Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries

Lead, Cadmium, and Arsenic in Raw Cow's Milk in a Central Andean Area and Risks for the Peruvian Populations

Milk and its derivatives are basic foods in Peru, especially for children. The Junín region, in the central Andes, is one of the leading dairy basins. However, the safety of milk is affected by mining-metallurgical activities, wastewater dumping, organic residues, and inappropriate use of organophosphate fertilizers in agriculture whose contaminants reach the food chain, putting human health at risk. The purpose of this study was to evaluate the bioaccumulation of lead (Pb), cadmium (Cd), and arsenic (As) in milk produced on a representative farm in central Peru, which uses phosphorous agrochemicals and is adjacent to a small mineral concentrator and a municipal solid waste dump, and to evaluate the potential risk for the Peruvian population of 2-85 years considering three levels of daily intake by age, which constitutes the innovative contribution of the study. These three elements were quantified by flame atomic absorption spectrometry following standardized procedures. The mean contents of Pb (0.062 mg/kg), Cd (0.014 mg/kg), and As (0.030 mg/kg) in milk exceeded the maximum limits allowed by international standards. At all ages, the target quotient hazard followed a descending order of As > Pb > Cd, being > 1 in the case of As. The hazard index was >1 for children under 7, 9, and 11 years of age in the scenarios of low, medium, and high milk intake. The information is valid for formulating policies to prevent adverse health effects and develop standards and awareness programs, monitoring, and control of heavy metals in milk in Peru.

The challenge of dietary management in soft drink consumption and its oral and systemic repercussions

Background:Soft drinks are drinks high in sugar and acidity, but low in nutritional benefits. Despite its great popularity, its consumption is alerted due to the numerous systemic harm caused. Aim:This work aims to provide information and critically review the literature on the risk of soft drink consumption in an integrative view with nutritional, dental, and medical aspects. Methods:A search was carried out based on the identification of the theme, determination of inclusion and exclusion criteria, selection of databases for research and, finally, the reading, interpretation, and discussion of the selected sources. A search was conducted using the keywords: "soft drinks" AND "obesity" OR "dental erosion" OR "diabetes" OR "hypertension" OR "mental health" OR "multimorbidities" in databases PubMed, SciELO, and LILACS between 2017 and 2022. Results:Seventy-six studies were included in the article after the qualitative synthesis. Conclusion:We conclude that the high consumption of soft drinks is associated with oral and general diseases. Therefore, a multi-professional approach to guide patients to moderate the consumption of these beverages is extremely important.

Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean

OBJECTIVE

Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean.

DESIGN

SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations.

SETTING

Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis.

PARTICIPANTS

Participants (n 1701) enrolled in the ECS.

RESULTS

Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)).

CONCLUSIONS

Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.

Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (β = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (β = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

Association between sugar-sweetened beverage consumption frequency and muscle strength: results from a sample of Chinese adolescents

BACKGROUND

Although sugar-sweetened beverage consumption has become an important and widespread concern, there are few studies on the association between sugar-sweetened beverage consumption frequency and muscle strength in Chinese adolescents. The objective of this study was to analyze the association between sugar-sweetened beverage consumption frequency and muscle strength in Chinese adolescents.

METHODS

A stratified whole-group sampling method was used to survey 25,893 adolescents aged 13-15 years old in China for sugar-sweetened beverage consumption frequency and muscle strength for grip strength and standing long jump. The subjects' basic information, body mass index (BMI), and covariates were investigated. The association between sugar-sweetened beverage consumption frequency and muscle strength was analyzed by multivariate logisitc regression analysis.

RESULTS

The proportions of Chinese adolescents who consumed sugar-sweetened beverage ≥ 3 times/week, 1-2 times/week, and < 1 time/week were 12.23%, 52.79%, and 34.98%, respectively. The differences in sugar-sweetened beverage consumption frequency were statistically significant when compared across gender, parental education, duration of physical activity, snacks, and mode of commuting to school (χ² values = 228.570, 51.422, 275.552, 3165.656, 10.988, P < 0.01). Logistic regression analysis showed that overall Chinese adolescents with sugary drinks 1-2 times/week (OR = 1.207, 95% CI:1.132-1.287) and sugary drinks ≥ 3 times/week (OR = 1.771, 95% CI:1.611-1.947) were associated with lower muscle strength compared to sugary drinks < 1 time/week showed a positive association (P < 0.01). The same trend was found for boys and girls.

CONCLUSION

Chinese adolescents' sugar-sweetened beverage consumption is common, and high-frequency sugar-sweetened beverage consumption is associated with lower muscle strength. In the future, we should control the use of sugar-sweetened beverages and increase muscular strength training in Chinese adolescents to promote healthy growth.

Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy

BACKGROUND

Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated.

DESIGN

Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level.

RESULTS

The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables.

CONCLUSION

SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.

Fructose drives de novo lipogenesis affecting metabolic health

Despite the existence of numerous studies supporting a pathological link between fructose consumption and the development of the metabolic syndrome and its sequelae, such as non-alcoholic fatty liver disease (NAFLD), this link remains a contentious issue. With this article, we shed a light on the impact of sugar/fructose intake on hepatic de novo lipogenesis (DNL), an outcome parameter known to be dysregulated in subjects with type 2 diabetes and/or NAFLD. In this review, we present findings from human intervention studies using physiological doses of sugar as well as mechanistic animal studies. There is evidence from both human and animal studies that fructose is a more potent inducer of hepatic lipogenesis than glucose. This is most likely due to the liver's prominent physiological role in fructose metabolism, which may be disrupted under pathological conditions by increased hepatic expression of fructolytic and lipogenic enzymes. Increased DNL may not only contribute to ectopic fat deposition (i.e. in the liver), but it may also impair several metabolic processes through DNL-related fatty acids (e.g. beta-cell function, insulin secretion, or insulin sensitivity).

Impact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake, metabolism, and gastro-intestinal symptoms: Results of the SWEET beverages trial

Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter "S&SE") alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (∼2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p < 0.001 in mixed-effects models), while the stevia RebA and sucralose blends reduced the glucose iAUC (p < 0.05) compared with sucrose. Post-prandial levels of triglycerides plus hepatic transaminases did not differ across conditions (p > 0.05 for all). Compared with sucrose, there was a 3% increase in LDL-cholesterol after stevia RebA-thaumatin (p < 0.001 in adjusted models); and a 2% decrease in HDL-cholesterol after sucralose-ace-K (p < 0.01). There was an impact of blend on fullness and desire to eat ratings (both p < 0.05) and sucralose-acesulfame K induced higher prospective intake vs sucrose (p < 0.001 in adjusted models), but changes were of a small magnitude and did not translate into energy intake differences over the next 24 h. Gastro-intestinal symptoms for all beverages were mostly mild. In general, responses to a carbohydrate-rich meal following consumption of S&SE blends with stevia or sucralose were similar to sucrose.

