Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis

School food environments and practices affect dietary behaviors of US public school children

BACKGROUND

Changes to school food environments and practices that lead to improved dietary behavior are a powerful strategy to reverse the childhood obesity epidemic.

OBJECTIVES

To estimate the effects of school food environments and practices, characterized by access to competitive foods and beverages, school lunches, and nutrition promotion, on children's consumption of sugar-sweetened beverages, low-nutrient energy-dense foods, and fruits/vegetables at school.

DESIGN

Cross-sectional study using data from the third School Nutrition Dietary Assessment Study, a nationally representative sample of public school districts, schools, and children in school year 2004-2005. Data from school principals and foodservice directors, school menu analysis, and on-site observations were used to characterize school food environments and practices. Dietary intake was assessed using 24-hour recalls.

SUBJECTS/SETTING

The sample consists of 287 schools and 2,314 children in grades one through 12.

STATISTICAL ANALYSES PERFORMED

Ordinary least squares regression was used to identify the association between school food environments and practices (within elementary, middle, and high schools) and dietary outcomes, controlling for other school and child/family characteristics.

RESULTS

Sugar-sweetened beverages obtained at school contributed a daily mean of 29 kcal in middle school children and 46 kcal in high school children across all school children. Attending a school without stores or snack bars was estimated to reduce sugar-sweetened beverage consumption by 22 kcal per school day in middle school children (P<0.01) and by 28 kcal in high school children (P<0.01). The lack of a pouring rights contract in a school reduced sugar-sweetened beverage consumption by 16 kcal (P<0.05), and no à la carte offerings in a school reduced consumption by 52 kcal (P<0.001) in middle school children. The most effective practices for reducing energy from low-energy, energy-dense foods were characteristics of the school meal program; not offering french fries reduced low-nutrient, energy-dense foods consumption by 43 kcal in elementary school children (P<0.01) and sugar-sweetened beverage consumption by 41 kcal in high school children (P<0.001).

CONCLUSIONS

To improve children's diet and reduce obesity continued changes to school food environments and practices are essential. Removing sugar-sweetened beverages from school food stores and snack bars, improving à la carte choices, and reducing the frequency of offering french fries merit testing as strategies to reduce energy from low-nutrient, energy-dense foods at school.

Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants

BACKGROUND

Access to foods and beverages on school campuses, at home, and other locations affects children's diet quality, energy intake, and risk of obesity.

OBJECTIVES

To describe patterns of consumption of "empty calories"--low-nutrient, energy-dense foods, including sugar-sweetened beverages--by eating location among National School Lunch Program (NSLP) participants and nonparticipants.

DESIGN

Cross-sectional study using 24-hour dietary recall data from the 2004-2005 third School Nutrition Dietary Assessment Study.

SUBJECTS/SETTING

A nationally representative sample of 2,314 children in grades one through 12, including 1,386 NSLP participants.

STATISTICAL ANALYSES PERFORMED

Comparisons, using t tests, of the proportion of children consuming low-nutrient, energy-dense foods and beverages, mean daily energy and energy from low-nutrient, energy-dense foods, and energy density by NSLP participation status.

RESULTS

On a typical school day, children consumed 527 "empty calories" during a 24-hour period. Eating at home provided the highest mean amount of energy from low-nutrient, energy-dense foods (276 kcal vs 174 kcal at school and 78 kcal at other locations). NSLP participants consumed less energy from sugar-sweetened beverages at school than nonparticipants (11 kcal vs 39 kcal in elementary schools and 45 kcal vs 61 kcal in secondary schools, P<0.01), but more energy from low-nutrient, energy-dense solid foods such as french fries and higher-fat baked goods in secondary schools (157 kcal vs 127 kcal, P<0.01). Participants were not more likely to consume sugar-sweetened beverages or low-nutrient, energy-dense foods at home or other locations. School lunch participants' consumption at school was less energy-dense than nonparticipants' consumption at school (P<0.01). Energy density was highest for consumption at locations away from home and school.

CONCLUSIONS

Improving home eating behaviors, where the largest proportion of total daily and energy from low-nutrient, energy-dense foods are consumed (especially from sugar-sweetened beverages, chips, and baked goods) is warranted. At schools, consumption of energy from low-nutrient, energy-dense foods may be reduced by limiting access to competitive foods and beverages, enforcing strong school wellness policies, and minimizing the frequency of offering french fries and similar potato products and higher-fat baked goods in school meals or à la carte.

Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial

OBJECTIVE

The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school.

METHODS

The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007).

RESULTS

Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean +/- SD: 8.3 +/- 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent.

CONCLUSION

Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.

Effects of food form and timing of ingestion on appetite and energy intake in lean young adults and in young adults with obesity

OBJECTIVE

Overweight and obesity have been attributed to increased eating frequency and the size of eating events. This study explored the influence of the timing of eating events and food form on appetite and daily energy intake.

DESIGN

Crossover, clinical intervention where participants consumed 300-kcal loads of a solid (apple), semisolid (apple sauce), and beverage (apple juice) at a meal or 2 hours later (snack).

SUBJECTS

Twenty normal-weight (body mass index 22.6+/-1.8) and 20 obese (body mass index 32.3+/-1.5) adults. There were 10 men and 10 women within each body mass index group.

MEASUREMENTS

On six occasions, participants reported to the laboratory at their customary midday mealtime. Appetite questionnaires and motor skills tests were completed upon arrival and at 30-minute intervals for the 2 hours participants were in the laboratory and at 30-minute intervals for 4 hours after leaving the laboratory. Diet recalls were collected the next day. Data were collected between January 2006 and March 2007.

RESULTS

Whether consumed with a meal or alone as a snack, the beverage elicited the weakest appetitive response, the solid food form elicited the strongest appetitive response and the semisolid response was intermediate. The appetite shift was greatest for the solid food when consumed as a snack. The interval between test food consumption and the first spontaneous eating event >100 kcal was shortest for the beverage. No significant treatment effects were observed for test day energy intake or between lean individuals and individuals with obesity.

CONCLUSIONS

Based on the appetitive findings, consumption of an energy-yielding beverage either with a meal or as a snack poses a greater risk for promoting positive energy than macronutrient-matched semisolid or solid foods consumed at these times.

Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions

Sugar-sweetened soft drinks (SSD) are a special target of many obesity-prevention strategies, yet critical reviews tend to be more cautious regarding the aetiological role of SSD in promoting excess body weight. Since ongoing evaluation of this issue is important, the present systematic review re-examined the evidence from epidemiological studies and interventions, up to July 2008. Database searches of Medline, Cochrane reviews, Google scholar and a hand search of cross-references identified forty-four original studies (twenty-three cross-sectional, seventeen prospective and four intervention) in adults and children, as well as six reviews. These were critically examined for methodology, results and interpretation. Approximately half the cross-sectional and prospective studies found a statistically significant association between SSD consumption and BMI, weight, adiposity or weight gain in at least one subgroup. The totality of evidence is dominated by American studies where SSD consumption tends to be higher and formulations different. Most studies suggest that the effect of SSD is small except in susceptible individuals or at high levels of intake. Methodological weaknesses mean that many studies cannot detect whether soft drinks or other aspects of diet and lifestyle have contributed to excess body weight. Progress in reaching a definitive conclusion on the role of SSD in obesity is hampered by the paucity of good-quality interventions which reliably monitor diet and lifestyle and adequately report effect sizes. Of the three long-term (>6 months) interventions, one reported a decrease in obesity prevalence but no change in mean BMI and two found a significant impact only among children already overweight at baseline. Of the six reviews, two concluded that the evidence was strong, one that an association was probable, while three described it as inconclusive, equivocal or near zero. Reasons for some discrepancies are presented.

On the role and fate of sugars in human nutrition and health. Introduction

The recently implemented European Regulation (EC) No. 1924/2006 on nutrition and health claims made on foods is fuelling scientific research efforts in the food and health arena. Essentially, it is now established that only claims that are scientifically substantiated will be allowed. Because this new legislation covers the idea that foods with health or nutritional claims might be perceived by consumers as having a health advantage over products without claims, it introduces a further requirement (enclosing the new concept of 'nutrient profile') to avoid a situation where claims could mislead consumers when trying to make healthy choices in the context of a balanced diet. Thus, only those foods having an appropriate nutrition profile (composition of different nutrients such as sugars and other substances with particularly relevant nutritional or physiological effects) will be allowed to bear claims. A scientific expert workshop was organized to critically review the available evidence behind current intake recommendations for sugars, focusing on the strength/gaps of the scientific evidence available and the identification of those fields where further research is needed. Work was distributed in the following topics covering potential effects of dietary sugars on (i) body weight control; (ii) diabetes-insulin resistance; (iii) dental health and (iv) micronutrient dilution. New approaches, including intervention studies and the application of nutrigenomic technologies, should be undertaken and interpreted bearing in mind that foods, food components and their combinations can have both positive and negative effects on health, thus requiring benefit-risk analysis.

Changes in food and nutrient intake of 6- to 17-year-old Germans between the 1980s and 2006

OBJECTIVE

To compare the food consumption and nutrient intakes of German children and adolescents in the 1980s with present dietary habits.

DESIGN

Two cross-sectional representative surveys, the German National Food Consumption Study (Nationale Verzehrsstudie, NVS) from 1985-8 and the nutrition module 'EsKiMo' of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2006, were analysed for differences in food and nutrient intakes stratified by age and sex groups.

SETTING

Secondary analyses of data from representative observational studies.

SUBJECTS

Children and adolescents aged 6-17 years living in Germany in the 1980s (n 2265) and in 2006 (n 2506).

RESULTS

Food consumption was characterised by higher amounts of vegetables/pulses, fruits/nuts and beverages and less meat products/sausages, butter, fats/oils, potatoes/potato products and bread/pastries in 2006 than in 1985-8. The overall changes in food intake were reflected in improvements of macronutrient composition, increased water intake and lower energy density of the diet. Intake of most vitamins and minerals increased in relation to energy intake, but the nutrient density of the diet for vitamins B12 and D decreased. The most critical nutrients observed in NVS and EsKiMo were folate, vitamin D, vitamin A, vitamin E, Ca and Fe. In addition, dietary fibre intake was relatively low and fatty acid and carbohydrate compositions were not favourable.

CONCLUSIONS

Further efforts will be necessary to improve dietary habits among children and adolescents.

Global influences on milk purchasing in New Zealand--implications for health and inequalities

BACKGROUND

Economic changes and policy reforms, consistent with economic globalization, in New Zealand in the mid-1980s, combined with the recent global demand for dairy products, particularly from countries undergoing a 'nutrition transition', have created an environment where a proportion of the New Zealand population is now experiencing financial difficulty purchasing milk. This situation has the potential to adversely affect health.

DISCUSSION

Similar to other developed nations, widening income disparities and health inequalities have resulted from economic globalization in New Zealand; with regard to nutrition, a proportion of the population now faces food poverty. Further, rates of overweight/obesity and chronic diseases have increased in recent decades, primarily affecting indigenous people and lower socio-economic groups. Economic globalization in New Zealand has changed the domestic milk supply with regard to the consumer and may shed light on the link between globalization, nutrition and health outcomes. This paper describes the economic changes in New Zealand, specifically in the dairy market and discusses how these changes have the potential to create inequalities and adverse health outcomes. The implications for the success of current policy addressing chronic health outcomes is discussed, alternative policy options such as subsidies, price controls or alteration of taxation of recommended foods relative to 'unhealthy' foods are presented and the need for further research is considered.

SUMMARY

Changes in economic ideology in New Zealand have altered the focus of policy development, from social to commercial. To achieve equity in health and improve access to social determinants of health, such as healthy nutrition, policy-makers must give consideration to health outcomes when developing and implementing economic policy, both national and global.

Intake of calorically sweetened beverages and obesity

The prevalence of obesity has increased in the past 30 years, and at the same time a steep increase in consumption of soft drinks has been seen. This paper reviews the literature for studies on associations between intake of calorically sweetened beverages and obesity, relative to adjustment for energy intake. Conclusions from previous reviews have been inconsistent, but some included many cross-sectional studies or studies supported by sugar industry. A literature search was performed for prospective and experimental studies using Medline and Scirus. Fourteen prospective and five experimental studies were identified. The majority of the prospective studies found positive associations between intake of calorically sweetened beverages and obesity. Three experimental studies found positive effects of calorically sweetened beverages and subsequent changes in body fat. Two experimental studies did not find effects. Eight prospective studies adjusted for energy intake. Seven of these studies reported associations that were essentially similar before and after energy adjustment. In conclusion, a high intake of calorically sweetened beverages can be regarded as a determinant for obesity. However, there seems to be no support that the association between intake of calorically sweetened beverages and obesity is mediated via increased energy intake, and alternative biological explanations should be explored.

Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms

Nonnutritive sweeteners (NNS) are ecologically novel chemosensory signaling compounds that influence ingestive processes and behavior. Only about 15% of the US population aged >2 y ingest NNS, but the incidence is increasing. These sweeteners have the potential to moderate sugar and energy intakes while maintaining diet palatability, but their use has increased in concert with BMI in the population. This association may be coincidental or causal, and either mode of directionality is plausible. A critical review of the literature suggests that the addition of NNS to non-energy-yielding products may heighten appetite, but this is not observed under the more common condition in which NNS is ingested in conjunction with other energy sources. Substitution of NNS for a nutritive sweetener generally elicits incomplete energy compensation, but evidence of long-term efficacy for weight management is not available. The addition of NNS to diets poses no benefit for weight loss or reduced weight gain without energy restriction. There are long-standing and recent concerns that inclusion of NNS in the diet promotes energy intake and contributes to obesity. Most of the purported mechanisms by which this occurs are not supported by the available evidence, although some warrant further consideration. Resolution of this important issue will require long-term randomized controlled trials.

A comprehensive review on salt and health and current experience of worldwide salt reduction programmes

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure (BP), cholesterol and smoking, are the major risk factors. Among these, raised BP is the most important cause, accounting for 62% of strokes and 49% of coronary heart disease. Importantly, the risk is throughout the range of BP, starting at systolic 115 mm Hg. There is strong evidence that our current consumption of salt is the major factor increasing BP and thereby CVD. Furthermore, a high salt diet may have direct harmful effects independent of its effect on BP, for example, increasing the risk of stroke, left ventricular hypertrophy and renal disease. Increasing evidence also suggests that salt intake is related to obesity through soft drink consumption, associated with renal stones and osteoporosis and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake, for example, Japan (1960-1970), Finland (1975 onwards) and now the United Kingdom. The challenge is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.

Mapping solutions to obesity: lessons from the Human Genome Project

OBJECTIVE

To discuss appropriate endpoints for research designed to prevent obesity. Research investigating practical solutions to the complex multi-factorial global obesity epidemic may be stalled by undue emphasis on reduced body weight as the only acceptable endpoint.

APPROACH

Considering prevention research in cardiovascular disease and tobacco control, we contend that investigations of intermediate endpoints make an important contribution to the multi-faceted approach needed to combat the complex problem of obesity.

CONCLUSION

Intermediate endpoints are respected in other public health areas: reductions in risk factors such as high blood cholesterol or smoking are acceptable study endpoints for research aimed at reducing heart disease or lung cancer. Likewise, practical endpoints can be valuable in studies investigating interventions to reduce identified and potential intermediate risk factors for obesity, such as soft drink consumption.

IMPLICATIONS

Reduced obesity is the global aim but obesity is not caused by one exposure and will not be solved by a single modality intervention. A wider debate about endpoint selection may assist research which identifies individual building blocks of obesity prevention in the same way as individual gene mapping contributed to the Human Genome Project.

A public health approach to winning the war against cancer

The "war on cancer" in the United States has been viewed primarily as an effort to develop and disseminate cancer cures, but cancer is far more easily prevented than cured. There are three major approaches to cancer prevention: Primary prevention, through reduction in risk factors and changes to the environment that reduce human exposure to widely-consumed cancer-promoting agents. The most important actions for primary prevention of cancer are those that reduce tobacco use through taxation, smoke-free environment policies, advertising restrictions, counter-advertising, and cessation programs. The World Health Organization's MPOWER package outlines these actions, each of which covered less than 5% of people in the world in 2007. Similarly, cancer can be prevented by reducing alcohol consumption through policies such as alcohol taxes and limits on alcohol sales, and restoring caloric balance through policies such as creating healthier food environments and engineering the built environment to increase opportunities for physical activity. Vaccination is an effective approach to preventing specific virus-associated cancers, such as using human papillomavirus vaccine to prevent cervical cancer and hepatitis B virus vaccine to prevent hepatocellular cancer. Secondary prevention reduces cancer mortality through screening and early treatment; this approach has been used successfully for breast and cervical cancer but is still underused against colon cancer. Progress can be made in all three approaches to cancer prevention, but will require a greater emphasis on public health programs and public policy. Winning the war on cancer will require a much larger investment in prevention to complement efforts to improve treatment.

Consumption of sugar-sweetened beverages and its association with nutrient intakes and diet quality in German children and adolescents

In the present study the relationship of sugar-sweetened beverage (SSB) consumption with the intake of single nutrients and total diet quality in German children and adolescents was evaluated using a repeated-measures regression analysis model. We used dietary data from 7145 three-day weighed records of 1069 subjects aged 2-19 years participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Intake of macronutrients as percentage of total energy intake (%En), intake of micronutrients as percentage of German reference values (intake quality score) and nutritional quality index (NQI) as an indicator of diet quality were chosen as separate dependent variables. SSB consumption was positively associated with %En from carbohydrates (boys v. girls: +4.00 v. +4.09 En%/MJ from SSB) and added sugars (boys v. girls: +7.36 v. +9.52 En%/MJ from SSB) and negatively with %En from protein (boys v. girls: - 1.25 v. - 1.31 En%/MJ from SSB) and fat (boys: - 2.82 v. - 2.73 En%/MJ from SSB). With respect to micronutrients, SSB consumption was negatively associated with folate and Ca intake, for which mean intake levels were inadequate in girls. Absolute diet quality was negatively associated with SSB consumption, whereas the effect was larger for girls (boys v. girls: - 1.41 v. - 2.63 points of NQI/MJ from SSB). Overall, results show a diluting effect of SSB consumption on micronutrient intake and diet quality. This effect might be relevant especially in girls as the association with diet quality was larger and mean NQI levels were lower in comparison with boys.

Soft drinks and 'desire to drink' in preschoolers

Interest in soft drink consumption has increased following a dramatic rise in intake over recent years. Research to date has focused primarily on general trends in consumption or on understanding the mechanism by which soft drink consumption may be linked to weight gain. It is clear however that there is considerable individual variability in the extent to which soft drinks are consumed and factors potentially influencing intake have received little attention. This study examines how the Child Eating Behaviour Questionnaire (CEBQ) construct 'Desire to Drink' (DD) relates to drink consumption, preferences and BMI-SDS.Three hundred and forty six same-sex twin children (mean age 11.2 years; s.d. 0.54; 56% female; 53% dizygotic) were weighed, measured and reported their liking for milk, water, fruit juice, fruit squash and sweetened soft drinks. Mothers reported on their child's drink consumption and completed the CEBQ.Scores on the CEBQ DD subscale were not significantly related to child BMI-SDS in this sample. Children scoring higher on DD had higher preferences for sugar-sweetened soft drinks (p = 0.016), fruit squash (p = 0.042) and milk (p = 0.020) than children scoring lower on the scale. DD was also positively related to more frequent consumption of sugar-sweetened soft drinks (p = 0.017) and low calorie soft drinks (p = 0.003). No relationship was observed between DD scores and liking for or intake of water or 100% fruit juice.These findings suggest that the construct desire to drink in children is related to a liking for consuming sweetened drinks, and does not appear to simply denote greater thirst or hunger. This may have important implications for the ongoing development of dietary patterns and weight status in the longer term through an increased preference for sweet things in the mouth and a failure to compensate for calories provided by drinks.

