Total Sugar-sweetened Beverages Research Articles

Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages.

The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province. A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires. The mean body mass index (BMI) was 28.5±7.3kg/m2, with 40% being classified as obese (BMI ≥30kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased. The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Characteristics Associated With Purchasing Sugar-Sweetened Beverages and Bottled Water Among US Households, 2015

BackgroundFrequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. ObjectiveThis study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. DesignThis study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. Participants/settingsA total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. Explanatory variablesThe included demographic and socioeconomic variables were household head’s age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households’ residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. Main outcome measuresAnnual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. Statistical analysisUnadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana’s household projection factors. ResultsNearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. ConclusionsThese findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status.

Abstract PR014: Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort

Abstract Background: In the general population, sugar intake is associated with a wide range of adverse health conditions related to premature aging, including obesity, diabetes, and cardiovascular disease. Childhood cancer survivors are at increased risk of premature aging and mortality compared to their healthy peers and may be especially vulnerable to adverse consequences of excess sugar intake. Objective: To examine the association between sugar and sugar-sweetened beverage intake and premature aging in childhood cancer survivors. Method: A total of 3,322 adult survivors of childhood cancer (age range 18-65 years; mean age: 31 years) in SJLIFE self-reported their typical diet using the 110-item Block Food Frequency Questionnaire. Added sugars included all sugars added to foods during preparation or processing. Total sugar-sweetened beverages are the sum of regular and diet soda and fruit-flavored drinks. Survivors’ sociodemographics, cancer histories, and health conditions were abstracted from medical records. Premature aging was assessed using the Deficit Accumulation Index (DAI) that was a ratio of the number of age-related chronic health conditions each survivor had out of 45 conditions total. The DAI was categorized into low (<0.2), medium (0.2-0.34), and high (>0.35) aging risk groups. Multinomial logistic regressions (reference: low aging risk group) adjusting for confounders, including sociodemographics, lifestyle factors, cancer treatments, and overall diet quality, were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Survivors’ average total sugar intake was 120 g/day and added sugar intake was 71 g/day. 41% of survivors consumed sugar-sweetened beverages ≥1 time/day, and 26% consumed soda daily; 75% of soda consumed was regular (vs. diet). Survivors with higher consumption of sugar and sugar-sweetened beverages were more likely to be non-Hispanic Black and have lower educational attainment and income. Total sugar intake was associated with a significantly increased risk of premature aging (per 25 g/1,000 kcal increment, OR=1.31 [95% CI: 1.00-1.70] in the medium-risk group; OR=1.52 [95% CI: 1.03-2.25] in the high-risk group). Added sugar intake was associated with a 19% (OR=1.19, 95% CI: 1.07-1.31, per 20 g/1,000 kcal increment) and an 18% (OR=1.18, 95% CI: 1.02-1.37) increased risk of premature aging in the medium- and high-risk group, respectively. Consuming ≥2 servings/day (vs. ≤ 1/week) of total sugar-sweetened beverage was also related to an increased risk of premature aging (OR=1.54 [95% CI: 0.83-2.83] in the medium-risk group; OR=6.71 [95% CI: 2.95-15.2] in the high-risk group). Regular soda, but not diet soda, consumption was associated with premature aging risk. Conclusion: Higher consumption of sugar and sugar-sweetened beverages was associated with an increased risk of premature aging in childhood cancer survivors. Intervention efforts to reduce sugar intake among this vulnerable population are needed. Citation Format: Tuo Lan, Mei Wang, AnnaLynn M. Williams, Matthew J. Ehrhardt, Emily R. Finch, Jennifer Q. Lanctot, Shu Jiang, Kevin R. Krull, Gregory T. Armstrong, Melissa M. Hudson, Graham A. Colditz, Leslie Robison, Kirsten K. Ness, Yikyung Park. Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr PR014.

Different Sources of Sugar Consumption and Cognitive Performance in Older Adults: Data From the National Health and Nutrition Examination Survey 2011-2014.