Dietary sugar consumption and health: umbrella review

OBJECTIVE

To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary sugar consumption and health outcomes.

DESIGN

Umbrella review of existing meta-analyses.

DATA SOURCES

PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of reference lists.

INCLUSION CRITERIA

Systematic reviews and meta-analyses of randomised controlled trials, cohort studies, case-control studies, or cross sectional studies that evaluated the effect of dietary sugar consumption on any health outcomes in humans free from acute or chronic diseases.

RESULTS

The search identified 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and nine unique outcomes in meta-analyses of randomised controlled trials. Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected. Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence). Low quality evidence indicated that each serving/week increment of sugar sweetened beverage consumption was associated with a 4% higher risk of gout (class III evidence) and each 250 mL/day increment of sugar sweetened beverage consumption was associated with a 17% and 4% higher risk of coronary heart disease (class II evidence) and all cause mortality (class III evidence), respectively. In addition, low quality evidence suggested that every 25 g/day increment of fructose consumption was associated with a 22% higher risk of pancreatic cancer (class III evidence).

CONCLUSIONS

High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022300982.

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents' physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world's child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15-19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.

Changes in energy, macronutrient, and food consumption in 47 countries over the last 70 years (1950-2019): a systematic review and meta-analysis

OBJECTIVES

We aimed to systematically examine trends in dietary energy, macronutrient, and food consumption in different geographic regions.

METHODS

We searched Medline, Embase, CINAHL, and organizations for studies and reports using individual-level dietary assessments from 1950 to 2019 (PROSPERO CRD42022302843) and quantified changes using multivariable linear mixed-effects models.

RESULTS

We identified 109 articles and reports from 47 countries, including Europe and Australasia (47% of studies), Asia (30%), Latin America (13%), the Middle East (6%), and North America (4%). In Southeast and East Asia, carbohydrate intake decreased, whereas fat consumption increased; the opposite pattern occurred in North America; and fat decreased while carbohydrate intake remained stable in Europe and Australasia. Consumption of carbohydrate and fat were stable in South Asia, Latin America, and the Middle East, but data were limited in these regions. A greater increase in national gross domestic product over time was associated with decreased carbohydrate and increased fat and protein intake. Dietary saturated fatty acid intake decreased in Northern and Eastern Europe and was stable in other regions. Changes in food varied by region; East and Southeast Asia increased meat, fish, dairy, egg, fruit, and vegetable consumption and decreased intake of grains, roots and tubers, legumes, whereas North America decreased dairy and red meat but increased eggs, nuts, poultry, and vegetable oil intake. Intakes of fruits, nuts, legumes, and roots and tubers were below recommendations in most regions.

CONCLUSIONS

Our findings indicate regional variations in dietary trends and identify countries that would benefit from nutritional policies aimed at decreasing lower-quality carbohydrate foods and increasing consumption of fruits, vegetables, nuts, legumes, and dairy.

Testing effects of partner support and use of oral contraception during relationship formation on severity of nausea and vomiting in pregnancy

BACKGROUND

A recent study focusing on dietary predictors of nausea and vomiting in pregnancy (NVP) found that women with higher levels of partner support, and those who had used oral contraception (OC) when they met the father, both tended to report less severe NVP compared with previous non-users or those with less supportive partners. We provide a further test of these factors, using a large sample of women from four countries who retrospectively scored their NVP experience during their first pregnancy.

METHODS

We recruited women who had at least one child to participate in a retrospective online survey. In total 2321 women completed our questionnaire including items on demographics, hormonal contraception, NVP, and partner support. We used general linear models and path analysis to analyse our data.

RESULTS

Women who had used OC when they met the father of their first child tended to report lower levels of NVP, but the effect size was small and did not survive adding the participant's country to the model. There was no relationship between NVP and partner support in couples who were still together, but there was a significant effect among those couples that had since separated: women whose ex-partner had been relatively supportive reported less severe NVP. Additional analyses showed that women who were older during their first pregnancy reported less severe NVP, and there were also robust differences between countries.

CONCLUSIONS

These results provide further evidence for multiple influences on women's experience of NVP symptoms, including levels of perceived partner support.

Soft Drink Intake in Europe-A Review of Data from Nationally Representative Food Consumption Surveys

Public health interest in reducing the intake of sugar-sweetened soft drinks has resulted in various guidelines and initiatives related to their consumption, together with an increase in availability and sales of low and no-sugars versions. The aim of this review was to gain insight regarding individual-level amounts and types of soft drinks consumed across the lifecycle as reported in nationally representative surveys in Europe. The review highlighted significant gaps and challenges regarding the availability of recent country-specific soft drink consumption data including heterogeneity in categorisations used in reporting soft drinks. Nonetheless, crude estimates of mean intake (across countries) indicated that total soft drinks and soft drinks with sugars was highest in adolescents and lowest in infants/toddlers and older adults. For infants/toddlers, crude mean intakes of soft drinks with reduced/no sugars were higher than soft drinks with sugars. The review also found that consumption of total soft drinks is decreasing with a shift to consumption of soft drinks with reduced/no sugars in replacement of sugars-containing soft drinks. This review provides valuable insight into what data are currently available on soft drink consumption in Europe with heterogeneity in categorisations, terminology, and definitions of soft drinks observed.

Sugar-Sweetened Beverages Consumption in a Multi-Ethnic Population of Young Men and Association with Sociodemographic Characteristics and Obesity

Sugar-sweetened beverages are frequently consumed among adults and are linked with the incidence of obesity. We aimed to determine rates of weekly and daily sugar-sweetened beverage intake in a multi-ethnic population of young men and their association with sociodemographic characteristics and obesity. This cross-sectional study included 3600 young men who lived in Riyadh, KSA. Participants' sociodemographic characteristics and frequency of sugar-sweetened beverage consumption were gathered through personal interviews. The outcome variables in this study are based on the weekly and daily consumption of sugar-sweetened beverages. Weight and height were measured following standard protocols. The rates of weekly and daily sugar-sweetened beverage intake by participants were 93.6% and 40.8%, respectively. Nationality was a predictor of weekly and daily consumption of sugar-sweetened beverages. The highest rates of weekly (99.5%) and daily (63.9%) consumption were observed in subjects from the Philippines and Yemen, respectively, while Bangladeshi subjects had the lowest rates of weekly (76.9%) and daily (6.9%) consumption. Obesity was another predictor of sugar-sweetened beverage consumption. Obese participants had a significantly higher odds ratio of weekly sugar-sweetened beverage consumption than non-obese subjects (OR = 4.53, p = 0.037). In conclusion, sugar-sweetened beverage consumption was relatively high and our results support an association between the consumption of sugar-sweetened beverages and certain sociodemographic variables and obesity.

