Sugar-Sweetened Beverages and Child Health: Implications for Policy

Tiered dietary exposure assessment of steviol glycosides in the Belgian population

The objective of the present study was to assess the dietary intake of steviol glycosides in the Belgian population and to conduct a risk assessment by comparing the estimated intakes to the acceptable daily intake (ADI). A tiered approach was adopted in this study. First, a Tier 2 assessment was performed using maximum permitted levels. Next, the calculations were refined because market share data were used (refined Tier 2). Finally, the actual concentration data of 198 samples purchased from the Belgian market were used for Tier 3 exposure assessment. Based on a Tier 2 assessment, the ADI was exceeded for the high-consumer children population. However, the results of a more refined exposure assessment (Tier 3) of high consumers (P95) within the child, adolescent and adult populations were 13·75, 10 and 6·25 % of the ADI, respectively, using mean analytical results. Even with more conservative refined approaches, the estimated daily intake remained below 20 % of ADI. Flavoured drinks, flavoured fermented milk products and jams, jellies, and marmalades were the top three contributing food groups to steviol intake at 26–49 %, 12–27 % and 5–13 %, respectively. Despite the high concentrations (up to 94 000 mg/kg) of steviol glycosides in tabletop sweeteners, their contribution to the total intake remains low. The impact of the use of food supplements on the total intake was also considered to be limited. It was concluded that there was no risk for the Belgian population related to dietary exposure to steviol glycoside.

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.

Total water intake and its contributors in infants and young children

Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5-35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children's water consumption.

Associations between adherence to the dietary approaches to stop hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES)

BACKGROUND AND AIMS

The DASH diet conveys protection against type 2 diabetes mellitus (T2D) Via plant-based and non-plant-based recommendations. Research has not identified which glucose homeostasis pathways are improved. We examined associations between adherence to a DASH diet and six glucose homeostasis traits, probing whether associations could be attributed to the plant-based (DASH-P) and/or non-plant based (DASH-NP) components.

METHODS AND RESULTS

We included data from 295 adults without T2D (age 59.3 ± 9.00 years; 63.46% non-Hispanic White and 36.54% African American, self-reported race ancestry) participating in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). An oral glucose tolerance test (OGTT) yielded fasting plasma glucose, insulin, C-peptide, and insulin secretion, sensitivity, and disposition index. Habitual dietary intake was assessed by food frequency questionnaire (FFQ). Associations between DASH components and glucose homeostasis traits were examined, controlling for demographics, body mass index (BMI), physical activity, and energy intake. For significant associations, the models were repeated with scores for DASH-P and DASH-NP as predictors in the same model. DASH and DASH-P scores were inversely associated with fasting plasma glucose (DASH:β = -0.036 ± 0.012,P = 0.005; DASH-P: β = -0.04 ± 0.017,P = 0.002), and positively associated with insulin sensitivity (DASH:β = 0.022 ± 0.012,P = 0.042; DASH-P: = 0.036 ± 0.015,P = 0.014). The DASH score was also associated with disposition index (β = 0.026 ± 0.013,P = 0.038), but this association did not reach significance with DASH-P (β = 0.035 ± 0.018,P = 0.051). No associations were observed with DASH-NP score (all P > 0.05).

CONCLUSIONS

DASH diet is associated with improvement in specific glucose homeostasis traits, likely arising from increased plant-based foods. Such research may help tailor future dietary advice to specific metabolic risk, and to food groups most effective at improving these.

Food and Nutrient Displacement by Walnut Supplementation in a Randomized Crossover Study

The aim of this article is to evaluate the effect of a daily supplement of walnuts on the overall daily diet and nutrient profile of healthy adults. A randomized controlled trial with crossover design was conducted for two 6-month diet periods in southeast Californian communities. Subjects were randomized to receive a control diet or a walnut-supplemented diet, then switched. The walnut supplement represented approximately 12% of their daily energy intake. Trained nutritionists collected seven 24 h dietary recalls from each participant (a total of 14 recalls for both periods). Ninety participants were able to complete the study, including 50 females and 40 males. The average age of the participants was 54.3 years. Diets in the walnut period had significantly higher vegetable protein, total fat, total PUFA, PUFA 18:2, PUFA 22:6, and total dietary fiber (p < 0.05), while also exhibiting significantly lower PUFA 20:5. All mineral levels were higher on the walnut-supplemented diet. Calcium, phosphorus, magnesium, and zinc were, particularly, significantly higher among the walnut-supplemented group (p < 0.05). Displacement occurred in more than one-third of the entire nuts and seeds group; four-fifths of the non-alcoholic beverages and desserts groups; and the majority of the candy, sugar, and sweets group. Walnut supplementation can lead to favorable modifications in nutrient and food intake profiles that may contribute to chronic disease prevention. Nutrient and food displacement may be a mechanism to explain the favourable association between walnut intake and improved diet.

