Sugar-sweetened Fruit Drinks Research Articles

Initial development of the Sugar-Sweetened Fruit Drink Questionnaire for examining beliefs, knowledge, and behaviors in an intervention to reduce sugar-sweetened fruit drink intake in Alaska Native children.

Alaska Native children may be at increased risk for dental caries because of added sugar intake from sugar-sweetened fruit drinks. This study describes development of a questionnaire to (a) assess Alaska Native caregivers' beliefs, knowledge, and behaviors regarding sugar-sweetened fruit drinks, and (b) describe behavior changes within a community-based intervention. Questionnaire development was conducted in three phases with Yup'ik Alaska Native caregivers in Southwest Alaska: (1) initial selection and adaptation of questionnaire items; (2) cognitive testing; and (3) data collection. The Sugar-Sweetened Fruit Drink Questionnaire (SFDQ) contains 31 culturally-tailored items across six areas: beliefs/values, environment/skills, knowledge, motivation, self-efficacy, and behaviors. Eighty-one percent of caregivers gave their children sugar-sweetened fruit drinks. Motivations included: what they grew up with (52%), few other options (46%), makes child happy (46%), healthier than soda (45%), and others in community drink them (42%). On average, 93% of caregivers believed drinking a lot of sugar-sweetened fruit drinks leads to cavities in children and caregivers agreed (mean 4.1 on 5-point scale, 5 = strongly agree) it is important to limit sugar-sweetened fruit drinks. Among a sub-sample of respondents (n = 20), we found low to moderate temporal stability in some SFDQ items over a 10-14 day period, indicating respondent ambivalence and/or uncertainty. Using community-based participatory research methods, we developed a culturally tailored exploratory questionnaire that will be used to describe changes in caregiver knowledge, beliefs, attitudes, self-efficacy, and behavior within a planned intervention to reduce sugar-sweetened fruit drink intake in Alaska Native children.

U.S. Households’ Children's Drink Purchases: 2006–2017 Trends and Associations With Marketing

Sugar-sweetened beverages contribute a large proportion of added sugar in young children's diets; yet, companies market sugar-sweetened children's drinks extensively to children and parents. This study examines the changes in children's drink purchases by U.S. households with young children and the associations with marketing practices. Longitudinal Nielsen U.S. household panel data provided monthly volume purchases by children's drink category (sugar-sweetened fruit drinks and flavored water and unsweetened juices) among households with young children (aged 1-5 years) from 2006 to 2017. Differences by household race/ethnicity and income were assessed. The 2-part models examined the associations between household purchases and marketing (including price and brand TV advertising) for each category, controlling for sociodemographics. Data were collected and analyzed in 2019-2020. Households' volume purchases of children's fruit drinks and unsweetened juices declined from 2006 to 2017, whereas flavored water purchases increased. Non-Hispanic Black households purchased significantly more fruit drinks (351.23 fluid ounces/month, 95% CI=342.63, 359.82) than non-Hispanic White (204.43 fluid ounces/month, 95% CI=201.81, 207.05) and Hispanic (222.63 fluid ounces/month, 95% CI=217.11, 228.15) households. Low-income households purchased more fruit drinks and fewer unsweetened juices than higher-income households (p<0.001). TV brand advertising was positively associated with purchases across all categories, and this relationship was stronger for low-income households (p<0.05). Despite expert recommendations that young children do not consume Sugar-sweetened beverages, households with young children purchase more sweetened fruit drinks than unsweetened juices. Extensive TV advertising for children's drink brands may exacerbate the racial and income disparities in sugar-sweetened beverage purchases. Public health initiatives to address sugar-sweetened beverage consumption by young children and restrictions on marketing sugar-sweetened beverages to children are necessary.

302-OR: Medical Prescriptions for Vegetables Are Associated with Reduced Consumption of Unhealthy Foods, Improved Food Security, and Lowered Cardiometabolic Risk among Adults with or at Risk of Type 2 Diabetes