Determinants of Sugar-Sweetened Beverage Consumption Among Adults in Perambalur District of India

Background Sugar is a ubiquitous element in processed meals and is a major source of the energy we derive from them. The risk of obesity and other chronic conditions, such as high blood pressure, cardiovascular disease, type 2 diabetes mellitus, tooth destruction, as well as dental cavities, increases proportionally with the consumption of sugar-sweetened beverages (SSBs). This study intends to determine the prevalence of SSB intake among adults in the Perambalur area of Tamil Nadu, India, as well as the factors that influence it. Methodology We surveyed 1007 individuals using a cross-sectional design from June to November 2022. We included residents who were at least 18 years old and less than 80 years old. Using a convenience sample method, we gathered responses from the public in the urban and rural field practice areas of a teaching medical college in the district of Perambalur, India. We conducted in-person interviews to get data regarding the consumption of SSBs. Among other socio-demographic information, the participants' names, ages, religions, levels of education and employment, household incomes, family compositions, marital statuses, lifestyle behaviors, and comorbid conditions were also gathered. We measured the SSB consumption frequency and duration, and we also considered the contexts in which they consumed SSBs. We examined the factors that play a role in SSB consumption and questioned the participants' familiarity with SSBs' constituents, adverse effects, and cumulative toll. Besides examining the effects of SSB use, the research also explores the possibility of reducing or stopping it altogether. Results The prevalence of SSB use among the current study population was 96.3%. Half of the population has consumed SSBs, between 100 and 200 ml, for over 10 years. Taste and peer pressure are the primary reasons for facilitating SSBs, whereas the media has a minor impact. Most of the population (69%) began consuming SSBs, mostly during vacations and at parties. About one-fifth of the population experiences negative consequences after ingesting SSBs, while only half of the population is aware of the contents of SSBs. Likewise, just 50% of the population is aware of the long-term implications of SSBs. Nearly 16.7% of the population attempted to stop using SSBs. Being overweight, belonging to a high socioeconomic class, and dwelling in a rural location are risk factors related to the consumption of SSBs. Conclusion The prevalence of SSB use among the current study population is exceptionally high. Being overweight, belonging to a high socioeconomic class, and dwelling in a rural location are risk factors related to the consumption of SSBs. There is a need to educate the public about the short- and long-term negative effects of consuming SSBs. Government and non-government entities must work together to generate public behavior change communication.

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis

OBJECTIVE

To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001-2002 and 2017-2018 and in neighbouring comparison countries (without a tax).

DESIGN

Repeated cross-sectional surveys.

SETTING

Health Behaviour in School-aged Children study, spanning five survey years (school years 2001-2002 to 2017-2018).

PARTICIPANTS

Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls).

RESULTS

Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15).

CONCLUSIONS

Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

Association between Hyperactivity and SSB Consumption in Schoolchildren: A Cross-Sectional Study in China

Sugar-sweetened beverages (SSBs) consumption has risen significantly, which may lead to various health problems. Studies about the association between SSBs and attention-deficit/hyperactivity disorder (ADHD) in children are rare and inconsistent. We have used the two-stage cluster sampling method to select 6541 students aged 6-12. We further investigated their basic information and SSB intake. Teachers' questionnaires and parents' questionnaires were used to evaluating the hyperactive behaviors in children. We examined the associations between SSB consumption and hyperactivity index (HI) by adopting the censored least absolute deviation (CLAD) estimator. Then, we further evaluated the impacts of sex and age on the association between SSB intake and hyperactivity. Children who weekly drank SSB two or more times were associated with 0.05 (0.04, 0.07) and 0.04 (0.02, 0.06) higher scores of ln (HI+1) reported by teachers and parents, respectively, compared to non-consumers children (p for trend < 0.05). A stronger association between SSB intake and hyperactivity occurred in girls and old children. (p for interaction < 0.05). SSB intake has a positive correlation with the risk of hyperactivity in children, and the frequency of SSB consumption and hyperactivity have a dose-response relationship.

A randomized trial to evaluate the impact of Singapore's forthcoming Nutri-grade front-of-pack beverage label on food and beverage purchases

BACKGROUND

The epidemic of non-communicable diseases (NCDs) is a growing concern worldwide and Singapore is no exception to this global trend. As part of measures to address this concern, the Singapore government will implement a mandatory color-coded front-of-package (FOP) nutrition label for beverages, called Nutri-Grade (NG), which will complement the existing FOP label, Healthier Choice Symbol (HCS) logos, currently displayed on select food and beverage items. NG grades beverages on a four-point scale, A (healthiest) to D (least healthy), in terms of sugar and saturated fat levels. This study aimed to evaluate the effectiveness of the NG label on nutritional quality of pre-packaged beverages using a fully functional online grocery store.

METHODS

We conducted a 2-arm crossover trial involving actual purchases with 138 participants randomly exposed to: 1) Control with HCS logos displayed on qualifying items; 2) Similar to Control except that all beverages displayed the NG label. The effects of the NG label were estimated using a linear mixed-effects model that addresses correlations between repeated measures and accommodates missing data.

RESULTS

We found that the NG label encouraged consumers to choose beverages with higher ratings. This led to a reduction in sugar from beverages purchased by 1.51 g [95% CI: - 2.68, - 0.34] per serving but was not effective at reducing saturated fat purchased (- 0.009 g [95% CI: - 0.22, 0.20]) per serving or improvements in overall diet quality, measured by the weighted (by the number of servings) average Nutri-Score value ranging from 1 to 5 (- 0.024 [95% CI: - 0.13, 0.08]).

CONCLUSIONS

Results suggest that the Nutri-Grade label is likely to reduce sugar purchased from beverages. However, to improve overall diet quality in Singapore, additional measures will be needed.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov under the identifier: NCT05018026 on 24th August 2021.

The health and economic burden associated with sugar-sweetened beverage consumption in Trinidad and Tobago

BACKGROUND

In Trinidad and Tobago, non-communicable diseases (NCDs) are the leading cause of death. Unhealthy diet is one modifiable NCD risk factor, which contributes to the NCD burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of NCDs.