Excess sugar consumption, particularly in sugar-sweetened beverages (SSBs), has been linked to poor cognitive performance. We aimed to assess the association of consumption of total sugar, as well as the consumption of SSBs, solid desserts, and 100% fruit juice with cognitive performance among older adults. Consumption of total sugar, SSBs, solid desserts, and 100% fruit juice were obtained from the 24-hr recall interview. Cognitive performance was evaluated using the Consortium to Establish a Registry for Alzheimer's Disease word list, the Animal Fluency Test, and the Digit Symbol Substitution Test. Binary logistic regression models were used to evaluate the association between consumption of sugar (total and from different sources) and cognitive performance. A total of 1,938 participants aged 60years or older from the National Health and Nutrition Examination Survey 2011-2014 were included. Compared to the lowest tertile, the highest tertile of total sugar consumption was independently associated with higher odds of low memory performance (odds ratio [OR]=1.87, 95% confidence interval [CI]=1.00; 3.50, p=.049). Consumption of SSBs was associated with higher risk of low memory (OR=1.58, 95% CI=1.11; 2.25, p=.014), whereas consumption of solid desserts was associated with lower risk of low verbal fluency performance (OR=0.62, 95% CI=0.41; 0.95, p=.032). Higher consumption of total sugars and SSBs was associated with lower memory performance, while consumption of solid desserts was associated with higher verbal fluency performance.

Sugar-sweetened beverage intakes and age of menarche in Chinese girls in 2004-2015

To investigate the prospective association between sugar-sweetened beverage intakes and age at menarche among Chinese girls. Based on China Health and Nutrition Survey(CHNS) from 2004 to 2015, 293 girls aged 7-16 years with both data on sugar-sweetened beverage intake 1-5 years before menarche and age of menarche were included in the present study. Multivariate linear regression analysis and Logistic regression analysis were used to explore the influence of the sugar-sweetened beverage consumption on menarcheal age of Chinese girls. The median age at menarche of girls was 12 years old. The consumption of sugar-sweetened beverages(SSBs) was 0.5(0.2, 1.0) L/week for sweetened soft drinks, 0.5(0.2, 0.9) L/week for sweetened fruit drinks and 0.6(0.3, 1.3) L/week for total. After adjusting age at baseline, residency, maternal educational, level, energy intake at baseline and body mass index standard deviation score, no significant association was found between sweetened soft drinks, sweetened fruit drinks, total sugar-sweetened beverage intake and age at menarche. The intake of sugary beverages may not be prospectively related to the age of menarche among Chinese girls.

Association between maternal sugar-sweetened beverage consumption and the social-emotional development of child before 1 year old: A prospective cohort study.

Excessive consumption of sugar-sweetened beverages (SSBs) has become an international public health issue. Adverse effects of sugary beverage consumption on both mother and child during pregnancy continue to be found. However, evidence regarding maternal SSB consumption and social-emotional development of children is lacking. Based on the Shenzhen Birth Cohort Study (loss rate: 10.97%), we included 985 mother-infant pairs from 2018 to 2022. All mothers had a singleton live birth without hypertension, diabetes, tumor, or serious immune system disease before pregnancy. We used a chart of frequency distribution to show maternal SSB consumption, including non-diet soda, tea drinks (not 100% tea), fruit drinks, Sugar-sweetened coffee, bubble tea, or cocoa drinks, and total SSBs. A multivariate logistic regression model was used to estimate the odds ratios of the potential delay on social-emotional development of each child was monitored at both 6 months and 12 months of age based on maternal SSB consumption. Among the mothers, 728 (73.91%) drank SSBs <1 time per week, 194 (19.70%) drank SSBs 1-2 times per week, 43 (4.37%) drank SSBs 3-4 times per week, and 20 (2.03%) drank SSBs 5 or more times per week. Children aged 12 months with mothers who drank SSBs five or more times per week during pregnancy had an increased risk of potential delay on social-emotional development compared to those with mothers who drank SSBs less than once per week [odds ratio: 3.08 (1.13-8.39)]. Regarding the specific kinds of SSBs, we found that tea drinks (not 100% tea) were positively associated with potential delay on social-emotional development in children aged 6 months. Nearly three-quarters of mothers consumed almost no SSBs during pregnancy. High SSB intake during pregnancy was associated with an increased risk of the potential delay on social-emotional development of a child at 6 and 12 months of age.

The Association between Maternal Sugar-Sweetened Beverage Consumption and Infant/Toddler Added Sugar Intakes.