Energy intake from beverages is increasing among Mexican adolescents and adults

Little is understood about the patterns and trends in adolescent and adult beverage intake in Mexico or most other countries. Here, we used nationally representative dietary intake, income, and food expenditure surveys, which included 416 adolescents (aged 12-18 y) and 2180 adults (aged >or=19 y) from the 1999 Mexican Nutrition Survey and 7464 adolescents and 21,113 adults from the 2006 Mexican Health and Nutrition Survey. We measured the volume and energy per day contributed by all beverages consumed by the sample subjects. In 2006, Mexican adolescents and adults obtained 20.1 and 22.3%, respectively, of their energy intake from energy-containing beverages. Whole milk, carbonated and noncarbonated sugar-sweetened beverages, fruit juice with various sugar and water combinations added, and alcohol represented the 4 major categories of beverage intake. The trends from the dietary intake surveys showed very large increases in the intake of energy-containing beverages among adolescents and adults between 1999 and 2006. Income elasticities showed a high likelihood that intakes will increase as Mexican incomes continue to rise. Whereas the own-price elasticities for whole milk and sodas were both modest, intakes of these were increasing and higher than those for all other food groups. Energy intake trends and current levels of beverage intakes in Mexico are the highest recorded in a nationally representative survey and present major challenges for public health authorities.

Association between long-term consumption of soft drinks and variables of bone modeling and remodeling in a sample of healthy German children and adolescents

BACKGROUND

Soft drinks are thought to displace milk in diets of children and adolescents and therefore might affect variables of bone modeling and remodeling.

OBJECTIVE

We assessed the association between long-term consumption of several types of soft drinks and bone variables in children and adolescents.

DESIGN

Long-term dietary data from 3-d weighed dietary records collected by 228 healthy children and adolescents enrolled in the DONALD Study in 4 y of study participation were used for data analysis. Variables of bone modeling and remodeling of the radius were assessed by using peripheral quantitative computed tomography.

RESULTS

After adjustment for age, sex, total energy intake, muscle area, BMI SD scores, and growth velocity, long-term consumption of all soft drinks and uncaffeinated soft drinks was negatively associated with bone mineral content (P < 0.05), cortical area (P < 0.05), and polar strength strain index (P < 0.05), all of which reflect a combination of bone modeling and remodeling. Long-term consumption of caffeinated soft drinks was negatively associated with polar strength strain index (P < 0.01) and periosteal circumference (P < 0.05), which reflect bone modeling. Milk intake was positively associated with polar strength strain index (P < 0.05). Consumption of all soft drinks was negatively associated with total protein and milk intake, but was not associated with potential renal acid load.

CONCLUSIONS

Long-term consumption of caffeinated and uncaffeinated soft drinks appears to have bone catabolic effects in boys and girls. This effect is mainly mediated by the negative association with total protein intake and is not primarily based on milk displacement.

High-fructose corn syrup: is this what's for dinner?

BACKGROUND

Research on trends in consumption of added sugar and high-fructose corn syrup (HFCS) in the United States has largely focused on calorically sweetened beverages and ignored other sources.

OBJECTIVE

We aimed to examine US consumption of added sugar and HFCS to determine long-term trends in availability and intake from beverages and foods.

DESIGN

We used 2 estimation techniques and data from the Nationwide Food Consumption Surveys (1965 and 1977), Continuing Survey of Food Intake by Individuals (1989-1991), and the National Health and Nutrition Examination Surveys (1999-2000, 2001-2002, and 2003-2004) to examine trends in HFCS and added sugar both overall and within certain food and beverage groups.

RESULTS

Availability and consumption of HFCS and added sugar increased over time until a slight decline between 2000 and 2004. By 2004, HFCS provided roughly 8% of total energy intake compared with total added sugar of 377 kcal x person(-1) x d(-1), accounting for 17% of total energy intake. Although food and beverage trends were similar, soft drinks and fruit drinks provided the most HFCS (158 and 40 kcal x person(-1) x d(-1) in 2004, respectively). Moreover, among the top 20% of individuals, 896 kcal x person(-1) x d(-1) of added sugar was consumed compared with 505 kcal x person(-1) x d(-1) of HFCS. Among consumers, sweetened tea and desserts also represented major contributors of calories from added sugar (>100 kcal x person(-1) x d(-1)).

CONCLUSION

Although increased intake of calories from HFCS is important to examine, the health effect of overall trends in added caloric sweeteners should not be overlooked.

Antagonism of glutamatergic NMDA and mGluR5 receptors decreases consumption of food in baboon model of binge-eating disorder

Excessive consumption of highly palatable foods may contribute to the development of weight gain. Therefore medications that selectively suppress eating of such foods would be useful in clinical practice. We compared the effects of the glutamatergic antagonists memantine and MTEP to dexfenfluramine in baboons given periodic access to highly palatable food and ad libitum access to a standard chow diet. Three days a week baboons received a sugar-coated candy during the first meal and standard standard-diet chow pellets were available in subsequent meals. All baboons derived a greater amount of energy from the single single-candy meal than from the standard diet across an entire day. Pre-treatment with dexfenfluramine, memantine, and MTEP produced decreases in candy consumption without altering candy-seeking behaviour. At the same time, dexfenfluramine and memantine, but not MTEP, produced a decrease in seeking and consumption of standard chow pellets. Both memantine and MTEP are promising agents for the treatment of obesity.

Consumption of 'extra' foods by Australian adults: types, quantities and contribution to energy and nutrient intakes

OBJECTIVES

To identify the types and quantities of 'extra' foods, or energy-dense, nutrient-poor foods, consumed by Australian adults, and assess their contribution to total energy and nutrient intakes.

SUBJECT/METHODS

We used 24-h recall data from 10 851 adults, aged 19 years and over, who participated in the nationally representative 1995 National Nutrition Survey. 'Extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating and by applying cut points for maximum amounts of fat and sugar within each food category.

RESULTS

'Extra' foods contributed to 36% of daily energy intake with the highest contributors being fried potatoes (2.8%), margarine (2.6%), cakes and muffins (2.5%), beer (2.4%), sugar-sweetened soft drinks (2.4%), and meat pies (2.2%). Both age and sex were important determinants of 'extra' foods intake; younger adults were more likely to consume sugar-sweetened soft drinks, fried potatoes, meat pies and savoury pastries, pizza, crisps, lollies and chocolate; whereas older adults were more likely to consume sweet and savoury biscuits, cakes and muffins, margarine and butter. In all age groups, 'extra' foods contributed more to energy intake for men than women. Overall, 'extra' foods contributed 16% protein, 41% total fat, 41% saturated fat, 47% sugar and approximately 20% of selected micronutrients to the diet.