AIM

The aim of this paper is to estimate the burden of disease and economic costs associated with the consumption of SSBs in Trinidad and Tobago as evidence to support the implementation of health and fiscal policies on SSB consumption.

METHODS

The results of this study were obtained through the use of a mathematical model which used a comparative risk assessment approach to estimate the health and economic burden associated with SSB intake, by sex and age.

RESULTS

Estimates for one year showed that SSB consumption was associated with approximately 15,000 cases of overweight and obesity in adults and 11,700 cases in children, 28% of all the cases of diabetes and overall, an estimated 387 deaths and 9000 years of healthy life were lost due to premature death and disability. Approximately US$23.1 million was spent in the public healthcare system to treat diseases associated with consumption of sugary beverages.

CONCLUSIONS

The consumption of SSBs is associated with increases in diseases, deaths and rising healthcare costs in Trinidad and Tobago. It is hoped that the results of this study will provide an added rationale and impetus for the implementation of policies to reduce the consumption of SSBs.

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study

OBJECTIVE

Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago.

DESIGN

Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs.

SETTING

Argentina, Brazil, El Salvador, and Trinidad and Tobago.

PARTICIPANTS

Overall population.

PRIMARY AND SECONDARY OUTCOME MEASURES

The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases.

RESULTS

The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes (19%); 200 000 cases of heart disease (3.8%); 124 000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events.

CONCLUSIONS

The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.

Sugary drink consumption and the subsequent risk of gastric cancer: The Japan Public Health Center-based Prospective Study

BACKGROUND/OBJECTIVES

Evidence on the association between sugary drink consumption and gastric cancer (GC) risk is limited, especially in Asian populations. This study aimed to investigate the association between consumption of sugary drinks (sugar-sweetened beverages and 100% fruit juices) and GC risk in a Japanese population.

SUBJECTS/METHODS

This study included 74,455 Japanese individuals aged 45-74 years (35,102 males and 39,353 females) who participated in a population-based cohort study (Japan Public Health Center-based Prospective Study). Sugary drinks were assessed using a food frequency questionnaire. Cox proportional hazard regression was used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of GC incidence according to the quintile of sugary drink consumption.

RESULTS

We identified 2141 patients with GC cases during 16.7 years of follow-up. Sugary drink consumption was not associated with GC risk. The multivariate HR of total, cardia, and non-cardia GC in the highest vs. lowest quintile of sugary drinks consumption in males was 0.98 (95% CI: 0.82-1.17; p-trend 0.48), 0.48 (95% CI: 0.23-0.99; p-trend 0.03), and 1.03 (95% CI: 0.86-1.24; p-trend 0.88), respectively. In females, the respective multivariate HRs were 1.03 (95% CI: 0.79-1.33; p-trend 0.47), 1.28 (95% CI: 0.32-5.12; p-trend 0.53), and 1.01 (95% CI: 0.78-1.32; p-trend 0.56). The results did not change significantly after adjusting for Helicobacter pylori infection and atrophic gastritis status in the subgroup analysis.

CONCLUSIONS

In this Japanese prospective cohort study, sugary drink consumption was not associated with GC risk.

Long-Term Cola Intake Does Not Cause Evident Pathological Alterations in the Femoral Bone Microstructure: An Animal Study in Adult Mice

Short-term animal experiments and association studies in humans have shown that cola intake may have a detrimental impact on bone mineral density (BMD); however, other bone parameters have not been investigated. This study examined the effects of long-term cola consumption on the femoral bone microstructure using adult mice (n = 32) as an animal model, which were divided into water and cola groups depending on whether they received water or cola along with a standard rodent diet for 6 months. Micro-computed tomography revealed that cola intake did not significantly affect all measured parameters characterizing trabecular bone mass and microarchitecture, as well as cortical microarchitecture and geometry in both sexes, although a slight deterioration of these parameters was noted. Cola consumption also resulted in a slightly, statistically insignificant worsening of bone mechanical properties. In contrast to female mice, males receiving cola had a lower area of primary osteons' vascular canals. Nevertheless, long-term cola intake did not cause evident pathological alterations in the femur of adult mice, possibly due to a balanced diet and no restriction of physical activity. Therefore, the adverse effects of cola consumption on BMD, the only bone parameter studied so far, may be caused by other risk and lifestyle factors.

Regional Living Conditions and Individual Dietary Characteristics of the Russian Population

The goal of our study was to examine the effects of the regional characteristics of the living environment on individual a priori and a posteriori dietary patterns of the Russian population. For the analysis, we used cross-sectional data from the Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation study from 2013-2014. The sample included 18,054 men and women 25-64 years of age from 12 regions. Based on the frequency of consumption of basic foods, four a posteriori empirical dietary patterns (EDPs), along with an a priori cardioprotective dietary pattern (CPDP), were identified. To describe the regional living environment, five regional indices were used. Adherence to the meat-based EDP was directly associated with deterioration of social living conditions and a more northerly location for the region of residence. The probability of a CPDP increased with greater deterioration of social living conditions, aggravation of demographic crises, and higher industrial development in the region, as well as with declines in the economic development of the region, income, and economic inequality among the population. We detected several gender-dependent differences in the associations established. The patterns revealed reflect the national dietary preferences of Russians, and the regional indices characterize the effect of the living environment.

Aspartame-Sweetened Tap Water: Transformation Products and 2,6-Dichloro-1,4-Benzoquinone Formation

Aspartame (APM), a dipeptide of aspartic acid (ASP) and phenylalanine (PHE), is a widely used artificial sweetener in beverages. It is unclear whether residual chlorine in tap water can react with APM to form disinfection byproducts (DBPs). Therefore, we investigated the formation of DBPs from the reaction of APM with residual chlorine in authentic tap water. APM and a commercial sweetener (CS) packet containing APM were studied under authentic and simulated tap water conditions. Eight chlorinated products of APM were detected using solid-phase extraction (SPE) and high performance liquid chromatography quadrupole time-of-flight mass spectrometry (HPLC-QTOF-MS). These new chloro-products were tentatively identified based on accurate masses, isotopic patterns of 35,37Cl, and MS/MS spectra. Furthermore, we identified APM as a precursor to 2,6-dichloro-1,4-benzoquinone (DCBQ). DCBQ significantly increased to 2.3-12 ng/L with the addition of APM or CS in tap waters collected from different locations compared to 1.4-1.8 ng/L in the same tap water samples without sweetener. DCBQ and two of the chlorinated transformation products were identified in cold prepared tea containing APM. DCBQ formation was eliminated when the residual chlorine in tap water was reduced by ascorbic acid or boiling prior to the addition of APM or CS. This study found that eight new DBPs and DCBQ were produced by the reactions of residual chlorine with APM and CS. These findings show an unintended exposure source of emerging DBPs via APM sweetened beverages.

Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study

BACKGROUND

Sugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru.

METHODS

This study used monthly household purchase data from a panel of 5145 households from January 2016-December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume.

RESULTS

The trends analysis showed a decline in total beverage volume of - 52 mL/capita/month (95% CI: - 72, - 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively).

CONCLUSIONS

Nearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Liver-derived metabolites as signaling molecules in fatty liver disease

Excessive fat accumulation in the liver has become a major health threat worldwide. Unresolved fat deposition in the liver can go undetected until it develops into fatty liver disease, followed by steatohepatitis, fibrosis, cirrhosis, and eventually hepatocellular carcinoma. Lipid deposition in the liver is governed by complex communication, primarily between metabolic organs. This can be mediated by hormones, organokines, and also, as has been more recently discovered, metabolites. Although how metabolites from peripheral organs affect the liver is well documented, the effect of metabolic players released from the liver during the development of fatty liver disease or associated comorbidities needs further attention. Here we focus on interorgan crosstalk based on metabolites released from the liver and how these molecules act as signaling molecules in peripheral tissues. Due to the liver's specific role, we are covering lipid and bile mechanism-derived metabolites. We also discuss the high sucrose intake associated with uric acid release from the liver. Excessive fat deposition in the liver during fatty liver disease development reflects disrupted metabolic processes. As a response, the liver secretes a variety of signaling molecules as well as metabolites which act as a footprint of the metabolic disruption. In the coming years, the reciprocal exchange of metabolites between the liver and other metabolic organs will gain further importance and will help to better understand the development of fatty liver disease and associated diseases.

Using GRADE Evidence to Decision frameworks to support the process of health policy-making: an example application regarding taxation of sugar-sweetened beverages

BACKGROUND

Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks are well-known tools that enable guideline panels to structure the process of developing recommendations and making decisions in healthcare and public health. To date, they have not regularly been used for health policy-making. This article aims to illustrate the application of the GRADE EtD frameworks in the process of nutrition-related policy-making for a European country.

METHODS

Based on methodological guidance by the GRADE Working Group and the findings of our recently published scoping review, we illustrate the process of moving from evidence to recommendations, by applying the EtD frameworks to a fictitious example. Sugar-sweetened beverage (SSB) taxation based on energy density was chosen as an example application.

RESULTS

A fictitious guideline panel was convened by a national nutrition association to develop a population-level recommendation on SSB taxation aiming to reduce the burden of overweight and obesity. Exemplary evidence was summarized for each EtD criterion and conclusions were drawn based on all judgements made in relation to each criterion. As a result of the high priority to reduce the burden of obesity and because of the moderate desirable effects on health outcomes, but considering scarce or varying research evidence for other EtD criteria, the panel made a conditional recommendation for SSB taxation. Decision-makers may opt for conducting a pilot study prior to implementing the policy on a national level.

CONCLUSIONS

GRADE EtD frameworks can be used by guideline panels to make the process of developing recommendations in the field of health policy more systematic, transparent and comprehensible.

Minerals and Trace Elements in 990 Beverages and Their Contribution to Dietary Reference Values for German Consumers

Beverages are an integral part of human nutrition, yet little is known about their contribution to daily intakes of minerals and trace elements in German consumers. Using inductively coupled plasma-mass spectrometry, we determined the concentration of five minerals and six trace elements in beverage samples (n = 990, assigned to different beverage groups) collected throughout Germany. For a calculation of their relative contribution to the mineral supply, available beverage consumption data was combined with our quantitative analysis to calculate the average contribution of beverage groups to meet the respective dietary reference values currently used in Germany, Austria and Switzerland (D-A-CH region). Based on their presence in beverages and their consumption, the top three minerals are phosphorous, calcium and magnesium, and they, therefore, may reasonably contribute to the reference values. Among the trace elements, beverages mostly contributed to the manganese supply, whereas at the same time, concentrations of iron, cobalt and copper were low across all tested groups. Our study provides an overview of the assumed mineral and trace element intake via beverages in Germany and may, thus, serve as a foundation for a mineral and trace element database of beverages that needs to be expanded in the future.

The Impact of the Sweetened Beverages Tax on Their Reformulation in Poland-The Analysis of the Composition of Commercially Available Beverages before and after the Introduction of the Tax (2020 vs. 2021)

The aim of this study was to estimate changes in the composition of carbonated and non-carbonated sugar-sweetened beverages before and after the introduction of the beverage tax in Poland. Based on the labels of 198 drinks, the composition and nutritional values of the drinks were compared. The nonparametric Mann-Whitney test was applied to compare the differences in the sugar and juice content as well as energy value. After the introduction of the tax, the median sugar content in the carbonated beverages decreased from 8.6 g to 6.9 g/100 mL (p = 0.004), while in the non-carbonated beverages, it decreased from 5.5 g to 4.8 g/100 mL (p < 0.001). In the entire beverage group, there was a significant drop in the proportion of beverages that contained >5 g of sugars/100 mL (44.4% in 2021 vs. 70.2% in 2020). The median juice content in the carbonated beverages increased from 1.0% to 3.3% (p = 0.121), but totalled 20.0% for both periods in the non-carbonated beverages. The percentage of beverages with a tax-exempt composition (juice content ≥ 20% and sugar content ≤ 5 g/100 mL) almost tripled. After the introduction of the tax, beneficial changes in the compositions of 62% of the analysed beverages were observed in terms of their sugar and/or juice content.

Public perception of the tax on sweetened beverages in France

OBJECTIVE

To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance.

DESIGN

A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling.

SETTINGS

NutriNet-Santé prospective cohort study.

PARTICIPANTS

Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France.

RESULTS

Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax.

CONCLUSION

The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

Global case study of digital marketing on social media by a top soda brand

The Big Soda segment is central in modern food systems, and they invest heavily in digital marketing, but little is known about it. We aimed to analyze the digital marketing on Facebook of the soda brand with a major worldwide reach. Countries were described in terms of soda brand presence and popularity on Facebook according to countries' socio-demographic index (SDI) and the market share of soda brand (%MS). From 149 countries, 57.0% had soda brand's Facebook page among the top five in the number of followers within the beverage segment. Among them, digital marketing was described by the number of the page followers, the number of posts, and the number of interactions (likes, comments and shares) that each post received by Facebook users. Also, we analyzed the characteristics, and the use of marketing strategies on posts in a random sample of 10% (n = 1217) of all posts. We found that soda brand's popularity on Facebook was higher among countries with higher SDI and higher %MS. Also, the number of users that engaged with soda brand's posts was higher among countries with lower SDI and higher brand's %MS. The brand's posts focus on young adults, display of brand's products and glorification of its attributes. Other identified features include sport-related thematic and appeals to socialization and healthy eating. In addition, posts' characteristics differed with countries' characteristics. Soda brand digital marketing varies according to countries' characterization and maintains the brand position on the global marketing of beverages.

