Intake Of Sweet Drinks Research Articles

Five-year follow-up of a family-based multidisciplinary program for children with obesity.

This study aimed to determine 5-year outcomes from a 12-month, family-based, multidisciplinary lifestyle intervention program for children. This study was the 5-year follow-up of a randomized clinical trial comparing a low-intensity control group (home-based assessments) with a high-intensity intervention group (assessments plus weekly sessions) in New Zealand. Participants were aged 5 to 16 years with BMI ≥ 98th centile or > 91st centile with weight-related comorbidities. The primary outcome was BMI standard deviation score (BMISDS). Secondary outcomes included various health markers. Of the 199 children included in the study at baseline (47% who identified as Māori, 53% who identified as female, 28% in the most deprived quintile, mean age = 10.7 years, mean BMISDS = 3.12), 86 completed a 5-year assessment (43%). BMISDS reduction at 12 months was not retained (control = 0.00 [95% CI: -0.22 to 0.21] and intervention = 0.17 [95% CI: -0.01 to 0.34]; p = 0.221) but was greater in participants aged <10 years versus >10 years at baseline (-0.15 [95% CI: -0.33 to 0.03] vs. 0.21 [95% CI: 0.03 to 0.40]; p = 0.008). BMISDS trajectory favored participants with high attendance (p = 0.013). There were persistent improvements in water intake and health-related quality of life in both groups as well as reduced sweet drink intake in the intervention group. This intervention, with high engagement from those most affected by obesity, did not achieve long-term efficacy of the primary outcome. Attendance and age remain important considerations for future interventions to achieve long-term BMISDS reduction.

Internalizing symptoms modulate real-world affective response to sweet food and drinks in children

The purpose of the current study was to examine affective response to sweet foods and drinks as a function of children's internalizing symptoms using ecological momentary assessment (EMA). A sample of 192 8-12-year-old children completed a self-report measure of internalizing symptoms and EMA prompts of affect and food intake for eight days, excluding time at school. There was an interaction between sweet food intake and internalizing symptoms for positive affect and for sweet drink intake and internalizing symptoms for negative affect. Those low in internalizing symptoms had significantly lower positive affect after consumption of sweet foods compared to when they did not consume sweet foods whereas those higher in internalizing symptoms had slightly, but not significantly, higher positive affect after consumption of sweet foods. Those low in internalizing symptoms had significantly higher negtive affect after consumption of sweet drinks compared to when they did not consume sweet drinks whereas those higher in internalizing symptoms had slightly, but not significantly, lower negative affect after consumption of sweet drinks. Findings highlight the ways in which internalizing symptoms may modulate affective response to sweet foods and drinks.

Two-year outcomes of Whānau Pakari, a multi-disciplinary assessment and intervention for children and adolescents with weight issues: A randomized clinical trial.

To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06). This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.

Dietary Intake and Eating Behaviours of Obese New Zealand Children and Adolescents Enrolled in a Community-Based Intervention Programme

ObjectivesThe aim of this study was to describe dietary intake and eating behaviours of obese children and adolescents, and also to determine how these differ in Indigenous versus non-Indigenous children at enrolment in an obesity programme.MethodsBaseline dietary intake and eating behaviour records were assessed from those enrolled in a clinical unblinded randomised controlled trial of a multi-disciplinary intervention. The setting was a community-based obesity programme in Taranaki, New Zealand. Children or adolescents who were enrolled from January 2012 to August 2014, with a BMI ≥98th percentile or >91st centile with weight-related comorbidities were eligible.Results239 participants (45% Māori, 45% NZ Europeans, 10% other ethnicities), aged 5–17 years were assessed. Two-thirds of participants experienced hyperphagia and half were not satiated after a meal. Comfort eating was reported by 62% of participants, and daily energy intake was above the recommended guidelines for 54%. Fruit and vegetable intake was suboptimal compared with the recommended 5 servings per day (mean 3.5 [SD = 1.9] servings per day), and the mean weekly breakfasts were less than the national average (5.9 vs 6.5; p<0.0001). Median sweet drink intake amongst Māori was twice that of NZ Europeans (250 vs 125 ml per day; p = 0.0002).ConclusionsThere was a concerning prevalence of abnormal eating behaviours and significant differences in dietary intake between obese participants and their national counterparts. Ethnic differences between Indigenous and non-Indigenous participants were also present, especially in relation to sweet drink consumption. Eating behaviours, especially sweet drink consumption and fruit/vegetable intake need to be addressed.

