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

Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe

Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2-14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

Global, regional, and national burden of disease attributable to a diet low in milk, 1990-2021: An updated analysis of the Global Burden of Disease study 2021

Diet low in milk has been linked to various chronic diseases and cancer. To better understand the global health effect of a diet low in milk, this study analyzed the latest data from the Global Burden of Disease study 2021. Our findings revealed that the number of deaths and disability-adjusted life years (DALY) of colon and rectum cancer (CRC) attributable to a diet low in milk increased from 1990 to 2021. The age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) for CRC due to low milk intake declined slightly over this period, with a faster decline observed among females. Predictive analysis shows similar tendency, even higher ASMR and ASDR in CRC associated with a diet low in milk in males than in females by 2050. In contrast, the rate of prostate cancer attributable to a diet low in milk remained relatively stable. Regionally, southern Latin America exhibited the highest ASMR and ASDR for CRC associated with a diet low in milk in 2021, whereas western sub-Saharan Africa had the most notable changes in these rates for prostate cancer. The largest decrease in ASMR and ASDR of CRC due to a diet low in milk was observed in the high socio-demographic index (SDI) region. In addition, the low SDI region exhibited the highest change rates for prostate cancer attributable to a diet low in milk. In summary, our study provides valuable insights into trends for the global burden of CRC and prostate cancer attributable to a diet low in milk, emphasizing the importance of considering gender, age, regional, and national differences in dietary habits and disease risk when formulating public health policies and dietary recommendations.

Trends in incidence of untreated caries in permanent teeth in BRICS countries: an age-period-cohort analysis from 1992 to 2021 and projections for the next two decades

OBJECTIVE

This study aimed to delineate the temporal trends and project the future incidence of untreated caries in permanent teeth in the BRICS countries.

MATERIALS AND METHODS

Data were obtained from the 2021 Global Burden of Disease (GBD) study. A joinpoint model was used to examine the trends in disease burden. The age-period-cohort (APC) model was applied to analyze the trends across different age groups, periods, and birth cohorts. The Bayesian age-period-cohort (BAPC) model was used to make projections of incidence for the next two decades.

RESULT

A total of 1,068.31 million cases of untreated caries in permanent teeth were found in BRICS countries in 2021, accounting for 45.07% of the global number. The incidence in most of the BRICS countries showed an increasing trend between 1992 and 2021. APC analyses indicated a net drift below 0 in most of the BRICS countries. The peak incidence was observed in people aged 20-24 years for most of the BRICS countries. There was a downward trend in the period rate ratio (RR) in BRICS countries except China and Russia. Compared to younger birth cohorts, older birth cohorts exhibited higher risks in most of the BRICS countries. It is projected that from 2022 to 2041, the age-standardized incidence rate (ASIR) for both males and females in most of BRICS countries may decline.

CONCLUSIONS

In conclusion, the burden of untreated dental caries in permanent teeth remains significantly high in BRICS countries, with age, time period, and birth cohort significantly affecting the incidence. All BRICS countries need to improve public health policies to mitigate this public concern, especially for high-risk groups.

CLINICAL RELEVANCE

The ASIR of untreated caries in permanent teeth in most BRICS countries may decrease in the next twenty years by projections, but the burden of disease remains high in the BRICS countries. It is crucial for BRICS countries to enhance public health policies related to caries prevention and treatment for high-risk populations.

Bugs got milk? Exploring the potential of lactose as a prebiotic ingredient for the human gut microbiota of lactose-tolerant individuals

Milk consumption is important to help meet daily nutrient requirements. However, lactose-present in dairy products-has been associated with digestive discomfort in individuals who are lactose intolerant or have inadequate lactase activity. Yet, a new perspective on this dietary component has emerged: its potential as a prebiotic for the lactose-tolerant population. We hypothesized that ingestion of lactose may improve the microbial community structure and metabolism of the gut microbiota from healthy adults. First, we assessed the acute impact of lactose ingestion on the gut microbiota of adults using a short-duration in vitro batch colonic model. Subsequently, we employed a long-duration in vitro dynamic multivessel colonic model to evaluate the effects of lactose chronic ingestion. In both cases, a mixture of lactose/galactose/glucose was administered in a defined proportion to mimic lactose metabolism and galactose/glucose absorption in lactose-tolerant adults. The hypothesis was confirmed, as a modulatory prebiotic effect was revealed on the microbial community structure and metabolism of the microbiota upon treatments simulating the ingestion of three doses of lactose, equivalent to half a glass, one glass, and two glasses of cow's milk. The long-duration model confirmed this potential, increasing the relative abundance of the beneficial genera Lactobacillus, Akkermansia, and Faecalibacterium, while the usually detrimental genus Clostridium decreased. Additionally, the health-promoting microbial metabolites acetate, propionate, and lactate were increased. Therefore, lactose ingestion could positively modulate the gut microbiota in healthy lactose-tolerant adults, thereby promoting gut health and shedding light on the dietary benefits of consuming milk.