CONCLUSIONS

'Extra' foods contribute excessively to the energy, fat and sugar intakes of Australian adults, while providing relatively few micronutrients. This is of concern for the increasing risk of overweight and chronic disease and poor micronutrient status.

The effect of soft drink availability in elementary schools on consumption

OBJECTIVE

To quantify the association among soft drink availability, school-based purchases, and overall consumption for elementary school children in the United States.

DESIGN

The study is a cross-sectional, descriptive analysis of children in fifth grade across the United States. Measures of soft drink availability, purchases, and consumption are reported by the child in direct assessments by interviewers.

SUBJECTS/SETTING

Subjects in the analysis are from the Early Childhood Longitudinal Survey-Kindergarten Cohort. The baseline sample from this survey is nationally representative of kindergarten students in the 1998-1999 school year. The analytic sample obtained from the sixth wave includes 10,215 children in fifth grade in 2,303 schools across 40 states.

MAIN OUTCOME MEASURES

Consumption of any soft drink in the past week, purchase of any soft drink at school in the past week, overall consumption of soft drinks in the past week, overall purchases of soft drinks at school in the past week, and share of all consumption that was school-based.

STATISTICAL ANALYSES PERFORMED

chi(2) square tests and t tests were conducted to determine significant differences across sociodemographic groups. Multivariate logistic regressions were conducted to estimate the effect of availability on the odds of any soft drink consumption and overall consumption level.

RESULTS

In this study, 26% of children who have access to soft drinks at school consume them. Those who consume more soft drinks at school, such as low-income and black non-Hispanic children, are more likely to consume more soft drinks overall. Controlling for covariates, limiting availability of soft drinks at school is associated with a 4% decrease (odds ratio 1.38) in the rate of any consumption overall.

CONCLUSIONS

These findings suggest that soft drink availability at school may have limited impact on overall consumption for elementary school children. Further research about predictors of consumption, how children respond to reduced availability, as well as food environments at home and at school, may identify next steps toward improving the diets of children.

Soft drink consumption linked with fatty liver in the absence of traditional risk factors

BACKGROUND

Little is known about dietary habits and their relationships with liver disease in nonalcoholic fatty liver disease (NAFLD) patients, particularly in the absence of obesity, diabetes or hyperlipidemia.

OBJECTIVE

To assess the association between soft drink consumption and the presence of fatty liver in NAFLD patients who do not have classic risk factors.

METHODS

Three hundred ten patients with NAFLD diagnosed by ultrasound were assessed for 36 months in a cross-sectional manner. Thirty-one patients (10%) who had NAFLD without classic risk factors were compared with 30 healthy controls. Physical activity was assessed during the preceding week and year, and every six months for 36 months. Data on daily dietary intake of food and soft drink, and the source of added sugar were collected during two seven-day periods, at the beginning of the study, and within two weeks after the metabolic tests by using a validated food questionnaire given by a trained dietician. Insulin resistance and lipid peroxidation were assessed by homeostasis model assessment-insulin resistance index (HOMA-IRI) and malondialdehyde (MDA) levels, respectively.

RESULTS

Eighty per cent of patients (25 of 31) consumed an excessive amount of soft drink beverages (more than 50 g/day of added sugar) for 36 months, compared with 20% in healthy controls (P<0.001). Twenty per cent of patients consumed one drink per day, 40% consumed two to three drinks per day, and 40% consumed more than four drinks per day for most days during 36 months. The most common soft drinks consumed were regular Coca-Cola (40% of patients), Diet Coke (40%) and flavoured fruit juices (20%). Ultrasound findings revealed mild fatty liver in 44% of cases (n=14), moderate fatty liver in 38% (n=12), and severe fatty liver in 18% (n=5). HOMA-IRI and MDA levels were significantly higher in patients with NAFLD than in healthy controls (HOMA-IRI, 3.7 versus 1.7, P<0.001; and MDA, 420+/-300 micromol/mL versus 200+/-100 micromol/mL; P<0.001). When controlled for other factors, including dietary composition and physical activity, soft drink beverage consumption was the only independent variable that was able to predict the presence of fatty liver in 82.5% of cases with a sensitivity of 100%, a specificity of 76%, a positive predictive value of 57% and a negative predictive value of 100%.

CONCLUSION

The present study may add important insight into the role of sugar-sweetened beverage consumption as a cause of fatty liver in patients without risk factors. Patients are encouraged to change their long-standing drinking behaviour.

Relation of dietary glycemic index, glycemic load, added sugar intake, or fiber intake to the development of body composition between ages 2 and 7 y

BACKGROUND

Observational studies in adults suggest that a diet with a high glycemic index (GI) or glycemic load (GL), a high intake of sugary foods, or a low fiber intake may increase the risk of overweight.

OBJECTIVES

We aimed to examine prospectively whether dietary GI, GL, added sugar intake, or fiber intake between age 2 and 7 y are associated with the development of body composition. If so, we aimed to ascertain whether these associations are modified by meal frequency.

DESIGN

Linear mixed-effect regression analyses were performed in 380 participants of the DOrtmund Nutrition and Anthropometric Longitudinally Designed (DONALD) Study for whom 4-6 weighed 3-d dietary records and anthropometric data were obtained between ages 2 and 7 y.

RESULTS

Changes in dietary GI, GL, or added sugar intake between ages 2 and 7 y were not associated with concurrent changes in percentage body fat (%BF, as estimated from skinfold thicknesses) or body mass index SD scores. An increase in fiber intake was related to a concurrent decrease in %BF between ages 2 and 7 y only in children who consumed <6 meals/d as toddlers (beta +/- SE from fully adjusted model: -0.26 +/- 0.09%BF per 1-SD increase in fiber intake, P = 0.005), whereas children with a higher meal frequency had no concurrent change (0.07 +/- 0.07%BF per 1-SD increase in fiber intake, P = 0.3).

CONCLUSIONS

Dietary GI, GL, or added sugar intake between ages 2 and 7 y does not appear to influence the development of body composition. Potential benefits associated with increasing fiber intake throughout childhood may be limited to toddlers with a lower meal frequency.

Industry funding and the reporting quality of large long-term weight loss trials

BACKGROUND

Quality of reporting (QR) in industry-funded research is a concern of the scientific community. Greater scrutiny of industry-sponsored research reporting has been suggested, although differences in QR by sponsorship type have not been evaluated in weight loss interventions.