Chronic Effects of a High Sucrose Diet on Murine Gastrointestinal Nutrient Sensor Gene and Protein Expression Levels and Lipid Metabolism

The gastrointestinal tract (GIT) plays a key role in regulating nutrient metabolism and appetite responses. This study aimed to identify changes in the GIT that are important in the development of diet related obesity and diabetes. GIT samples were obtained from C57BL/6J male mice chronically fed a control diet or a high sucrose diet (HSD) and analysed for changes in gene, protein and metabolite levels. In HSD mice, GIT expression levels of fat oxidation genes were reduced, and increased de novo lipogenesis was evident in ileum. Gene expression levels of the putative sugar sensor, slc5a4a and slc5a4b, and fat sensor, cd36, were downregulated in the small intestines of HSD mice. In HSD mice, there was also evidence of bacterial overgrowth and a lipopolysaccharide activated inflammatory pathway involving inducible nitric oxide synthase (iNOS). In Caco-2 cells, sucrose significantly increased the expression levels of the nos2, iNOS and nitric oxide (NO) gas levels. In conclusion, sucrose fed induced obesity/diabetes is associated with changes in GI macronutrient sensing, appetite regulation and nutrient metabolism and intestinal microflora. These may be important drivers, and thus therapeutic targets, of diet-related metabolic disease.

Teachers' Perceptions and Understanding of Children's Fluid Intake

No public health data exists on elementary teachers’ perceptions of both their own fluid intake and of their elementary school aged children’s fluid intake. A total of 271 (20 males, 251 females) teachers in developed areas of Australia, Belgium, England, Ireland, United Arab Emirates, and the United States of America completed an online questionnaire (Feb–Mar 2019) on: (i) their fluid intake, (ii) their perception and understanding of children’s fluid intake and (iii) barriers in the school day that they felt prevented school children consuming fluids. Overall, the data indicated that teachers consume considerably lower amounts than recommended themselves, but have a good awareness of children’s fluid intake and estimate children drink approximately half (1 litre (34% n = 93)) of what is recommended per day. The results were also similar to those reported by children previously. Yet, the data highlighted a lack of active encouragement of drinking water throughout the school day by teachers, with only 11% (n = 29) suggesting they actively encourage children to drink and 45% (n = 123) reporting no active encouragement at all. It is recommended as a public health measure that all school children consume an extra cup of water during lunch times in those schools where water intake was recognized as sub optimal. Furthermore, depending on weather conditions, a cup of water before, during and after Physical Education lessons should be encouraged by teachers. Water coolers or bottles may be used as a supplementary resource, provided that hygiene is maintained. From an educational perspective, more professional development needs to be provided to teachers on the importance of regular water consumption, and more time dedicated across the elementary curriculum to educational understanding of fluid consumption.

Chronic exposure to liquid sucrose and dry sucrose diet have differential effects on peripheral taste responses in female rats

Sugar-sweetened beverages are the major source of added calories in the Western diet and their prevalence is associated with obesity and metabolic disruption. Despite the critical role of the taste system in determining food selection and consumption, the effects of chronic sucrose consumption on the peripheral taste system in mammals have received limited attention. We offered female Sprague Dawley rats free access to water and one of three diets for up to 40 days: (1) sucrose-free chow or "NS" diet; (2) a high-sucrose dry diet or "HS"; or (3) 30% sucrose solution and the NS diet, designated "LiqS" diet. Sucrose consumption by LiqS rats gradually increased and by day 14 was equal to that of HS rats. Food intake decreased in LiqS rats, but their energy intake remained higher than for NS or HS rats. There was no significant difference in weight gain of the groups during the study. Recordings from the chorda tympani nerve (CT), which innervates taste buds on the anterior tongue, revealed decreased responses to 1 M sucrose in both LiqS and HS rats and to acesulfame K and salt tastants in LiqS rats after 40 days on diet. Umami, bitter, and acid response magnitudes were unchanged in both groups. These results demonstrate that chronic sucrose exposure inhibits taste responses to higher concentrations of sweet stimuli. More surprisingly, CT responses to NaCl and 0.5M NaAc were significantly reduced in rats on the LiqS diet. Thus, the physical form of the diet influences taste responsiveness to salt and sweet taste function. These data suggest that taste buds are previously unappreciated targets of chronic sucrose consumption.