Use of food practices by childcare staff and the association with dietary intake of children at childcare.

The study explored the associations between various childcare staff food practices and children’s dietary intake at childcare. A total of 398 one- to four-year-old children and 24 childcare staff members from 24 Dutch childcare centers participated in the study. Children’s dietary intake (fruit, vegetable, sweet snack, savory snack, water, and sweet drink intake) at childcare was registered on two weekdays, using observations by dieticians and childcare staff. Thirteen childcare staff practices were assessed using questionnaires administered by dieticians. Data were analyzed using multilevel regression analyses. Children consumed relatively much fruit and many sweet snacks at childcare, and they mainly drank sweet drinks. Various staff practices were associated with children’s dietary intake. When staff explained what they were doing to the children during food preparation, children ate significantly more fruit. Children ate less sweet snacks when they were allowed to help prepare the meals. When staff encouraged children to continue eating, they ate more vegetables. In conclusion, the study showed the importance of childcare staff food practices for children’s food intake at childcare. More research is needed to examine the specific conditions under which food practices can have a positive impact on children’s dietary intake.

A qualitative study of the factors that influence mothers when choosing drinks for their young children.

BackgroundThe consumption of sweetened beverages is a known common risk factor for the development of obesity and dental caries in children and children consume sweet drinks frequently and in large volumes from an early age. The aim of this study was to examine factors that influence mothers when choosing drinks for their children.MethodSemi-structured interviews (n = 32) were conducted with a purposive sample of mothers of young children from Victoria’s Barwon South Western Region (selected from a larger cohort study to include families consuming different types of water, and different socioeconomic status and size). Inductive thematic analysis was conducted on transcribed interviews.ResultsSeveral themes emerged as influencing child drink choice. Child age: Water was the main beverage for the youngest child however it was seen as more acceptable to give older children sweetened beverages. Child preference and temperament: influencing when and if sweet drinks were given; Family influences such as grandparents increased children’s consumption of sweet drinks, often providing children drinks such as fruit juice and soft drinks regardless of maternal disapproval. The Setting: children were more likely to be offered sweetened drinks either as a reward or treat for good behaviour or when out shopping, out for dinner or at parties.ConclusionsLimiting intake of sweet drinks is considered an important step for child general and oral health. However, the choice of drinks for children has influences from social, environmental and behavioural domains, indicating that a multi-strategy approach is required to bring about this change.

Inconsistent associations between sweet drink intake and 2‐year change in BMI among Victorian children and adolescents

The aim of this study was to examine whether baseline (T1) or 2-year change in sweet drink intake in children and adolescents was associated with age- and gender-standardized body mass index (BMIz) at time two (T2), 2 years later. Data on 1465 children and adolescents from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. At two time points between 2003 and 2008 (mean interval: 2.2 years) height and weight were measured and sweet drink consumption (soft drink and fruit juice/cordial) was assessed. No association was observed between T1 sweet drink intake and BMIz at T2 among children or adolescents. Children from higher socioeconomic status families who reported an increased intake of sweet drinks at T2 compared with T1 had higher mean BMIz at T2 (β: 0.13, P = 0.05). There was no evidence of a dose-response relationship between sweet drink intake and BMIz. In supplementary analyses, we observed that more frequent usual consumption of fruit juice/cordial was associated with a higher BMIz at T2 among children. This study showed limited evidence of an association between sweet drink intake and BMIz. However, the association is complex and may be confounded by both dietary and activity behaviours.

Association between sweet drink intake and adiposity in Danish children participating in a long‐term intervention study

In some previous studies direct associations between intake of soft drinks, sugar-sweetened beverages and adiposity have been reported. The majority of these studies were, however, conducted in the USA and it is uncertain if the results are applicable to non-US countries. To assess the association between sweet drink intake at age 6 and 9 years and the subsequent 3- to 7-year changes in body mass index (BMI) and sum of four skin-folds (Σ4SF). Information on sweet drink intake (7 days food record) and physical activity (accelerometer) was obtained at age 6 years (n = 366) [Correction made here after initial online publication.] and 9 years (n = 269). Weight, height and Σ4SF were measured at age 6, 9 and 13 years. Additional information on socio-economic status, maternal BMI and pubertal status was obtained. No associations were observed between sweet drink intake at age 6 years and change in BMI or logΣ4SF from age 6 to 9 years or 6 to 13 years. Also, no associations were observed between change in sweet drink intake from age 6 to 9 years and subsequent change in BMI or logΣ4SF from age 9 to 13 years. A weak direct association was observed between sweet drink intake at age 9 years and change in logΣ4SF from age 9 to 13 years (per 100 g ∼ 3.38 fl oz) (β: 0.014, 95% confidence interval [CI]: -0.001 to 0.029, P = 0.06), while no association was seen for BMI. In supplementary analyses a similar association was observed for soft drinks (β: 0.087, 95% CI: 0.048 to 0.126, P = 0.001) but only in the intervention group. We observed associations between intake of sweet drinks and soft drinks and change in skin-fold thickness in a group of Danish children. However, as the associations did not remain significant when multiple testing was considered or was only significant among children from the intervention group, the results do not confirm or refute the direct association reported in previous studies.