Previously, we have reported that improving access to fresh vegetables reduces cardio-metabolic risk for predominantly Mexican American adults with or at risk of type 2 diabetes (T2D). This analysis examined changes in self-reported consumption of less healthy foods (soda, sugary drinks, and tortillas) and the association with medical prescriptions for locally sourced fresh vegetables. In this observational cohort study, 202 adults (152 female, 80% Hispanic/Latino, mean ±SD age of 53.8 ±12.6 years) with (n=62) or at risk (American Diabetes Association risk calculator) of T2D received 21 servings per week of locally sourced fresh vegetables prescribed by a physician for 10 weeks. No nutrition education was provided. For participants with paired data, there were reductions in waist circumference (-0.9 ±3.7 cm, p=0.003); systolic blood pressure for those with baseline ≥ 130 mmHg (-8.9±16.5 mmHg, p=0.001); and HbA1c values for participants with a baseline &amp;gt;7.0 % (-0.4 [-0.8, -0.1] %, p=0.016). Fewer participants had low or very low food security (USDA 6-item Food Security Module) after the intervention (25 versus 76, p&amp;lt;0.0001), associated with reductions in consumption of tortillas (p&amp;lt;0.00001); soda and other sugar-sweetened fruit drinks, sweet tea, and sports or energy drinks (p&amp;lt;0.001); and their weekly frequency of eating out (p=0.01). The improvement in food security was also associated with better sleep (ρ=0.22, p=0.007). The use of medical prescriptions for vegetables is associated with greater food security and lower cardiometabolic risk in predominantly Mexican-American adults with or at risk of T2D, possibly related to less consumption of unhealthy foods. Disclosure N. M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. C. Conneely: Research Support; Self; Abbott, Eli Lilly and Company. A. J. Larez: Research Support; Self; Abbott, Eli Lilly and Company. W. C. Bevier: Research Support; Self; Abbott Diabetes, Eli Lilly and Company. D. Kerr: Advisory Panel; Self; Novo Nordisk, Sanofi-Aventis, Research Support; Self; Abbott Diabetes, Elsevier, Lilly Diabetes, Stock/Shareholder; Self; Glooko, Inc. Funding U.S. Department of Agriculture (2018-33800-28404)

An online randomized trial of healthy default beverages and unhealthy beverage restrictions on children's menus.

Several U.S. jurisdictions have adopted policies requiring healthy beverage defaults on children's menus, but it is unknown whether such policies or restrictions leads to fewer calories ordered. We recruited 479 caregivers of children for an online choice experiment and instructed participants to order dinner for their youngest child (2-6years) from two restaurant menus. Participants were randomly assigned to one type of menu: 1) standard beverages on children's menus (Control; n=155); 2) healthy beverages on children's menus (water, milk, or 100% juice), with unhealthy beverages available as substitutions (Default; n=162); or 3) healthy beverages on children's menus, with no unhealthy beverage substitutions (Restriction; n=162). We used linear regression with bootstrapping to examine differences between conditions in calories ordered from beverages. Secondary outcomes included percent of participants ordering unhealthy beverages (full-calorie soda, diet soda, and/or sugar-sweetened fruit drinks) and calories from unhealthy beverages. Calories ordered from beverages did not differ across conditions at Chili's [Default: 97.6 (SD=69.8); p=0.82; Restriction: 102.7 (SD=71.5); p=0.99; Control: 99.4 (SD=72.7)] or McDonald's [Default: 90.2 (SD=89.1); p=0.55; Restriction: 89.0 (SD=81.0); p=0.94; Control: 96.5 (SD=95.2)]. There were no differences in the percent of orders or calories ordered from unhealthy beverages. Though Restriction participants ordered fewer calories from full-calorie soda [(3.0 (SD=21.6)] relative to Control participants [13.4 (SD=52.1); p=0.04)] at Chili's, we observed no such difference between Default and Control participants, or across McDonald's conditions. Overall, there was no effect of healthy default beverages or restrictions in reducing total calories ordered from unhealthy beverages for children in our experiment.

The impact of front-of-package claims, fruit images, and health warnings on consumers' perceptions of sugar-sweetened fruit drinks: Three randomized experiments

We aimed to examine the impact of claims, fruit images, and health warnings on consumers' perceptions of fruit-flavored drinks with added sugar (i.e., “fruit drinks”). We conducted three 2x2x2 randomized experiments with online convenience samples of U.S. adults (Study 1 n = 2139 in 2018, current e-cigarette users and smokers; Study 2 n = 670 in 2018, current e-cigarette users; Study 3 n = 1006 in 2019, general sample). Participants viewed a fruit drink that differed in the presence of a “100% Vitamin C” claim, a fruit image, or a health warning. On average across the three studies, consumers who saw a claim on a fruit drink believed that the drink was more healthful than those who did not see the claim (mean average differential effect (ADE) = 0.66, p < .001); they were also more interested in consuming the drink (mean ADE = 0.38, p = .001). The health warning decreased perceived product healthfulness (mean ADE = -0.65, p < .001) and consumption interest (mean ADE = -0.49, p < .001). The fruit image had no effect on perceived product healthfulness (mean ADE = 0.03, p = .81) or purchase intentions (mean ADE = -0.04, p = .77). In Study 1 and Study 2, there were no interactions between claims, images, or warnings (all p > .05). In Study 3, the “100% Vitamin C” nutrition claim only increased perceived product healthfulness when the drink did not also have a health warning (interaction p < .05). These findings suggest that 100% Vitamin C claims increase the appeal of fruit drinks, whereas health warnings decrease the appeal. Together, these studies support policies to restrict marketing and require health warnings on sugar-sweetened beverage packaging.

Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents

BackgroundLow-income individuals who are eligible for nutrition assistance have been shown to consume a larger portion of their daily calories from beverages with added sugar. We examined the association between Supplemental Nutrition Assistance Program (SNAP) participation and self-reported sugar sweetened beverage (SSB) consumption as well as the association between self-reported consumption of SSBs and overweight/obesity in low-income children. DesignCross-sectional analysis of 1455 SNAP-eligible U.S. children, ages 2–17, who completed a questionnaire and physical examination during the 2009–2010 National Health and Nutrition Examination Survey (NHANES). ResultsSNAP-eligible children who received SNAP in the last month were more likely to drink soda in the last month [76.0% (2.2)] than those who did not receive benefits [70.5% (2.8)]. These children were also more likely to drink fruit drinks [74.8% (1.6) vs. 69.3% (3.1)]. Among youth in households receiving SNAP benefits, soda consumption in the past month was associated with a greater risk of obesity, particularly Hispanic youth [OR=1.93 (1.07, 3.50), p=0.0314] aged 2–5 [OR=2.71 (1.29, 5.69), p=0.0114]. Additionally, among youth in households receiving SNAP benefits, male children who consumed sugar-sweetened fruit drinks in the past month were significantly more likely to be overweight [3.13 (1.12, 8.73), p=0.0315] as compared to male peers who did not consume any sugar sweetened fruit drinks. ConclusionAmong youth, SNAP recipients drink more SSBs than their eligible non-recipient peers. Our results indicate that certain populations of children receiving SNAP benefits and consuming SSBs are more likely to be overweight or obese when compared to their peers who receive SNAP benefits but do not consume SSBs.

Alaska Native Children Do Not Prefer Sugar-Sweetened Fruit Drinks to Sugar-Free Fruit Drinks

BackgroundAlaska Native children, including children of Yup’ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks. ObjectiveThe study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks. DesignThis was an experimental two-alternative forced-choice paired preference test. Participants/settingThe study focused on a convenience sample of Yup’ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89). InterventionChildren evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs. Main outcome measuresThe outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink. Statistical analyses performedA test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests. ResultsThe data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup’ik and non-Yup’ik children, boys and girls, and children of different ages. ConclusionsTaste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup’ik children in Alaska Native communities.

Assessment of Total Sugar and Glucose Concentrations in Commonly Consumed Beverages in Japan

The intake of added sugars, such as high-fructose corn syrup and sucrose, has markedly increased in the last hundred years and is closely associated with the increased prevalence of obesity, metabolic syndrome, and type 2 diabetes. We recently reported that the glucose- and fructose-induced generation of glyceraldehyde (GA) caused GA-derived advanced glycation end-products (GA-AGEs), which may be used biomarkers to predict lifestyle-related diseases. Therefore, we assessed total sugar and glucose concentrations in 885 and 298 commonly consumed beverages, respectively, in Japan. Our results revealed that total sugar concentrations were markedly higher in some carbonated drinks, sugar-sweetened fruit drinks, milk beverages, fruit mix juices, milk, cocoa, black tea, fruit juices, and other beverages. Total glucose concentrations were also higher in some carbonated drinks, sugar-sweetened fruit drinks, fruit mix juices, and fruit juices. About 40% of the beverages contained 25 g or more sugar per bottle based on standard serving sizes. This is the upper limit of daily sugar intake, recommended in the guidelines by the American Heart Association and the World Health Organization to prevent health problems in women and adults/ children, respectively. This study has provided potentially useful data on the presence of sugars in commonly consumed beverages.

Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker.

BackgroundDental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup’ik children ages 6–17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay.MethodsA 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces.ResultsThe mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay.ConclusionsAdded sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup’ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.

Assessment of the concentrations of various advanced glycation end-products in beverages and foods that are commonly consumed in Japan.