OBJECTIVE

To evaluate the association of funding source and QR of long-term obesity randomized clinical trials (RCT).

METHODS

We analysed papers that reported long-term weight loss trials. Articles were obtained through searches of Medline, HealthStar, and the Cochrane Controlled Trials Register between the years 1966 and 2003. QR scores were determined for each study based upon expanded criteria from the Consolidated Standards for Reporting Trials (CONSORT) checklist for a maximum score of 44 points. Studies were coded by category of industry support (0=no industry support, 1=industry support, 2=in kind contribution from industry and 3=duality of interest reported). Individual CONSORT reporting criteria were tabulated by funding type. An independent samples t-test compared the differences in QR scores by funding source and the Wilcox-Mann-Whitney test and generalised estimating equations (GEE) were used for sensitivity analyses.

RESULTS

Of the 63 RCTs evaluated, 67% were industry-supported trials. Industry funding was associated with higher QR score in long-term weight loss trials compared with nonindustry-funded studies (mean QR (s.d.): industry=27.9 (4.1), nonindustry=23.4 (4.1); P<0.0005). The Wilcox-Mann-Whitney test confirmed this result (P<0.0005). Controlling for the year of publication and whether the paper was published before the CONSORT statement was released in the GEE regression analysis, the direction and magnitude of effect were similar and statistically significant (P=0.035). Of the individual criteria that prior research has associated with biases, industry funding was associated with greater reporting of intent-to-treat analysis (P=0.0158), but was not different from nonindustry studies in reporting of treatment allocation and blinding.

CONCLUSION

Our findings suggest that the efforts to improve reporting quality be directed to all obesity RCTs, irrespective of funding source.

Human glycemic response and phenolic content of unsweetened cranberry juice

This cross-sectional study determined the phenolic composition of an over-the-counter cranberry juice (CBJ) with high-performance liquid chromatography and examined the effects of low- and normal-calorie CBJ formulations on the postprandial glycemic response in healthy humans. The CBJ used in this study contained seven phenolic acids, with 3- and 5-caffeoylquinic acid being the primary components, and 15 flavonol glycosides, with myricetin-3-galactoside and quercetin-3-galactoside being the most prevalent. CBJ proanthocyanidins consisted of three different tetramers and a heptamer, which were confirmed with matrix-assisted laser desorption ionization-time of flight-mass spectrometry analysis. Participants received one of the following six treatments: nothing (no water/beverage), water (480 mL), unsweetened low-calorie CBJ (38 Cal/480 mL), normal-calorie CBJ (280 Cal/480 mL), isocaloric normal calorie (high fructose corn syrup [HFCS]), or isocaloric low-calorie beverages. No significant differences in postprandial blood glucose or insulin were observed in the groups receiving nothing, water, or low-calorie treatments. In contrast, the ingestion of normal-calorie CBJ and normal-calorie control beverage resulted in significantly higher blood glucose concentrations 30 minutes postprandially, although the differences were no longer significant after 180 minutes. Plasma insulin of normal-calorie CBJ and control (HFCS) recipients was significantly higher 60 minutes postprandially, but not significantly different 120 minutes postprandially. CBJ ingestion did not affect heart rate or blood pressure. This study suggests that the consumption of a low-calorie CBJ rich in previously uncharacterized trimer and heptamer proanthocyanidins is associated with a favorable glycemic response and may be beneficial for persons with impaired glucose tolerance.

Sugar-added beverages consumption among kindergarten children of Crete: effects on nutritional status and risk of obesity

Objective

To assess the intake of sugar-added beverages such as soft drinks and commercially available fruit juices in kindergarten children, and to examine its association with obesity indices, physical activity levels and dietary habits.

Methods

A total of 856 children aged 4–7 years living in Crete, Greece in 2004–5 were included in this cross-sectional study. Nutrient and food intake was assessed with the use of 3-day weighed food records. Body measurements were used in order to assess BMI and waist circumference, and moderate-to-vigorous physical activity was calculated with the use of a questionnaire.

Results

Approximately 59.8% of all children consumed sugar-added beverages on a daily basis. High intake of sugar-added beverages (> 250 g/day) was associated with low intakes of calcium (p < 0.001), vitamin A and E (p < 0.010), fruits and vegetables (p = 0.007), and milk and yogurt (p = 0.048). Compared to non or low consumers, high consumers of sugar-added beverages (> 250 g/day) had higher BMI levels and two times greater risk of being overweight and/or obese (OR:2.35, p = 0.023).

Conclusion

High intake of sugar-added beverages in kindergarten children is associated with poor eating habits and inadequate nutrient intake, as well as increased risk for developing childhood obesity.

Meals and snacks from the child's perspective: the contribution of qualitative methods to the development of dietary interventions

OBJECTIVE

To explore the everyday consumption of meals and snacks from the child's perspective, among those with healthier v. less healthy dietary habits.

DESIGN

The sample in this qualitative study comprised two groups of Danish schoolchildren aged 10 to 11 years, one with a healthier diet (n 9) and the other with a less healthy diet (n 8). Both groups were recruited from respondents to a dietary survey. Semi-structured interviews took their starting point in photographs of their meals and snacks taken by the children themselves.

RESULTS

Both subgroups of children had a meal pattern with three main meals and two to four snacks. We found a connection between the nutritional quality of the diet and the social contexts of consumption, especially with regard to snacks. Among children with healthier eating habits, both snacks and meals tended to be shared social events and items of poor nutritional quality functioned as markers of a special social occasion. This was not the case among children with less healthy eating habits. All children described particular rules governing food consumption within their families. Although only some of them had participated in the development of these rules, and despite the fact that rules were different and were perceived as having been developed for different reasons, children from both subgroups tended to accept them.

CONCLUSIONS

The results of the study suggest that dietary interventions designed to promote children's health should focus more on the different social contexts of consumption and more on the role of parents.

Fructose consumption as a risk factor for non-alcoholic fatty liver disease

BACKGROUND/AIMS

While the rise in non-alcoholic fatty liver disease (NAFLD) parallels the increase in obesity and diabetes, a significant increase in dietary fructose consumption in industrialized countries has also occurred. The increased consumption of high fructose corn syrup, primarily in the form of soft drinks, is linked with complications of the insulin resistance syndrome. Furthermore, the hepatic metabolism of fructose favors de novo lipogenesis and ATP depletion. We hypothesize that increased fructose consumption contributes to the development of NAFLD.

METHODS

A dietary history and paired serum and liver tissue were obtained from patients with evidence of biopsy-proven NAFLD (n=49) without cirrhosis and controls (n=24) matched for gender, age (+/-5 years), and body mass index (+/-3 points).