Consumption patterns of sweet drinks in a population of Australian children and adolescents (2003–2008)

BackgroundIntake of sweet drinks has previously been associated with the development of overweight and obesity among children and adolescents. The present study aimed to assess the consumption pattern of sweet drinks in a population of children and adolescents in Victoria, Australia.MethodsData on 1,604 children and adolescents (4–18 years) from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. Sweet drink consumption (soft drink and fruit juice/cordial) was assessed as one day’s intake and typical intake over the last week or month at two time points between 2003 and 2008 (mean time between measurement: 2.2 years).ResultsAssessed using dietary recalls, more than 70% of the children and adolescents consumed sweet drinks, with no difference between age groups (p = 0.28). The median intake among consumers was 500 ml and almost a third consumed more than 750 ml per day. More children and adolescents consumed fruit juice/cordial (69%) than soft drink (33%) (p < 0.0001) and in larger volumes (median intake fruit juice/cordial: 500 ml and soft drink: 375 ml). Secular changes in sweet drink consumption were observed with a lower proportion of children and adolescents consuming sweet drinks at time 2 compared to time 1 (significant for age group 8 to <10 years, p = 0.001).ConclusionThe proportion of Australian children and adolescents from the state of Victoria consuming sweet drinks has been stable or decreasing, although a high proportion of this sample consumed sweet drinks, especially fruit juice/cordial at both time points.

Feeding the emergence of advanced heart disease in Soweto : a nutritional survey of black African patients with heart failure

To describe dietary habits and potential nutritional deficiencies in black African patients diagnosed with heart failure (HF). Dietary intake in 50 consecutively consenting HF patients (mean age: 47 ± 18 years, 54% female) attending a major hospital in Soweto, South Africa were surveyed using validated quantitative food frequency questionnaires. Food intakes, translated into nutrient data were compared with recommended values. In women, food choices likely to negatively impact on heart health included added sugar [consumed by 75%: median daily intake (interquartile range) 16 g (10-20)], sweet drinks [54%: 310 ml (85-400)] and salted snacks [61%: 15 g (2-17)]. Corresponding figures for men were added sugar [74%: 15 g (10-15)], sweet drinks [65%: 439 ml (71-670)] and salted snacks [74%: 15 g (4-22)]. The womens' intake of calcium, vitamin C and vitamin E was only 66, 37 and 40% of the age-specific requirement, respectively. For men, equivalent figures were 66, 87 and 67%. Mean sodium intake was 2 372 g/day for men and 1 972 g/day for women, 470 and 294% respectively, of recommended consumption levels. The nutritional status of black African patients with HF could be improved by recommending healthier food choices and by reducing the intake of sweet drinks and excess salt.

Do parents really still not understand this message?

Dental UpdateVol. 38, No. 7 AbstractsDo parents really still not understand this message?Peter CarrottePeter CarrotteSearch for more papers by this authorPeter CarrottePublished Online:20 Jun 2017https://doi.org/10.12968/denu.2011.38.7.484AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Intake of sweet drinks and sweet treats versus reported and observed caries experience. Lee JG and Messer LB. Eur Archiv Paed Dent 2010; 11: 5–17. Medline, Google Scholar FiguresReferencesRelatedDetails 2 September 2011Volume 38Issue 7ISSN (print): 0305-5000ISSN (online): 2515-589X Metrics History Published online 20 June 2017 Published in print 2 September 2011 Information© George Warman Publications (UK) LimitedPDF download

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.