Sweet beverages and the risk of colorectal cancer: the Norwegian Women and Cancer Study

BACKGROUND

Colorectal cancer (CRC) is the third most common type of cancer worldwide, with Norwegian women having the highest incidence rate of colon cancer in 2022. The consumption of sweet beverages is a suggested modifiable risk factor for CRC; however, current evidence is limited and inconclusive.

OBJECTIVE

To assess the associations between the intake of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and juice and the risk of overall and subsite-specific CRC among Norwegian women.

METHODS

In this prospective cohort study, we included 73,921 participants aged 41-61 years at baseline. Information on sweet beverage consumption was collected using self-reported food frequency questionnaires at two time points between 1998 and 2014. We used Cox proportional hazards models to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for the associations between sweet beverage consumption and the risk of overall CRC, proximal colon cancer, distal colon cancer, and rectal cancer.

RESULTS

During a mean follow-up time of 16.5 years from baseline, 1,187 women were diagnosed with CRC. Compared to no consumption, juice consumption was inversely associated with overall CRC risk (HR≥ 7 glasses/wk = 0.81, 95% CI: 0.67-0.98; p-trend = 0.025), colon cancer (HR≥ 7 glasses/wk = 0.73, 95% CI: 0.58-0.94; p-trend = 0.015) and proximal colon cancer (HR≥ 7 glasses/wk = 0.71, 95% CI: 0.52-0.99; p-trend = 0.065) after adjusting for age, education, and diabetes status at baseline. No associations were observed between juice consumption and distal colon cancer or rectal cancer risk, or between the intake of SSBs or ASBs and CRC.

CONCLUSION

We observed no substantial association between the intake of SSBs or ASBs and the risk of CRC or cancer in colorectal subsites in our cohort of Norwegian women. Conversely, our results indicate that juice consumption is associated with a reduced risk of CRC, particularly in the colon. These results warrant further investigation in larger cohorts with power to detect possible differences in cancer risk across colorectal subsites, especially as patterns of sweet beverage consumption are changing.

The mediating roles of anthropo-metabolic biomarkers on the association between beverage consumption and breast cancer risk

BACKGROUND

Breast cancer (BC) is the most common malignancy in women, yet the role of beverage consumption in BC risk remains unclear. Additionally, the contribution of anthropo-metabolic biomarkers as mediators is unknown, limiting the development of effective prevention strategies.

METHODS

This study included 13,567 participants from the Guangzhou Biobank Cohort Study (GBCS), where beverage consumption was assessed at baseline using a food frequency questionnaire. BC cases were identified through cancer registry linkage over a mean follow-up of 14.8 years. Mendelian randomization (MR) analyses were performed to evaluate the causal effects of beverage consumption on BC risk, with a two-step MR approach used to estimate mediation effects.

RESULTS

During follow-up, 243 BC cases were identified. Weekly consumption of ≥ 1 portion of sugar sweetened beverages (SSB), versus < 1 portion, was significantly associated with a higher risk of BC (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.12-2.23). This association was partly mediated by body mass index (proportion mediated [PM] 4.2%, 95% CI 0.9-17.1%) and uric acid (PM 18.8%, 95% CI 1.5-77.5%). Weekly consumption of > 6 portions of dairy-based milk was associated with a non-significantly higher BC risk (HR 1.41, 95% CI 0.99-2.03), while 3-6 portions of soy milk were associated with a lower BC risk (HR 0.31, 95% CI 0.10-0.98). No significant associations were found for pure fruit juice, coffee, tea, or alcoholic drinks. MR analyses supported the detrimental effect of SSB on BC risk, with high-density lipoprotein cholesterol, polyunsaturated fatty acids to total fatty acids (TFAs) ratio, and omega-6 fatty acids to TFAs ratio mediating 2.44%, 2.73%, and 3.53% of the association, respectively.