Intake of added sugars during early life is associated with poor health outcomes. Maternal dietary intake influences the intake of their children, but little research investigates the relationship between maternal sugar sweetened beverage (SSB) and infant/toddler added sugar intakes. Our objective was to explore the relationship between maternal total sugars and SSB intakes and infant/toddler added sugar intakes. This cross-sectional study (n = 101) of mother-infant dyads measured maternal dietary intake by food frequency questionnaire and infant intake by three 24-h dietary recalls. Pearson’s correlations explored the relations between maternal total sugars and SSB intakes and infant added sugar intakes. Hierarchical stepwise regressions determined if maternal total sugars and SSB intakes explained the variation in infant added sugar intakes after accounting for known risk factors for early introduction of added sugars. Maternal total sugars (r = 0.202, p = 0.043) and SSB (r = 0.352, p < 0.001) intakes were positively correlated with infant/toddler added sugar intakes. In the hierarchical models, maternal total sugar intakes did not account for more variance in infant added sugar intakes (β = 0.046, p = 0.060), but maternal SSB intake was a significant contributor of infant added sugar intakes (β = 0.010, p = 0.006) after accounting for confounders. Interventions to reduced maternal SSB consumption may help reduce infant/toddler added sugar intakes.

Exploring differences in adolescent BMI and obesity-related behaviors by urban, suburban, and rural status

Data from the nationally representative 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study was examined to identify differences in adolescent Body Mass Index (BMI) and obesity-related behaviors by rurality status (i.e., urban, suburban, rural) while accounting for relevant demographics (i.e., sex, race/ethnicity, household income). This secondary, cross-sectional analysis included 1,353 adolescents. Analyses included descriptive statistics, one-way analysis of variance, Chi-squared tests, and multiple linear regression models (reported significance level p < 0.05). Rurality was not associated with BMI when controlling for demographics. However, relative to rural adolescents, suburban adolescents had significantly higher junk food, sugar-sweetened beverages (SSB), sugary food (all β=+0.2, p ≤ 0.001), and fruit/vegetable intake (β=+0.1, p ≤ 0.05). Compared to Non-Hispanic White adolescents, Non-Hispanic Black adolescents had significantly higher BMI (β=+4.4, p ≤ 0.05), total sedentary time (β=+4.1, p ≤ 0.001), junk food, SSB, and sugary food intake (all β=+0.2, p ≤ 0.05). Relative to their lower-income household counterparts, adolescents from higher-income households had significantly lower BMI (β = -9.7, p ≤ 0.001), junk food (β = -0.2, p ≤ 0.05), and SSB intake (β = -0.5, p ≤ 0.001). Contrary to literature, rurality was not a significant predictor of adolescent BMI. While suburban status was significantly associated with several diet-related risk factors, it was not in the direction anticipated. Being non-Hispanic Black and from a low-income household had the greatest influence on adolescent BMI. Findings highlight the importance of using a three-category classification for rurality.

Feasibility of parents promoting fruit-infused water to reduce preschool children's sugar-sweetened beverage consumption.

Background: Increasing water and decreasing sugar-sweetened beverage (SSB) consumption in preschoolers provide a strategy to reduce lifelong obesity risks. Aim: To determine feasibility/acceptability and examine preliminary findings of an innovative intervention for preschooler parents to promote fruit-infused water (FIW) to decrease SSB intake. Methods: Fourteen parents of preschoolers completed a pre-intervention survey, attended a presentation with a FIW demonstration/taste-testing, received pitchers/strainers, cutting boards, and FIW recipes/instructions, and received 8 supportive text messages over one month. Feasibility/acceptability was determined from analyzing parents' responses about participating. Descriptive statistics were conducted to analyze pre-/post-intervention survey data. Results: Three themes emerged: "Healthy Option Alternative"; "Feasible to Make FIW at Home"; and "Benefits for Parents". Preliminary findings from ten parents completing both pre-/post-intervention surveys indicated a decrease in preschoolers' total SSB amount/kcal intake, and an increase in parent self-efficacy and FIW knowledge/consumption. Conclusion: Preliminary findings provide valuable feasibility/acceptability information to guide a larger future study.

Longer Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Is Not Associated with Reduced Sugar-Sweetened Beverage Intake among Black Participants.