Erratum to Intake of sweet drinks and sweet treats versus reported and observed caries experience

Erratum to Intake of sweet drinks and sweet treats versus reported and observed caries experience

Intake of sweet drinks and sweet treats versus reported and observed caries experience

This was to study the intakes of sweet drinks and sweet treats of children and their caries risk using the Paediatric Risk Assessment Tool (PRAT, 2003) and Caries-risk Assessment Tool (CAT, 2007-8). Parents of 266 healthy primary school children completed the PRAT questionnaire during their child's dental appointment at the Royal Dental Hospital of Melbourne, Australia, describing their fluid and sweet treat intakes in the past 24 hours, oral hygiene practices and past caries. A subgroup (n=100) was examined clinically (CAT) for caries requiring restoration, visible plaque, gingivitis, orthodontic appliances, enamel defects, and use of dental care. The estimated mean daily fluid intake was 1.5+/-0.5L; fluids were consumed 3-5/ day by 57% of children and 78% usually had evening/night drinks. Fluids consumed were: tap water by 90%, milk by 74%, juice by 50%, regular soft drink by 30%; sweet treats were consumed by 62% and confectionery by 25%. Most children (69%) brushed their teeth > or =2/day; 5% flossed daily. Parentally-reported caries was associated significantly with increasing treats frequency (p=0.006). In the subgroup, 81% were at high caries risk; 47% had irregular dental care; 21% had sweet drinks/foods frequently between meals; 49% had visible plaque/gingivitis, and 34% had enamel demineralisation. Caries observed in the past 12 months was associated significantly with evening sweet drinks (p=0.004), and suboptimal fluoride exposure (p=0.009). Caries observed in the past 24 months was associated significantly with treats frequency (p=0.006), intake of sweet drinks plus treats (p=0.000), enamel demineralisation (p=0.000) and irregular dental care (p=0.000). The PRAT and CAT are valuable tools in assessing children's caries risk. The risk of caries from frequent intake of sweet drinks, either alone or in addition to sweet treats, must be emphasised to parents. All parents, and particularly those of children assessed at high risk from intakes of sweet drinks and sweet treats, suboptimal fluoride exposure, or enamel demineralisation, must be encouraged to obtain regular dental care for their children.

US Acculturation, Food Intake, and Obesity among Asian-Pacific Hotel Workers

Background Both obesity and immigration continue to increase in the United States. Studies suggest that a transition in lifestyle patterns, such as food intake, may mediate the relationship between immigration and obesity. Objective We examine obesity among hotel workers in relation to age, sex, race/ethnicity, and indicators of food intake, immigration, and acculturation. Subjects/setting Four thousand five hundred thirty hotel workers in 30 hotels were studied from the first year of the Work, Weight and Wellness program, before intervention (during 2005-2006). Main outcome measures Weight and height were measured, whereas race/ethnicity, language, education, immigration, acculturation, and food intake variables were assessed by questionnaire. Results The study included 43% male and 57% female hotel workers (mean age 44.4±11.3 years; 42% Filipino, 32% other Asian, 13% Pacific Islander, 9% white, 1% black/African American, and 3% other race/ethnicity). On average (mean value), 55% of participants were born outside the United States; 57% were overweight or obese (body mass index [BMI] >25). The BMI of those born in the United States was 1.3 higher than that of those born in another country, adjusting for sex and race/ethnicity. Intake of sweet drinks and meat was positively associated with BMI while intake of fruit was negatively associated with BMI. Age at arrival in United States (“generation”) was negatively associated with BMI, whereas greater acculturation was positively associated with BMI. Conclusions Food intake behaviors are probably related to place of birth, generation of migration to the United States, and acculturation. Direct measures of food intake added explanatory power to models, suggesting the importance of food intake to obesity. Further study of the influence of immigration, acculturation, and food intake on obesity using longitudinal study designs is warranted.

Influence of environmental factors on food intake and choice of beverage during meals in teenagers: a laboratory study

Environmental conditions influence meal size in adults and children. Intake of sweet drinks could contribute significantly to energy intake and potentially affect body weight, particularly in young individuals. The objectives of the present study were to measure the lunch intake of food and drinks under controlled laboratory settings in teenagers and to compare the influence of different meal conditions. Normal-weight adolescents (fourteen males and fifteen females) participated in four standardised lunches, scheduled 1 week apart. The same popular items (meat dish, dessert, water, juice, soda) were served at all meals. Ad libitum intake was measured under four conditions: subjects ate alone; in groups; alone while viewing television; alone while listening to music. Visual analogue scales were used to assess pre- and post-meal hunger and thirst and meal palatability. Energy, solid food and fluid intake was different (significantly lower) only in the 'eating in group' condition, in spite of identical intensity of pre-meal hunger. More soda was consumed when participants were watching television, and more water was consumed while listening to music. Across all conditions, more soda than water was consumed. Post-meal ratings of hunger, thirst and palatability did not differ between conditions. We concluded that, in teenagers, a 'social inhibition' effect appears rather than the 'social facilitation' previously reported in adults. Although teenagers do not respond to the presence of television or another 'distractor' such as music by eating more, they do ingest more soda when the television is on. The social significance of meals, conditioned responses and habituation to 'distractors' may be different between adolescents and adults.