Dietary consumption has recently been identified as a major environmental source of pro-inflammatory advanced glycation end-products (AGEs) in humans. It is disputed whether dietary AGEs represent a risk to human health. Nε-(carboxymethyl)lysine (CML), a representative AGE compound found in food, has been suggested to make a significant contribution to circulating CML levels. However, recent studies have found that the dietary intake of AGEs is not associated with plasma CML concentrations. We have shown that the serum levels of glyceraldehyde-derived AGEs (Glycer-AGEs), but not hemoglobin A1c, glucose-derived AGEs (Glu-AGEs), or CML, could be used as biomarkers for predicting the progression of atherosclerosis and future cardiovascular events. We also detected the production/accumulation of Glycer-AGEs in normal rats administered Glu-AGE-rich beverages. Therefore, we assessed the concentrations of various AGEs in a total of 1,650 beverages and foods that are commonly consumed in Japan. The concentrations of four kinds of AGEs (Glu-AGEs, fructose-derived AGEs (Fru-AGEs), CML, and Glycer-AGEs) were measured with competitive enzyme-linked immunosorbent assays involving immunoaffinity-purified specific antibodies. The results of the latter assays indicated that Glu-AGEs and Fru-AGEs (especially Glu-AGEs), but not CML or Glycer-AGEs, are present at appreciable levels in beverages and foods that are commonly consumed by Japanese. Glu-AGEs, Fru-AGEs, CML, and Glycer-AGEs exhibited concentrations of ≥85%, 2–12%, <3%, and trace amounts in the examined beverages and ≥82%, 5–15%, <3%, and trace amounts in the tested foods, respectively. The results of the present study indicate that some lactic acid bacteria beverages, carbonated drinks, sugar-sweetened fruit drinks, sports drinks, mixed fruit juices, confectionery (snacks), dried fruits, cakes, cereals, and prepared foods contain markedly higher Glu-AGE levels than other classes of beverages and foods. We provide useful data on the concentrations of various AGEs, especially Glu-AGEs, in commonly consumed beverages and foods.

Changes in adolescents’ and parents’ intakes of sugar-sweetened beverages, fruit and vegetables after 20 months: results from the HEIA study – a comprehensive, multi-component school-based randomized trial

BackgroundInterventions conducted in school-aged children often involve parents, but few studies have reported effects on parents’ own behaviour as a result of these interventions.ObjectiveTo determine if a multi-component, cluster randomized controlled trial targeting 11–13 year olds influenced their consumption of fruit, vegetables, sugar-sweetened soft drinks and fruit drinks, and to explore whether the results varied by gender, adolescent weight status or parental educational level. A final aim was to assess whether the parents’ intakes were affected by the intervention.DesignParticipants were 1,418 adolescents, 849 mothers and 680 fathers. Baseline and post-intervention data from the 20 months intervention study HEIA (HEalth In Adolescents) were included. Data were collected assessing frequency (and amounts; beverages only).ResultsNo significant differences were found at baseline between the intervention and control groups, except for the parental groups (educational level and intakes). At post-intervention, the adolescents in the intervention group consumed fruit more frequently (P<0.001) and had a lower intake of sugar-sweetened fruit drinks compared to the control group (P=0.02). The parental educational level moderated the effect on intake of sugar-sweetened fruit drinks in adolescents. The intake was less frequent in the intervention groups compared to the control groups (P=0.02) for those who had parents with low and medium educational level. Furthermore, the intervention may have affected mothers’ fruit intake and the vegetable intake in higher educated fathers.ConclusionFavourable effects in favour of the intervention group were found for intake of fruit and sugar-sweetened fruit drinks among the adolescents in the HEIA study. Our results indicate that it is possible to reduce adolescents’ intake of sugar-sweetened fruit drinks across parental education, and potentially affect sub-groups of parents.

Soft drink consumption in Sri Lankan adolescents

To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka. A cross-sectional study where the data were collected by means of a self-administered questionnaire. Government, private and international schools in the Colombo district of Sri Lanka. Adolescents aged 17 years attending sixty-five schools. Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks. The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.

Intakes and perceived home availability of sugar-sweetened beverages, fruit and vegetables as reported by mothers, fathers and adolescents in the HEIA (HEalth In Adolescents) study

To investigate the intakes of sugar-sweetened beverages (SSB), fruit and vegetables (FV) among adolescents and their parents and to explore differences in the perceived availability by gender and parental education. Baseline data from the HEIA (HEalth In Adolescents) study. Data on intake of SSB were collected assessing frequency and amounts, whereas consumption of FV was assessed on the basis of frequency. Further, perceived availability at home and at school (taken from home) was reported. Participants were 1528 Norwegian adolescents aged 11 years, as well as 1200 mothers and 1057 fathers. The adolescents' intake of SSB was low on weekdays but doubled during weekend days. This pattern was observed among parents as well. There were significant differences in intake between boys, girls, mothers and fathers, except for vegetables. Fathers reported the lowest frequency of FV intake. Compared with adolescents, mothers reported lower availability of SSB and higher availability of FV. Compared with their sons, fathers reported higher availability of vegetables and lower availability of sugar-sweetened fruit drinks at school. Significant differences in adolescents' intake of SSB and in the perceived availability of both SSB and FV by parental education were found. The intake of SSB was higher during weekend days than during weekdays, whereas the frequency of FV intake was low. Differences in adolescents' perceived availability of both SSB and FV on the basis of parental education were found, whereas the differences in intake were significant only for SSB. Increasing parental awareness of availability and their potential as role models across parental gender and educational level could improve adolescents' dietary habits.