This study assessed relationships of duration of family Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participation with racial/ethnic disparities in child sugar-sweetened beverage (SSB) and water intake. Child beverage intake and family duration on WIC were collected during three cross-sectional surveys of WIC-participating families in Los Angeles County, California (2014, 2017 and 2020; n = 11,482). The associations of family duration of WIC participation, a proxy for the amount of WIC services received, with daily intake of total SSBs, fruit-flavored SSBs and water were assessed in race/ethnicity strata with multivariable negative binomial and Poisson regression models. Among English-speaking Hispanic children, those of families reporting 10 years of WIC participation consumed 33% and 27% fewer servings of total and fruit-flavored SSBs compared to those of families reporting 1 year on WIC. Among Black children, those from families reporting 5 and 10 years of participation in WIC consumed 33% and 45% more daily servings of fruit-flavored SSBs than those from families reporting 1 year on WIC. Disparities in daily total and fruit-flavored SSB intake between Black and White children increased with longer family duration on WIC. Duration of family WIC participation is associated with healthier beverage choices for infants and children, but does not appear to be equally beneficial across racial/ethnic groups in Los Angeles County.

Prospective Associations of Sugar-Sweetened Beverage Consumption During Adolescence with Body Composition and Bone Mass at Early Adulthood

BackgroundAdolescents have a higher consumption of sugar-sweetened beverages (SSBs) than other age groups, but little is known of the impact of SSB intake during adolescence on body composition and bone mass in early adulthood. ObjectivesAssociations of SSB intake from 14 to 20 y with fat, lean, and bone mass at 20 y of age were evaluated. MethodsStudy participants were 1137 offspring (562 females) from the Raine Study. Food intake, including SSB consumption in servings/d (1 serving = 250 mL), was estimated using FFQs at 14, 17, and 20 y of age. DXA scanning at 20 y measured whole body fat mass, lean mass, and bone mineral content (BMC). Using latent class growth analysis, 4 SSB intake trajectory classes were identified: consistently low (n = 540, intakes mostly <0.5 serving/d), increasing (n = 65), decreasing (n = 258), and consistently high (n = 274, intakes mostly >1.3 servings/d). ResultsMedian total SSB intake was 0.8, 0.7, and 0.5 serving/d, and median carbonated SSB intake was 0.3, 0.3, and 0.4 serving/d at 14, 17, and 20 y, respectively. Mean ± SD BMI (in kg/m2) was 23.9 ± 4.2 at 20 y. After adjustment for covariates including sex, demographic, energy intake, and maternal factors, individuals with “consistently high” SSB consumption had significantly higher total body fat mass at 20 y than those with “consistently low” consumption (23.3 ± 0.6 compared with 21.2 ± 0.4 kg, P = 0.004), which remained significant after further adjustment for “Healthy” and “Western” dietary patterns (23.2 ± 0.6 compared with 21.2 ± 0.4 kg, P = 0.011). No significant associations were observed between SSB intake trajectory classes and lean body mass or BMC at 20 y. ConclusionsIn this cohort, consistently higher consumption of SSBs in adolescence and early adulthood are associated with increased fat mass but not with bone mass at 20 y of age.

Longer Family Participation in WIC is Associated With Lower Childhood Sugar-Sweetened Beverage Intake

ObjectiveTo evaluate if children of families with a longer duration of participation in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC) consume fewer sugar-sweetened beverages (SSB) and more water. DesignA repeated cross-sectional study. SettingConducted among representative samples of WIC-participating families in Los Angeles County, California, in 2014, 2017, and 2020. ParticipantsChildren aged 4–59 months participating in WIC. Main Outcome MeasuresDaily servings of total SSBs, daily servings of specific types of SSBs, and daily servings of water. AnalysisMultivariable count regression models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for associations of the duration of family WIC participation with daily servings of total SSBs, water, and specific types of SSBs. Zero-inflated negative binomial regression models were used for total SSBs and specific types of SSBs, and Poisson regression was used for water. ResultsChildren of families with 2 years of WIC participation consumed significantly fewer daily servings of total SSBs (IRR, 0.95; 95% CI, 0.93–0.98; P = 0.002), fruit-flavored SSBs (IRR, 0.95; 95% CI, 0.91–0.99; P = 0.02), soda (IRR, 0.86; 95% CI, 0.76–0.98; P = 0.02), and water (IRR, 0.99; 95% CI, 0.98 to < 1.00; P = 0.03) than children of families with 1 year of WIC participation. Protective associations for total SSBs, fruit-flavored SSBs, and soda remained statistically significant and increased in magnitude through 10 years of family WIC participation. Conclusions and ImplicationsDuration of WIC participation was associated with decreased SSB intake by young children. Given the role that increasing water intake in lieu of SSBs plays in child obesity, improving the effectiveness of WIC nutrition education on parental perceptions and provision of fruit-flavored SSBs and water to their children merits detailed evaluation.