Sip size of orangeade: effects on intake and sensory-specific satiation

Sensory-specific satiation (SSS) drives food selection and contributes to meal termination. We hypothesised that smaller sips would increase SSS due to increased oro-sensory exposure, irrespective of energy content. The objective was to determine the effects of sip size and energy content on ad libitum intake of orangeade and subjective SSS for orangeade. Orangeade intake and ratings of wanting and liking were measured before and after ad libitum orangeade consumption in a 2 x 2 cross-over design (n 53). Conditions differed in energy content (no-energy v. regular-energy orangeade) and in sip size (large, 20 g/sip v. small, 5 g/sip). The mean intake of both orangeades was lower when consumed with small sips than when consumed with large sips (regular-energy, 352 v. 493 g; no-energy, 338 v. 405 g; both P < 0.001). When consumed with large sips, the mean intake of no-energy orangeade was lower than that of regular-energy orangeade (P = 0.02). When consumed with small sips, subjective SSS (based on the desire to drink) was higher for no-energy orangeade than for regular-energy orangeade (P = 0.01), while mean intake was comparable. We concluded that smaller sip size, i.e. increased oro-sensory exposure per unit of consumption, can lower intake of sweet drinks. Only with low oro-sensory exposure (large sip size) was intake higher for an energy-containing sweet drink than for a no-energy sweet drink. This suggests that intake of sweet drinks is stimulated by (metabolic) reward value and inhibited by sensory satiation. This underpins the importance of SSS for meal termination.

Factors influencing caries experience among adults with physical and intellectual disabilities

There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care-recipients. To examine caries experience and associated factors among adults with PID. Mailed questionnaire survey (2005-2006) of carers of adults with PID (18-44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care-recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). Carers completed questionnaires for 485 care-recipients, 267 of whom were examined (completion rate=55.1%). The prevalence of decay (D>0) was 16.9% and 76.3% had caries experience (DMFT>0). In unadjusted analysis, care-recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care-recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR+/-95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer-contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer-contact. Higher odds of caries experience were associated with age and no OHA. Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer-contact hours.

Obesity, dietary pattern and physical activity among children in a suburb with a high proportion of immigrants

Obesity among children is a growing problem. Interventions should be planned to meet needs in different cultural settings. The objective of this study was to explore dietary patterns, physical activity and perceptions of relationships between life-style and health among children in a suburb with low socio-economic status and a high proportion of immigrants and refugees. All children (n = 114) in Grades 5 and 6, aged 11 to 12 years, at a local Swedish school were invited, 112 participated. Food and exercise habits and perceptions on health and body image were assessed by a validated questionnaire and an interview. Height and weight were measured and risk for passing BMI 25 and 30 kg/m(2), respectively at the age of 18 was calculated. Thirty-one percent of the children were obese or overweight. Thirty-four percent spent more than 3 h daily watching TV or using computer, a behaviour, which clustered with excess intake of sweet drinks and habitually skipping breakfast. Only about half of the children believed that their life-style could affect their health. The results show that low socio-economic status and migration are proxies for overweight and obesity. Obesity, unhealthy living and a low awareness of relations between life-style and health call for action, for culturally sensitive prevention and treatment approaches.

Inadvertently Induced Hypoglycemia

<h3>To the Editor.—</h3> Factitious hypoglycemia, induced by oral antidiabetic agents,^1,2should be suspected in diabetic or psychiatric patients and in subjects who have diabetic relatives or work in medical institutions.³ None of this was true in our patient, a 62-year-old housewife, who was admitted to our department because of unconsciousness. Her blood glucose level was 33 mg/dl. After intravenous (IV) administration of glucose, she promptly regained consciousness, and the blood glucose level rose to 96 mg/dl. The patient's past history was irrelevant, except for glaucoma, presently treated with acetazolamide (Diamox) and pilocarpine. Two days before admission the patient complained of an unusual weakness and vertigo; she became slightly confused and had a voracious appetite. A copious intake of sweet drinks and chocolate abated these symptoms. Six hours after admission, while receiving a 5% glucose infusion, the patient became noticeably confused. Her blood glucose level again dropped to 43