RESULTS

Consumption of fructose in patients with NAFLD was nearly 2- to 3-fold higher than controls [365 kcal vs 170 kcal (p<0.05)]. In patients with NAFLD (n=6), hepatic mRNA expression of fructokinase (KHK), an important enzyme for fructose metabolism, and fatty acid synthase, an important enzyme for lipogenesis were increased (p=0.04 and p=0.02, respectively). In an AML hepatocyte cell line, fructose resulted in dose-dependent increase in KHK protein and activity.

CONCLUSIONS

The pathogenic mechanism underlying the development of NAFLD may be associated with excessive dietary fructose consumption.

Fructose consumption as a risk factor for non-alcoholic fatty liver disease

BACKGROUND/AIMS

While the rise in non-alcoholic fatty liver disease (NAFLD) parallels the increase in obesity and diabetes, a significant increase in dietary fructose consumption in industrialized countries has also occurred. The increased consumption of high fructose corn syrup, primarily in the form of soft drinks, is linked with complications of the insulin resistance syndrome. Furthermore, the hepatic metabolism of fructose favors de novo lipogenesis and ATP depletion. We hypothesize that increased fructose consumption contributes to the development of NAFLD.

METHODS

A dietary history and paired serum and liver tissue were obtained from patients with evidence of biopsy-proven NAFLD (n=49) without cirrhosis and controls (n=24) matched for gender, age (+/-5 years), and body mass index (+/-3 points).

RESULTS

Consumption of fructose in patients with NAFLD was nearly 2- to 3-fold higher than controls [365 kcal vs 170 kcal (p<0.05)]. In patients with NAFLD (n=6), hepatic mRNA expression of fructokinase (KHK), an important enzyme for fructose metabolism, and fatty acid synthase, an important enzyme for lipogenesis were increased (p=0.04 and p=0.02, respectively). In an AML hepatocyte cell line, fructose resulted in dose-dependent increase in KHK protein and activity.

CONCLUSIONS

The pathogenic mechanism underlying the development of NAFLD may be associated with excessive dietary fructose consumption.

Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis

BACKGROUND

Rates of overweight and obesity have increased. Consumption of sugar-sweetened beverages (SBs) may play a role.

OBJECTIVE

The purpose of this meta-analysis was to determine whether the results of original research with the use of longitudinal and randomized controlled trials (RCTs) support the hypothesis that SB consumption is associated with weight gain among children and adolescents.

DESIGN

The MEDLINE database was used to retrieve all original studies of SBs and weight gain involving children and adolescents. Twelve (10 longitudinal and 2 RCT) studies were reviewed. Eight of the longitudinal studies and both RCT studies were incorporated into a quantitative meta-analysis. Forest plots and overall estimates and CIs for the association of the difference (Delta) in SB consumption with Deltabody mass index (BMI; in kg/m(2)) were produced. Funnel plots were examined as a diagnostic test for publication bias. Databases of unpublished scientific studies were searched. Sensitivity tests were conducted to examine the robustness of the meta-analysis results.

RESULTS

The overall estimate of the association was a 0.004 (95% CI: -0.006, 0.014) change in BMI during the time period defined by the study for each serving per day change in SB consumption with the fixed-effects model and 0.017 (95% CI: -0.009, 0.044) with the random-effects model. The funnel plot is consistent with publication bias against studies that do not report statistically significant findings. The sensitivity tests suggest that the results are robust to alternative assumptions and new studies.

CONCLUSION

The quantitative meta-analysis and qualitative review found that the association between SB consumption and BMI was near zero, based on the current body of scientific evidence.

Effect of snacking frequency on adolescents' dietary intakes and meeting national recommendations

PURPOSE

To determine how snacking level impacts intake of nutrients and food groups and assists in meeting recommendations outlined in the U.S. Department of Agriculture's MyPyramid Food Guidance System.

METHODS

Dietary data based on 24-hour recall from 4357 adolescents 12-19 years of age participating in the National Health and Nutrition Examination Survey 2001-2004 (NHANES) were analyzed. Regression analyses were applied to examine the effect of snacking on nutrient and food group intake and to determine its effect on the likelihood of meeting MyPyramid recommendations.

RESULTS

Food energy, carbohydrate, total sugars, and vitamin C intake were positively associated, whereas protein and fat intake were negatively associated, with snacking frequency. Fruit intake increased, whereas solid fat intake decreased, as snacking incidence rose. Increasing snacking frequency was also associated with a greater likelihood of meeting milk and oil recommendations for boys and meeting fruit recommendations for both genders. Non-Hispanic black adolescents were less likely to meet their milk recommendations at low and high snacking levels and more likely to meet their fruit recommendations at high levels only. Foods consumed as snacks provided 12-39% of the day's total number of portions of the five MyPyramid food groups, 35% of total discretionary calorie intake, and 43% of total added sugar intake.

CONCLUSIONS

Snacking frequency affects intake of macronutrients and a few micronutrients and promotes consumption of fruits. Top food choices for snacks provide an excess of discretionary calories in the form of added sugars and fats. Modification of these choices would assist adolescents in consuming diets more consistent with national recommendations.

Association between dietary and beverage consumption patterns in the SUN (Seguimiento Universidad de Navarra) cohort study

OBJECTIVE

The objective of the present study was to determine the dietary patterns of a Mediterranean cohort and relate them to the observed patterns of beverage consumption.

DESIGN

Prospective cohort study. Dietary habits were assessed with a semi-quantitative FFQ validated in Spain. A principal components factor analysis was used to identify dietary patterns and to classify subjects according to their adherence to these patterns. The association between adherence to each dietary pattern and beverage consumption was assessed cross-sectionally. In a longitudinal analysis (2-year follow-up), the relationship between adherence to the baseline dietary patterns and the likelihood of changing alcohol consumption was ascertained.

SETTING

The SUN (Seguimiento Universidad de Navarra) study is conducted in Spain.

SUBJECTS

In total, 15 073 university graduates were included in the analyses.

RESULTS

Two major dietary patterns were identified. We labelled them as 'Western dietary pattern' (WDP) and 'Mediterranean dietary pattern' (MDP). Higher adherence to the WDP was associated with higher consumption of carbonated beverages and whole-fat milk (P for trend <0.001), while higher adherence to the MDP was associated with higher consumption of decaffeinated coffee, orange juice, other natural juices, diet carbonated drinks, low-fat milk and bottled water (P for trend <0.001). Participants with higher adherence to the WDP were less likely to decrease their alcohol consumption during follow-up (OR between extreme quintiles = 0.68; 95 % CI 0.56, 0.84). By contrast, participants with higher adherence to the MDP were less likely to increase their alcohol consumption (OR = 0.66, 95 % CI 0.46, 0.95).