Association Between Sugar-Sweetened Beverage Intake and Mortality Risk in Women: The California Teachers Study

BackgroundThe evidence linking sugar-sweetened beverage (SSB) intake and mortality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear. ObjectiveTo examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women. DesignProspective cohort study. Participants/settingParticipants of the California Teachers Study (n = 100,314; median age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire. Main outcome measureMortality was ascertained via annual linkage with state- and nationwide mortality records and the National Death Index over 20 years. Statistical analysisMultivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group. ResultsThere were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed ≥ 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming ≥ 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming ≥ 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01). ConclusionsAlthough the baseline frequency of total SSB intake was not significantly associated with mortality, consuming ≥ 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption.

Food Insecurity and Dietary Intake among College Students with Unlimited Meal Plans at a Large, Midwestern University

BackgroundFood insecurity, a state of not being able to consistently access nutritious food due to financial constraints, has been associated with poor dietary intake among college students. The extent to which campus food resources contribute to this association is unknown. ObjectivesThis study examined the association between food insecurity and dietary intake in a sample of undergraduate students with unlimited meal plans and dining hall access at a large, public Midwestern university. DesignThe study design is cross-sectional. The data used are baseline data from a broader sugar-sweetened beverage intervention study that were collected using a Qualtrics survey prior to the intervention. Participants/settingThe sample consisted of 1033 undergraduate students recruited from 3 dining halls. The data were collected in November 2018. Main outcome measuresFood security was assessed using the 6-item Short Form Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute 26-item Dietary Screener Questionnaire and the Beverage Intake Questionnaire-15. Statistical analyses performedGeneralized linear regression models were used to examine differences in dietary intake by students’ food security status, adjusting for students’ sociodemographic characteristics. ResultsIn the sample, 14% of students were food-insecure. After adjusting for sociodemographic variables, food-insecure students reported 9% lower intake of fruits (P = 0.02), 9% lower intake of vegetables (P < 0.001), 10% higher intake of dairy (P = 0.002), 6% higher intake of total added sugars (P = 0.01), 10% higher intake of added sugars from sugar-sweetened beverages (P = 0.01), 4% higher intake of calcium (P = 0.01), and 4% lower intake of fiber (P = 0.01) compared with food-secure students. With respect to beverage intake, food-insecure students had 56% higher intake of total sugar-sweetened beverages (P = 0.002), which was driven by 185% higher intake of energy and sports drinks (P = 0.001), and 121% higher intake of sweetened teas (P = 0.001). ConclusionsDespite having identical food resources within campus dining halls, there were significant differences in the diets of college students by food security status.

Substitution of pure fruit juice for fruit and sugar-sweetened beverages and cardiometabolic risk in European Prospective Investigation into Cancer and Nutrition (EPIC)-NL: a prospective cohort study.

Dietary guidelines on pure fruit juice differ between countries regarding the question whether pure fruit juice (without added sugars) is an acceptable substitute for fruit or should be avoided because of its comparable sugar content with that of sugar-sweetened beverages (SSB). We modelled whether substituting pure fruit juice for fruit or SSB was associated with cardiometabolic risk. Prospective cohort study. Based on a validated FFQ at baseline, we calculated the relative contribution of pure fruit juice to total consumption of fruit and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{fruit}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$) and to total consumption of SSB and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{SSBs}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$). In multivariate analyses (Cox regression), we assessed associations with incidence of type 2 diabetes, CVD, CHD and stroke after an average follow-up of 14·6 years. About 35 000 participants from the EPIC-NL study, aged 20-70 years at enrolment. Substitution of pure fruit juice for SSB was associated with lower risk of all endpoints. For type 2 diabetes and CHD, for example, drinking 75-100 % (as compared with 0-<25 %) of total SSB + pure fruit juice as pure fruit juice showed hazard ratio (95 % CI) of 0·74 (95 % CI 0·64, 0·85) and 0·85 (95 % CI 0·76, 0·96), respectively. Substitution of pure fruit juice for fruit was not associated with the risk of type 2 diabetes, CVD, CHD and stroke. Substituting pure fruit juice for SSB was associated with lower cardiometabolic risk, whereas substituting pure fruit juice for fruit was not associated with cardiometabolic risk.

