Intake of sugar sweetened soft drinks among adolescents: Trends and social inequality in Denmark 2002-2018

Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.

Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income

BACKGROUND

Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents' soft drink intake through potential mediators.

METHODS

Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas.

RESULTS

Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents' higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income.

CONCLUSIONS

Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis

BACKGROUND

Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations.

RESULTS

The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p  =  0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES.

CONCLUSION

Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

Three-Year Intervention Effects on Food and Beverage Intake-Results from the Quasi-Experimental Copenhagen School Child Intervention Study (CoSCIS)

The diet of Danish children is often not in accordance with dietary guidelines. We aimed to evaluate changes in the intake of selected foods and beverages during a multi-component school-based physical activity intervention, and to investigate if changes were modified by socioeconomic status (SES). The study included 307 children (intervention group: 184; comparison group: 123) with information on dietary intake pre- and post-intervention as well as on SES. Linear regression models were conducted to assess the effect of the intervention on changes in dietary factors. Children from the intervention group increased their intake of whole-grain bread during the intervention (group means: 6.1 g/d (95% CI: 2.2 to 10.0) vs. 0.3 g/d (95% CI: −3.1 to 3.7) in the comparison group, p = 0.04). A significant interaction between SES and group allocation was observed to change in fruit intake (p = 0.01). Among children from low SES families, only those from the comparison group decreased their fruit intake (group means: −40.0 g/d (95% CI: −56.0 to −23.9) vs. 9.3 g/d (95% CI: −16.1 to 94) in the intervention group, p = 0.006). The present study found no convincing effect of introducing a multi-component intervention on dietary intake except a small beneficial effect on whole-grain bread consumption. However, beneficial intervention effects in fruit intake were found particularly among children from low SES families.

Two-Year Change in Blood Pressure Status and Left Ventricular Mass Index in Chinese Children

Background: Elevated blood pressure (BP) is associated with target organ damage, such as left ventricular hypertrophy (LVH), in childhood. However, it is unclear if children who resolve elevated BP have reduced levels of left ventricular mass index (LVMI). This study aimed to examine the association between change in BP status over 2 years and LVMI among Chinese children.

Methods: Data were from 1,183 children aged 6–11 years at baseline in 2017 who were followed up in 2019 in the Huantai Childhood Cardiovascular Health Cohort Study. Change in BP status over 2 years from baseline to follow-up was categorized as: persistent normal BP, resolved elevated BP (elevated BP at baseline, normal BP at follow-up), incident elevated BP (normal BP at baseline, elevated BP at follow-up), and persistent elevated BP. Elevated BP status was defined according to national reference standards as systolic or diastolic BP levels ≥ sex-, age-, and height-specific 95th percentiles.

Results: LVMI levels were lowest in children with persistent normal BP (30.13 g/m^2.7), higher in those with incident elevated BP (31.27 g/m^2.7), and highest in those with persistent elevated BP (33.26 g/m^2.7). However, LVMI levels in those who had resolved elevated BP (30.67 g/m^2.7) were similar to those with persistent normal BP. In the fully adjusted model, compared with children with persistent normal BP, those with persistent elevated BP and incident elevated BP had higher LVMI at follow-up (ß = 3.131, p < 0.001; ß = 1.143, p = 0.041, respectively). In contrast, those who had resolved elevated BP did not have a significantly higher LVMI (ß = 0.545, p = 0.194) than those with persistent normal BP.

Conclusion: Developing or maintaining elevated BP over a 2-year period in childhood associated with higher levels of LVMI, but those able to resolve their elevated BP status over the same period had LVMI levels that were similar with those who had normal BP at both time points. Thus, it is important to identify children with elevated BP at early time and to take effective measures to lower their BP levels, thereby reducing high LVMI levels and related cardiovascular diseases in the future.

Sugar-sweetened beverage consumption from 1998-2017: Findings from the health behaviour in school-aged children/school health research network in Wales

To date no study has examined time trends in adolescent consumption of sugar-sweetened beverages and energy drinks, or modelled change in inequalities over time. The present study aimed to fill this gap by identifying historical trends among secondary school students in Wales, United Kingdom. The present study includes 11–16 year olds who completed the Health Behaviour in School-aged Children (HBSC) survey and the Welsh School Health Research Network (SHRN) survey between 1998 to 2017. Multinomial regression models were employed alongside tests for interaction effects. A total of 176,094 student responses were assessed. From 1998 to 2017, the prevalence of daily sugar-sweetened beverage consumption decreased (57% to 18%) while weekly consumption has remained constant since 2006 (49% to 52%). From 2013 to 2017, daily consumption of energy drinks remained stable (6%) while weekly consumption reports steadily decreased (23% to 15%). Boys, older children and those from a low socioeconomic group reported higher consumption rates of sugar-sweetened beverages and energy drinks. Consumption according to socioeconomic group was the only characteristic to show a statistically significant change over time, revealing a widening disparity between sugar-sweetened beverage consumption rates of those from low and high socioeconomic groups. Findings indicate a positive shift in overall consumption rates of both sugar-sweetened beverages and energy drinks. Adolescents from a low socioeconomic group however were consistently shown to report unfavourable sugar-sweetened beverages consumption when compared to peers from high socioeconomic group. Given the established longer term impacts of sugar-sweetened beverage and energy drink consumption on adolescent health outcomes, urgent policy action is required to reduce overall consumption rates, with close attention to equity of impact throughout policy design and evaluation plans.

Adherence to food-based dietary guidelines among adolescents in Germany according to socio-economic status and region: results from Eating Study as a KiGGS Module (EsKiMo) II

OBJECTIVE

Dietary habits developed during childhood and adolescence are likely to continue into adulthood. An unbalanced diet may cause nutrient deficiencies and excessive energy intake; these enhance the risk for developing overweight and obesity and their co-morbidities. In the present analysis, food consumption of adolescents is described and evaluated against German food-based dietary guidelines with special focus on socio-economic status (SES) and region of residence.

DESIGN

Within the 'German Health Interview and Examination Survey for Children and Adolescents' (KiGGS Wave 2), the cross-sectional 'Eating Study as a KiGGS Module' (EsKiMo II) was conducted from 2015 until 2017 to provide data about dietary behaviour.

SETTING

Germany.

PARTICIPANTS

1353 adolescents aged 12-17 years from a nationwide representative sample with food consumption data from computer-assisted dietary history interviews.

RESULTS

The median consumption of fruits, vegetables, starchy foods and milk/dairy products among adolescents in Germany was below the recommendation. The median consumption of both meat/meat products and unfavourable foods, like confectionery, which should be consumed sparingly, was about 1·5 times the recommended amount. The total amount of beverages consumed by most adolescents was above the minimum amount recommended. Soft drink consumption of adolescents with a low SES was three to five times higher than soft drink consumption of adolescents with a high SES.

CONCLUSIONS

The results indicate the need for an improvement of dietary habits among adolescents in Germany. Further approaches to promote healthy diets in Germany should be continued, and the focus on social inequalities should be strengthened.