Detection of endocrine and metabolism disrupting xenobiotics in milk-derived fat samples by fluorescent protein-tagged nuclear receptors and live cell imaging

Nuclear receptors (NRs) are ligand-modulated transcription factors that regulate multiple physiological functions in our body. Many NRs in their unliganded state are localized in cytoplasm. The ligand-inducible nuclear translocation of NRs provides a valuable tool for studying the NR-ligand interactions and their downstream effects. The translocation response of NRs can be studied irrespective of the nature of the interacting ligand (agonist, antagonist, or a small molecule modulator). These nuclear translocation studies offer an advantage over promoter-reporter-based transcription assays where transcription response is observed only with the activating hormones or agonistic ligands. Globally, milk serves as a major dietary source. However, suspected presence of endocrine/metabolism disrupting chemicals like bisphenols, parabens, organochlorine pesticides, carbamates, non-steroidal anti-inflammatory drugs, chloramphenicol, brominated flame retardants, etc. has been reported. Considering that these chemicals may impart serious developmental and metabolism-related health concerns, it is essential to develop assays suitable for the detection of xenobiotics present at differing levels in milk. Since milk samples cannot be used directly on cultured cells or for microscopy, a combination of screening strategies has been developed herein based on the revelation that i) lipophilic NR ligands can be successfully retrieved in milk-fat; ii) milk-fat treatment of cells is compatible with live-cell imaging studies; and finally, iii) treatment of cells with xenobiotics-spiked and normal milk derived fat provides a visual and quantifiable response of NR translocation in living cells. Utilizing a milk-fat extraction method and Green Fluorescent Protein (GFP) tagged NRs expressed in cultured mammalian cells, followed by an assessment of NR response proved to be an effective approach for screening xenobiotics present in milk samples.HighlightsDiverse endocrine and metabolism disrupting chemicals are suspected to contaminate milk.Nuclear receptors serve as 'xenosensors' for assessing the presence of xenobiotics in milk.Nuclear import of steroid receptors with (ant)agonist can be examined in live cells.Lipophilic xenobiotics are extracted and observed enriched in milk-fat fraction.A comprehensive cell-based protocol aids in the detection of xenobiotics in milk.

Young population consume twice as much artificial sweetener than the general population - A wastewater-based assessment in China

Understanding artificial sweetener consumption patterns and levels in different demographics is important for formulating public health policies on controlling sugar consumption. There is a considerable knowledge gap with respect to the pattern of artificial sweetener consumption in China. To narrow this gap, wastewater analysis was used to assess the temporal patterns of consumption of seven artificial sweeteners in an urban population and a university town in a megacity in South China over a one-year period. Daily influent wastewater samples were collected from an urban catchment and weekly samples collected from a university sub-catchment. Population normalized per capita consumption of the four detected artificial sweeteners (cyclamate, acesulfame, sucralose and saccharin) in the university catchment (1.0-5.9 mg d^-1 p^-1) was much higher than those in urban catchment (0.5-1.3 mg d^-1 p^-1), indicating younger population consume more artificial sweeteners than the general population. The daily consumption of artificial sweeteners was found to be stable throughout the week in the urban catchment. Time-series analysis showed that an average increase in temperature of 1 °C was associated with an increase consumption of 33 μg d^-1 p^-1 for acesulfame, 15 μg d^-1 p^-1 for sucralose and 14 μg d^-1 p^-1 for saccharin. This was the first study that objectively quantified the greater consumption of artificial sweeteners (proxy for consumption of artificially sweetened food and beverages) in a younger age group when compared to the general population, which could potentially pose a risk of health related diseases.

'I Knew I Should Stop, but I Couldn't Control Myself': a qualitative study to explore the factors influencing adolescents' consumption of sugar-sweetened beverages and sugary snacks from a socio-ecological perspective

OBJECTIVE

To explore the factors influencing Taiwanese adolescents' consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective.

DESIGN

This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire.

SETTING

Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018.

PARTICIPANTS

Fifty-nine participants aged 12-14 years participated in this study.

RESULTS

Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents' consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people's consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants' access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors.

CONCLUSIONS

Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents' increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.

Changes in the global burden of untreated dental caries from 1990 to 2019: A systematic analysis for the Global Burden of Disease study

Objective

To investigate the burden of untreated dental caries in 204 countries and territories over 30 years.

Methods

Data of untreated dental caries from 1990 to 2019, including the incidence, prevalence, and years lived with disability, were extracted from the Global Burden of Disease 2019 database. Estimated annual percentage changes were calculated to assess the changes in the age-standardized incidence, prevalence, and years lived with disability rates.

Results

Globally, in 2019, there were 3.09 billion (95% uncertainty interval [UI]: 2.76–3.39 billion) new cases of untreated dental caries in permanent teeth (48.00% increase), 2.03 billion (1.77–2.33) prevalent cases (46.07% increase), and 2.00 million (0.93–3.88) YLDs (45.64% increase), all since 1990. From 1990 to 2019, the age-standardized incidence rate (ASIR) of untreated dental caries in permanent teeth showed an upward trend (estimated annual percentage changes [EAPC] = 0.01), but age-standardized prevalence rate (ASPR) (EAPC = −0.13) and age-standardized YLD rate (ASYR) (EAPC = −0.13) decreased. There were 1.15 billion (0.79–1.52) new cases of untreated dental caries in deciduous teeth (11.74% increase), 0.52 billion (0.41–0.63) prevalent cases (5.89% increase), and 0.20 million (0.09–0.43) YLDs (6.03% increase), all since 1990. From 1990 to 2019, the ASIR of untreated dental caries in permanent teeth showed a stable trend (EAPC = 0), but the ASPR (EAPC = −0.15) and ASYR (EAPC = −0.14) decreased. The incidence of untreated dental caries peaked at the ages of 5–9 and 20–24 years, and the prevalence and years lived with disability at 1–4, 20–24, and 60–64 years.

Conclusion

Untreated dental caries remains a major global public health challenge, but demographic, sex, and regional differences in trends remain. Proactive intervention strategies, at both administrative and academic levels, based on dynamic changes, are needed.