Young Children's Sugar-Sweetened Beverage Consumption and 5-Year Change in BMI: Lessons Learned from the Timing of Consumption.

Sugar-sweetened beverages (SSBs) are an already known risk factor for weight gain in childhood. To identify windows of opportunity for public health interventions, insight into the consumption behavior of SSBs is needed. We investigated whether total SSB consumption was related to body mass index (BMI) change and overweight and compared whether the timing of consumption over the day differed between low and high consumers. In the Dutch GECKO Drenthe birth cohort, a cohort embedded within the Groningen Expert Center for Kids with Obesity (GECKO), height and weight were measured by trained nurses at age 5/6 years (y) and 10/11 y (N = 1257). BMI was standardized for age and sex (BMI-z). In the food pattern questionnaire completed by parents at age 5/6 y, beverages were assessed for seven time segments (breakfast, morning, lunch at school, lunch at home, afternoon, dinner, and evening). Linear and logistic regression analyses were adjusted for potential confounders (sex, baseline BMI-z, parental BMI, parental education level, maternal age at birth, maternal smoking during pregnancy). The median daily SSB consumption frequency ranged from 1.9 times per day (1.5–2.0, 25th–75th percentile) in the lowest quartile to 4.9 times per day (4.6–5.5) in the highest quartile. In the highest compared to the lowest quartile of SSB consumption frequency, the confounder-adjusted odds ratio for overweight incidence was 3.12 (95% CI, 1.60–6.07). The difference in consumption between quartile 1 and quartile 4 occurred mainly during main meals and in the evening, e.g., at breakfast (31% vs. 98%, p < 0.001), lunch at home (32% vs. 98%, p < 0.001), and dinner (17% vs. 72%, p < 0.001). These drinking occasions characterizing high SSB consumers mostly occurred in the home environment, where parental influence on dietary behaviors is profound. Therefore, these results exposed a window of opportunity, leading to the advice for parents to offer their children sugar-free drinks to quench thirst with main meals.

Associations Between College-Student Food Insecurity and Diet at a Large, Public Midwestern University

Abstract Objectives Food insecurity, a state of not being able to consistently access nutritious food, is an issue that 43% of students on college campuses experience. This study examines the associations between food insecurity and dietary intake in a sample of undergraduate students at a large, public Midwestern university. Methods A Qualtrics survey was completed by 1033 students, recruited from three dining halls as part of a different sugar-sweetened beverage intervention study. Baseline data, collected prior to the intervention, were used in the present study. Food security was assessed using the 6-item Short Form Food Security Survey Module and dietary intake was assessed using the National Cancer Institute 26-item Dietary Screener Questionnaire and the Beverage Intake Questionnaire-15. Generalized linear regression models were used to examine differences in dietary intake by student's food security status. Results After adjusting for sociodemographic variables, food-insecure students reported 9% lower intake of fruits, 9% lower intake of vegetables, 10% higher intake of dairy, 6% higher intake of total added sugars, 10% higher intake of added sugars from sugar-sweetened beverages, 4% higher intake of calcium, and 4% lower intake of fiber, compared to food-secure students. With respect to beverage intake, food-insecure students had 55% higher intake of fruit drinks, 148% higher intake of energy drinks, 129% higher intake of sweetened teas, 46% higher intake of flavored milk, 54% higher intake of total sugar-sweetened beverages, and 66% higher intake of diet soda. Conclusions Despite having similar access to university dining halls, there were significant differences in the diets of college students by food security status, providing more reason to increase food insecurity awareness among college students and contribute to initiatives to alleviate food insecurity, such as on-campus food pantry programs. Funding Sources This study was supported by a grant from Poverty Solutions at the University of Michigan.

