, Public health.

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.