Sugar-sweetened beverages, artificially sweetened beverages and natural juices and risk of inflammatory bowel disease: a cohort study of 121,490 participants

BACKGROUND

Inflammatory bowel diseases (IBD) have been related to high-sugar dietary patterns, but the associations of different types of beverages with IBD risk are largely unknown.

AIMS

To examine any associations between intake of sugar-sweetened beverages, artificially sweetened beverages and natural juices and IBD risk METHODS: This cohort study included 121,490 participants in the UK Biobank who were free of IBD at recruitment. Intake of beverages was obtained from repeated 24-h diet recalls in 2009-2012. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of beverage intake with IBD risk.

RESULTS

During a mean (standard deviation) follow-up of 10.2 (1.5) years, we documented 510 incident IBD cases, (143 Crohn's disease (CD) and 367 ulcerative colitis (UC)). Compared to non-consumers, participants consuming >1 unit per day of sugar-sweetened beverages were at significantly higher risk of IBD (HR 1.51, 95% CI 1.11-2.05), but the trend was non-significant (p-trend = 0.170). This association was significant for CD (HR 2.05, 95% CI 1.22-3.46), but not for UC (HR 1.31, 95% CI 0.89-1.92). We did not observe significant associations for the consumption of artificially sweetened beverages or natural juices.

CONCLUSIONS

Our findings suggest an association between consumption of sugar-sweetened beverages, rather than artificially sweetened beverages or natural juices, and IBD risk.

Sugar-sweetened beverages consumption in a multi-ethnic population of middle-aged men and association with sociodemographic variables and obesity

Background

Adults frequently consume sugar-sweetened beverages. These products are linked to negative health effects such as obesity. Our study was carried out to assess rates of weekly and daily sugar-sweetened beverages consumption in a multi-ethnic population of middle-aged men and association with sociodemographic variables and obesity.

Methods

A sum of 1,800 middle-aged men (36–59 years) living in Riyadh, KSA, participated in this cross-sectional study. Sociodemographic variables and the frequency of sugar-sweetened beverages consumption were gathered from participants using face to face interviews. Weekly and daily consumption of sugar-sweetened beverages were the two binary outcome variables applied in this research. Weight and height were measured following standard procedures.

Results

In this study, 93.8 and 32.6% of participants consumed sugar-sweetened beverages weekly and daily, respectively. The weekly and daily sugar-sweetened beverages consumption was predicted by nationality. Subjects from Pakistan (99.3%) and Yemen (60.0%) reported the greatest rates of weekly and daily consumption, respectively, while Bangladeshi and Sudanese subjects reported the lowest rates of weekly (87%) and daily (2.9%) consumption, respectively. Another factor that predicted weekly sugar-sweetened beverages consumption was obesity. Obese subjects had a significantly greater odds ratio of weekly sugar-sweetened beverages intake than non-obese individuals (OR = 3.80, P = 0.003).

Conclusion

Consumption of sugar-sweetened beverages is common among middle-aged men who live in KSA. Results show connecting sugar-sweetened beverages intake with specific sociodemographic variables and obesity.

Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa

Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.

Sweetened beverage consumption and risk of liver cancer by diabetes status: A pooled analysis

BACKGROUND

Consumption of sweetened beverages has been linked to several risk factors for liver cancer including diabetes. Studies investigating the role of sweetened beverage consumption and liver cancer, however, are limited. As persons with diabetes are advised against consumption of sugar, the objective of this study was to examine the role of sweetened beverage consumption and liver cancer risk by diabetes status.

METHODS

Data from two U.S. cohorts: the NIH-AARP Diet and Health Study, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were harmonized and pooled. Hazard ratios and 95%CI were estimated using Cox proportional hazard models stratified by median follow-up time.

RESULTS

Among persons without diabetes, there were no statistical evidence of associations between liver cancer and consumption of sweetened beverages overall, sugar sweetened beverages (SSB), or artificially sweetened beverages (ASB). Sugar sweetened (SS) soda consumption, however, was associated with liver cancer in the first follow-up interval (HR:1.18. 95%CI: 1.03, 1.35). In contrast, among persons with diabetes, there were significant associations between liver cancer and consumption of sweetened beverages overall (HR: 1.12, 95%CI 1.01, 1.24), ASBs (HR: 1.13, 95% CI: 1.02, 1.25), soda overall (HR: 1.13, 95% CI: 1.00, 1.26) and artificially sweetened (AS) soda (HR: 1.13, 95% CI: 1.01, 1.27) in the first follow-up interval.

CONCLUSIONS

Increased soda consumption may be associated with risk of liver cancer. The results suggest that decreasing consumption of SS soda by persons without diabetes, and AS soda by persons with diabetes, could be associated with reduced liver cancer risk.

Exploring an Artificial Intelligence–Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study

Background

Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices.

Objective

This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app.

Methods

A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory.

Results

Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability.

Conclusions

A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale.

The power of women: Does increasing women's parliamentary representation reduce intake of sugar-sweetened beverages among children and adolescents?

OBJECTIVE

Consumption of sugar-sweetened beverages (SSB) is associated with overweight and obesity in children and adolescents. Although existing research confirms the significance of economic and social factors as determinants of SSB intake, comparative studies on political factors and cross-national analyses are lacking. Research indicates that including women in the process of political decision-making promotes healthcare and child protection. This study examined how women's parliamentary representation influences children's and adolescents' SSB intake compared with adults.

DESIGN

The study used cross-national food and beverage intake data from the Global Dietary Database. The outcome measurement was SSB consumption (g/day) for different population groups. We modelled SSB intake as a function of age groups, women's parliamentary representation at the national level (the independent variable), regime types (the contextual factor) and import tariffs on SSB (the mediator) using country and time-fixed effects regression models.

SETTING

One-hundred eighty-five countries across three waves from 2005 to 2015.

PARTICIPANTS

Different population groups.

RESULTS

The impact of female representation on reducing SSB consumption is more prevalent in children and adolescents than in adults. Furthermore, the effect of women's parliamentary representation on SSB consumption among children and adolescents is conditional on a country's democratic status. Finally, the marginal effect decreases when import tariffs on SSB are considered a link in a causal chain. No changes in adult SSB intake are statistically significant.

CONCLUSIONS

The findings suggest that the presence of women in the legislature can have a substantial impact on child and adolescent health.

Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean

Background

Excise taxes can be used to reduce the consumption of sugar-sweetened beverages (SSBs), an important preventable risk factor for noncommunicable diseases. This study aimed to compare novel standardized indicators of the level of taxes applied on SSBs as a percentage of the price across beverage categories in Latin America and the Caribbean.