CONCLUSION

This study suggested that SSB consumption was a risk factor for BC and identified key anthropo-metabolic biomarkers mediating this relationship. Reducing SSB consumption and addressing associated metabolic pathways may offer effective strategies for BC prevention.

Dietary patterns in Tanzania's transitioning rural and urban areas

BACKGROUND

Like other Sub-Saharan Africa (SSA) countries, Tanzania is undergoing socio-economic changes that impact lifestyles and dietary choices. Traditionally, differences in dietary habits between rural and urban areas in Tanzania and other SSA countries were prominent. However, recent research indicates converging lifestyles and dietary choices associated with increased risk of cardiometabolic diseases. The objective of the current study was hence to investigate differences and similarities in dietary patterns, energy, and food groups intake in urban and rural Tanzania.

METHODS

Dietary habits were assessed by use of a Food Frequency Questionnaire (FFQ) for 442 respondents aged 44-65 years in urban (Ubungo -Dar es Salaam) and rural (Kilindi- Tanga) districts of Tanzania. Dietary patterns were determined using Principal Components Analysis (PCA). Bivariate analyses identified determinants of dietary patterns in urban and rural Tanzania.

RESULTS

Two dietary patterns, a "mixed pattern" characterized by whole grains, potatoes, fruits, vegetables, meat, fried potatoes and tubers, alcohol, sugar-sweetened beverages (SSB), sugar and sweets, and added oils and a "plant-rich pattern" characterized by whole grains, fruits, pulses and peas, seasoning vegetables and salads, SSB, sugar and sweets, and added oils were identified. Urban residents contributed more to the mixed pattern, while rural residents had a higher contribution to the plant-rich pattern. Overall, dietary diversity was greater in urban than rural Tanzania. The estimated median daily energy intake was 2,902 kcal (IQR: 1449.2) with a lower energy intake in rural (2,817 kcal, IQR: 1,274) as compared to urban residents (3,052 kcal, IQR: 1558) (p = 0.021). The percent contribution to the median average daily energy intake for grains, fruits, and milk was higher in rural than urban participants. No differences were observed for meat, poultry and eggs.

CONCLUSION

We identified two distinct dietary patterns: a "mixed pattern" prominent in urban and a "plant-rich pattern" more common in rural. Urban diets were more diverse with slightly higher energy intake. These findings underscore the effects of urbanization on diets and the need for targeted nutritional intervention for both rural and urban populations.

Prevalence and Associated Factors with Sugar-sweetened Beverages Consumption among Kurdish High-school Children

Adolescents' excessive consumption of sugar-sweetened beverages (SSBs) has become a global concern due to its detrimental effects on health. We explored the prevalence and associated factors of the consumption of SSB in high-school children in the Kurdistan Region. In this study, we included 560 students randomly from the 152 available high schools in Duhok City in the Kurdistan Region. Both genders of high school children who registered for the academic years 2021-2022 in 32 high schools were eligible. The study found that a considerable number of students did not eat breakfast (32.68%). Mostly, the students had lunch (83.21%) and dinner (53.57%), with 53.57% having extra eating portions. A significant percentage of the students consumed junk food (fast food) more than three times per week (39.82%) and consumed SSB 1-3 times/day (61.07%) at varying frequencies. The study found that 14.64% and 12.86% were overweight and obese, respectively. The prevalence of SSB consumption 4-5 times/week was 47.68% (soda), 21.61% (tea), 34.64% (coffee), 22.50% (energy drink), and 36.25% (juice). A similar prevalence of SSB consumption was found among parents (23.39%) and friends/classmates (20.36%). The male students were more likely to consume tea (P = 0.0104). However, female students were more likely to consume juice and energy drinks (P = 0.004 and P < 0.0001, respectively). Students with lower levels of education were also more likely to consume SSB. The intake of SSB was high among high school children in the Kurdistan Region and was related to gender and parents' consumption.