CONCLUSION

In this cohort of university graduates, a healthier dietary pattern was associated with a healthier pattern of beverage consumption.

Relationship between taste-induced physiological reflexes and temperature of sweet taste

Excessive consumption of soft drinks has been argued as a key contributor to the epidemic of obesity in modern society. This is because they are characterized by high content of sugar, low satiety, and incomplete compensation for total energy. However, since obesity involves complex interactions of various factors, there must be more indices to link soft drink consumption and development of obesity. In this study, we have concentrated on the taste component of soft drinks and how they are consumed. We particularly investigated the temperature dependence of the indices associated with glucose metabolism such as cephalic phase insulin release and sympathetic nerve activity (SNA) of brown adipose tissue (BAT) to sweet solution since soft drinks are usually consumed in very cold temperature. Glucose solution incubated at room temperature (warm; 25 degrees C) or refrigerated to 4 degrees C (cold) was administered to the rats and significant rise in plasma insulin was observed at 3rd min in warm group while it was not increased until 15th min in cold group. The initial rise in plasma insulin did not coincide with a rise in blood glucose in warm group. Under the anesthesia, warm glucose solution significantly enhanced SNA of BAT while cold glucose solution exhibited no difference. The nerve response of chorda tympani also showed greater response to warm glucose solution than cold glucose solution. These results suggest that cold sweet taste stimulus does not accompany expected taste-induced physiological reflexes, possibly retarding organisms' energy expenditure system.

Preventing childhood obesity: two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS)

OBJECTIVE

To assess the long term effects of an obesity prevention programme in schools.

DESIGN

Longitudinal results after a cluster randomised controlled trial.

SETTING

Schools in southwest England.

PARTICIPANTS

Of the original sample of 644 children aged 7-11, 511 children were tracked and measurements were obtained from 434 children three years after baseline.

INTERVENTION

The intervention was conducted over one school year, with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks.

MAIN OUTCOME MEASURES

Anthropometric measures of height, weight, and waist circumference. Body mass index (BMI) converted to z scores (SD scores) and to centile values with growth reference curves. Waist circumference was also converted to z scores (SD scores).

RESULTS

At three years after baseline the age and sex specific BMI z scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but decreased in the intervention group by -0.01 (SD 0.58), with a mean difference of 0.10 (95% confidence interval -0.00 to 0.21, P=0.06). The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident. The BMI increased in the control group by 2.14 (SD 1.64) and the intervention group by 1.88 (SD 1.71), with mean difference of 0.26 (-0.07 to 0.58, P= 0.12). The waist circumference increased in both groups after three years with a mean difference of 0.09 (-0.06 to 0.26, P=0.25).

CONCLUSIONS

These longitudinal results show that after a simple year long intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years.

Soft drink availability, contracts, and revenues in American secondary schools

BACKGROUND

Soft drinks have been widely available in the nation's schools for some years, but recently, in response to rising concern about the epidemic of obesity among youth, concerns have been raised as to whether they should be available, and if so, under what circumstances. This paper looks at how widespread soft drink availability is at present in schools, as well as the availability of other classes of beverages. Because overweight occurs disproportionately among minorities and those of lower socioeconomic status (SES), this paper also seeks to determine to what extent environmental conditions differ for these students. Differences between middle and high schools are also examined.

METHODS

Data for 2004 and 2005 were used from two ongoing United States national surveys: the Youth, Education, and Society (YES) study of school administrators (N=345), and the Monitoring the Future (MTF) study of secondary school students in 8th, 10th, and 12th grades surveyed in those same schools (N=37,543). Data were gathered in YES on the availability of various beverages in schools from vending machines and other venues, as well as about the presence and nature of pouring rights contracts with soft drink bottlers. Data were analyzed in 2006.

RESULTS

The vast majority of high school students today have soft drinks available to them in the school environment both through vending machines (88%) and in the cafeteria at lunch (59%), with middle schools providing somewhat less access. Diet soft drinks are less available, particularly at lunch. Most students (67% in middle and 83% in high school) are in schools that have a contract with a bottler. Revenues to schools generated by soft drink sales are quite modest. Hispanics are most likely to have soft drinks available throughout the school day. The SES of the students correlates negatively with whether the school allows advertising and promotion of soft drinks.

CONCLUSIONS

Current school practices regarding soft drink availability, advertising, and sales would seem likely to be contributing to the extent of overweight among American young people, and to some extent to the higher risk faced by Hispanic and lower SES youth.

Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community

BACKGROUND

Consumption of soft drinks has been linked to obesity in children and adolescents, but it is unclear whether it increases metabolic risk in middle-aged individuals.

METHODS AND RESULTS

We related the incidence of metabolic syndrome and its components to soft drink consumption in participants in the Framingham Heart Study (6039 person-observations, 3470 in women; mean age 52.9 years) who were free of baseline metabolic syndrome. Metabolic syndrome was defined as the presence of > or = 3 of the following: waist circumference > or = 35 inches (women) or > or = 40 inches (men); fasting blood glucose > or = 100 mg/dL; serum triglycerides > or = 150 mg/dL; blood pressure > or = 135/85 mm Hg; and high-density lipoprotein cholesterol < 40 mg/dL (men) or < 50 mg/dL (women). Multivariable models included adjustments for age, sex, physical activity, smoking, dietary intake of saturated fat, trans fat, fiber, magnesium, total calories, and glycemic index. Cross-sectionally, individuals consuming > or = 1 soft drink per day had a higher prevalence of metabolic syndrome (odds ratio [OR], 1.48; 95% CI, 1.30 to 1.69) than those consuming < 1 drink per day. On follow-up (mean of 4 years), new-onset metabolic syndrome developed in 717 of 4033 participants (17.8%) consuming < 1 drink/day and in 433 of 2006 persons (21.6%) [corrected] consuming > or = 1 soft drink/day [corrected] Consumption of > or = 1 soft drink per day was associated with increased odds of developing metabolic syndrome (OR, 1.44; 95% CI, 1.20 to 1.74), obesity (OR, 1.31; 95% CI, 1.02 to 1.68), increased waist circumference (OR, 1.30; 95% CI, 1.09 to 1.56), impaired fasting glucose (OR, 1.25; 95% CI, 1.05 to 1.48), higher blood pressure (OR, 1.18; 95% CI, 0.96 to 1.44), hypertriglyceridemia (OR, 1.25; 95% CI, 1.04 to 1.51), and low high-density lipoprotein cholesterol (OR, 1.32; 95% CI 1.06 to 1.64).

CONCLUSIONS

In middle-aged adults, soft drink consumption is associated with a higher prevalence and incidence of multiple metabolic risk factors.