Methods

We used a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax share. The analysis focused on the most sold brand of five categories of non-alcoholic beverages. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of March 2019.

Findings

Of the 27 countries analyzed, 17 applied excise taxes on SSBs. Of these, median excise taxes represented the highest share of the price for large sugar-sweetened carbonated drinks (6·5%) and the lowest for energy drinks (2·3%). In countries where excise taxes were applied on bottled waters, tax incidence exceeded the one applied on most SSBs. Overall, excise tax shares were higher in Latin America than in the Caribbean. Including all other indirect taxes (e.g., value added tax), median total tax shares were between 12·8% and 17·5%. At least two countries earmarked part of SSB excise tax revenues for health purposes.

Interpretation

Excise tax levels are generally low in the region. From a public health perspective, tax rates could be increased, and tax designs improved (e.g., excluding bottled waters). The method describe here provides a feasible and informative way to monitor SSB taxation and could be replicated in other regions and over time.

Funding

Bloomberg Philanthropies through the Global Health Advocacy Incubator.

Examining the policy process of sugar-sweetened beverage taxation in Ireland

Sugar sweetened beverages (SSBs) are a growing source of weight gain, obesity, and type 2 diabetes that contain high added sugar amounts and provide minimal nutritional benefit. Taxing SSBs are effective in reducing sugar consumption and increasing awareness about health effects. The 2014 European Union Action Plan on Childhood Obesity combined with neighboring SSB tax proposals in the U.K. and France helped stimulate political discussions in Ireland. Following this momentum, in 2015, public health groups lead by the Irish Heart Foundation proposed an SSB tax with earmarked funds for public health and worked with the Irish Health Department through a whole-of-government approach to convince the Finance Department to introduce an SSB tax. These efforts resulted in the Finance Department proposing the Sugar Sweetened Drinks Tax (SSDT) in September 2016, which taxes non-alcoholic, water-based and juice-based drinks, which have an added sugar content of 5g per 100mL and above. Opposing stakeholders including the Irish Beverage Council and Food & Drink Industry Ireland argued that the tax would not decrease consumption of SSBs or impact obesity, disproportionately impact individuals with a low socioeconomic background, and create illicit trade. However, health groups argued the tax would reduce sugar consumption, encourage consumers to purchase healthier options, and help reduce obesity levels. These efforts with political will helped Ireland become the 36th country in the world (9th in Europe) to implement an SSB tax policy in May 2018. While the government reportedly raised €16.5 million (20.012 million USD) in 2018 and €33 million (40.024 million USD) in 2019 from the SSDT, the tax was not earmarked for public health purposes nor has it been evaluated despite multiple requests by public health groups representing an important missed opportunity. While other countries should follow Ireland's lead in enacting an SSB tax, it is important to evaluate the tax's impact on reducing sugar consumption and ensure the tax has earmarked funds for public health to further maximize the impact of reducing sugar consumption, promoting health equity and helping curb the NCD epidemic.

Lead and Cadmium Bioaccumulation in Fresh Cow's Milk in an Intermediate Area of the Central Andes of Peru and Risk to Human Health

The dairy basin of the Mantaro River located in the centre of Peru faces serious anthropogenic disturbances as it receives emissions and discharges from the metallurgical mining activity located in the headwaters of the basin and milk contaminated with lead (Pb) and cadmium (Cd) endangers the environmental and human health, especially children. To measure the concentrations of Pb and Cd in milk and the dangers of their consumption in the Peruvian population, 40 milk samples were collected and quantified by atomic absorption spectrometry. The mean concentration of Pb in milk was 15 ± 2.6 µg/kg, which represented 75% of the Maximum Limit (ML), and that of Cd was 505 ± 123 µg/kg, which exceeded the ML by more than 194 times. The estimated weekly intake of Pb for people aged 2−85 years was below the Provisional Tolerable Weekly Intake (PTWI) references, determining risk coefficients (CRD) < 1. Weekly Cd intake was much higher than the PTWIs and CRDs were between 14 and 34, indicating that consumers would experience carcinogenic health effects, with children being at higher risk than adults, therefore, milk from the area is not safe for consumption. Cd would be transferred mainly through the soil (water)-grass-milk pathway, due to its presence in irrigation water and in fertilizers that contain Cd. The main pathway for Pb entry would be air-soil (water)-milk grass, from the fine particles emitted into the air by the mining-metallurgical activity, developed approximately 90 km from the study area.

Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model

Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed a system dynamics simulation model to map the system driving diabetes and obesity prevalence in the Caribbean using Jamaica as a test case. The study aims to use the model to assess the magnitude changes necessary in physical activity and dietary intake to achieve global targets set by the WHO Global Action plan and to test scenarios for interventions to reduce the burden of diabetes and obesity. Continuing current trends in diet, physical activity, and demographics, the model predicts diabetes in Jamaican adults (20+ years) to rise from 12% in 2018 to 15.4% in 2030 and 20.9% by 2050. For obesity, it predicts prevalence to rise from 28.6% in 2018 to 32.1% by 2030 and 39.2% by 2050. The magnitude change necessary to achieve the global targets set by the World Health Organization is so great as to be unachievable. However, a combination of measures both upstream (including reducing the consumption of sugar sweetened beverages and ultra processed foods, increasing fruit and vegetable intake, and increasing moderate-to-vigorous activity) at the population level, and downstream (targeting people at high risk and with diabetes) can significantly reduce the future burden of diabetes and obesity in the region. No single intervention reduces the prevalence of these conditions as much as a combination of interventions. Thus, the findings of this model strongly support adopting a sustained and coordinated approach across various sectors to synergistically maximise the benefits of interventions.

Five Priorities of African Genomics Research: The Next Frontier

To embrace the prospects of accurately diagnosing thousands of monogenic conditions, predicting disease risks for complex traits or diseases, tailoring treatment to individuals' pharmacogenetic profiles, and potentially curing some diseases, research into African genomic variation is a scientific imperative. African genomes harbor millions of uncaptured variants accumulated over 300,000 years of modern humans' evolutionary history, with successive waves of admixture, migration, and natural selection combining with extensive ecological diversity to create a broad and exceptional genomic complexity. Harnessing African genomic complexity, therefore, will require sustained commitment and equitable collaboration from the scientific community and funding agencies. African governments must support academic public research and industrial partnerships that build the necessary genetic medicine workforce, utilize the emerging genomic big data to develop expertise in computer science and bioinformatics, and evolve national and global governance frameworks that recognize the ethical implications of data-driven genomic research and empower its application in African social, cultural, economic, and religious contexts. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.