Acquisition of Bottled Water Among US Households

Abstract Objectives While drinking plain water instead of sugar-sweetened beverages (SSB) may improve diet and prevent diseases, bottled water is more costly than tap water and typically does not contain fluoride for oral health benefits. We explored bottled water acquisition among US households and its relationship with SSB acquisition. Methods We used data from the USDA Food Acquisition and Purchasing Survey, which collected 7 days of data on all foods purchased or obtained for free in a nationally representative sample of 4826 households during 2012. Data were collected using food record books and bar code scanners. We assessed the prevalence of acquiring bottled water to bring home and for immediate consumption away from home, volume of water acquired, money spent on water, and the association of water acquisition with SSB acquisition. Differences in prevalence according to race/ethnicity, Census region, education level, rural status, and income/SNAP status were assessed using Chi-square tests. Adjusted linear models were used to assess the association of acquiring water for home or away from home with per-capita household total SSB calories acquired. Results A quarter (24.6%) of households acquired any bottled water during the study week with 16.2% acquiring water for home and 11.1% away from home. Prevalence of acquiring any bottled water differed by region and race/ethnicity and was highest among households in the South and West (each 26.8%) and among Hispanic households (35.2%). Among those that acquired each type, households spent $4.13 acquiring 14.1 liters of water for home, while households spent $1.65 acquiring 2.0 liters for away from home. In regression models, households that acquired bottled water for home had greater per capita SSB calorie acquisition than households that did not (adjusted mean: 1203 vs. 734 kcal/week; P = 0.0005); acquiring water for away from home was not associated with greater per capita SSB calorie acquisition (adjusted means: 931 vs. 1005 kcal; P = 0.34). Conclusions One quarter of US households acquire bottled water though acquisition differs according to demographic factors. Although plain water can reduce caloric intake when substituted for SSB, findings suggest that households that acquire bottled water for home also acquire more SSB calories than households that do not. Funding Sources Solely for authors time from their institutions.

Correlates of sugar-sweetened beverages consumption among adolescents.

To identify correlates and underlying beliefs regarding the adolescents' intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB. Correlational study. Region of Chaudière-Appalaches in the province of Quebec, Canada. 311 adolescents aged 13-18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured. Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13-14 years (β = -0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends' approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified. The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.

Distributional Changes in U.S. Sugar-Sweetened Beverage Purchases, 2002–2014

U.S. policy actions focus on reducing sugar-sweetened beverage purchases. Yet, there are no studies on trends in overall purchase distribution and how it has changed by key subpopulations. This study examined changes in distributions of total sugar-sweetened beverage purchases and its major subtypes(regular carbonated soft drinks and fruit/sports/energy drinks)in 2002-2014 and distinguished among low, moderate, and high purchasers. Longitudinal data on sugar-sweetened beverage purchases of U.S. households from the 2002-2014 Nielsen Homescan Panel were used. Sugar-sweetened beverages were defined as all caloric non-alcoholic beverages containing added sugars. Longitudinal quantile regression model examined trends across distributions (from quantile 25 to 95) of purchases (measured in kcal/day/capita), while accounting for households' unobserved differences. All statistical analyses were conducted in 2019. All households across the total purchase distribution significantly reduced their purchases. High purchasers made less proportional reductions than low purchasers (e.g., 35% at 95th quantile vs 62% at 25th quantile). However, the smaller relative reductions among higher purchasers translated into larger absolute decreases (e.g., 134 kcal/day/capita at 95th quantile vs 23 kcal/day/capita at 25th quantile). Similar patterns in heterogeneity were observed across sugar-sweetened beverage subtype distributions and among racial/ethnic and income groups. In addition, there were significant racial/ethnic and income disparities in total sugar-sweetened beverage purchases in 2002-2003. Although racial/ethnic disparities among higher purchasers improved, income disparity patterns at all purchase levels persisted into 2013-2014. From 2002‒2003 to 2013-2014, U.S. households at all purchase levels made meaningful reductions in sugar-sweetened beverage purchases in both absolute and relative terms. Furthermore, racial/ethnic disparities in total sugar-sweetened beverage purchases narrowed, but income disparity patterns persisted.