Consumption of Sugar Sweetened Beverages (SSBs) and Breast Cancer: A Narrative Review

Sugar sweetened beverages (SSBs) have become a cause of concern because of their growing consumption levels across age groups and associated chronic diseases such as diabetes mellitus, cardiovascular diseases and cancers. The aim of this review was to provide a detailed profile of the SSBs trends and associated health risk, with special focus on its role in breast cancer development. A review of current literature has depicted increased in-takes of SSBs across the globe with servings ranging from 3 to 11 per day in different countries, while children, adolescents and young adults report the highest intake levels. These increased intakes further contribute to different metabolic diseases via increased body adiposity, blood glucose and insulin levels, and increased post-menopausal estrogen levels, all of which contribute to chronic diseases, including cancers. Nutrition interventions including ones that target SSBs reduction seem to have a positive impact on reducing the development of these non-communicable diseases and are also associated with better prognosis and survival chances in cancer patients. However, the implementation of SSBs taxation and mass awareness campaign interventions remains poor due to lack of policy development and regulation for these beverages. The control of SSBs intake across the world requires rigorous research to construct efficient and practical policies to reduce the accessibility and marketing of SSBs while simultaneously increasing awareness in the public regarding the health risks of these beverages. To achieve this, a coordinated approach involving different public and private sectors is needed.

Alternative biological functions of lactose: a narrative review

Lactose, commonly known as "milk sugar," offers various health benefits beyond its role as an energy source. As a precursor for essential molecules, lactose impacts calcium absorption, has low cariogenicity, affects satiety, enhances athletic performance, and potentially functions as a prebiotic for gut health. However, not all individuals can digest lactose, with a minority of the population exhibiting gastrointestinal symptoms after its consumption. The ability to digest lactose during adulthood is a genetically conferred trait known as lactase persistence, which is also likely affected by epigenetic alterations and other endogenous factors. In the present review, we highlight the multifaceted health effects of lactose, including its impact on calcium absorption, its low cariogenicity, its role in satiety control, its ability to enhance athletic performance, and its potential benefits as a prebiotic for gut health. Since these benefits are inherently dependent on lactose intake trends and the digestion capacity of populations, we also present the latest available information on the current trends in lactose consumption around the world. Overall, the gathered evidence suggests that moderate lactose consumption is recommended, as it can foster multiple lifelong health benefits.

Description of Weight-Related Content and Recommended Dietary Behaviors for Weight Loss Frequently Reposted on X (Twitter) in English and Japanese: Content Analysis

BACKGROUND

Both obesity and underweight are matters of global concern. Weight-related content frequently shared on social media can reflect public recognition and affect users' behaviors and perceptions. Although X (Twitter) is a popular social media platform, few studies have revealed the content of weight-related posts or details of dietary behaviors for weight loss shared on X.

OBJECTIVE

This study aims to describe body weight-related content frequently reposted on X, with a particular focus on dietary behaviors for weight loss, in English and Japanese.

METHODS

We collected English and Japanese X posts related to human body weight having over 100 reposts in July 2023 using an application programming interface tool. Two independent researchers categorized the contents of the posts into 7 main categories and then summarized recommended weight loss strategies.

RESULTS

We analyzed 815 English and 1213 Japanese posts. The most popular main category of the content was "how to change weight" in both languages. The Japanese posts were more likely to mention "how to change weight" (n=571, 47.1%) and "recipes to change weight" (n=114, 9.4%) than the English posts (n=195, 23.9% and n=10, 1.2%, respectively), whereas the English posts were more likely to mention "will or experience to change weight" (n=167, 20.5%), "attitudes toward weight status" (n=78, 9.6%), and "public health situation" (n=44, 5.4%) than Japanese posts. Among 146 English and 541 Japanese posts about weight loss strategies, the predominant strategies were diet (n=76, 52.1% in English and n=170, 31.4% in Japanese) and physical activities (n=56, 38.4% and n=295, 54.5%, respectively). The proportion of posts mentioning both diet and physical activity was smaller in Japanese (n=62, 11.5%) than in English (n=31, 21.2%). Among 76 English and 170 Japanese posts about dietary behaviors for weight loss, more than 60% of posts recommended increasing intakes of specific nutrients or food groups in both languages. The most popular dietary component recommended to increase was vegetables in both English (n=31, 40.8%) and Japanese (n=48, 28.2%), followed by protein and fruits in English and grains or potatoes and legumes in Japanese. Japanese posts were less likely to mention reducing energy intake; meal timing or eating frequency; or reducing intakes of specific nutrients or food groups than the English posts. The most popular dietary component recommended to decrease was alcohol in English and confectioneries in Japanese.

CONCLUSIONS

This study characterized user interest in weight management and suggested the potential of X as an information source for weight management. Although weight loss strategies related to diet and physical activity were popular in both English and Japanese, some differences in the details of the strategies were present, indicating that X users are exposed to different information in English and Japanese.

School Milk Programs in Latin America and the Caribbean

Background

School milk programs have a long history in Latin America and the Caribbean. In recent decades, the region has undergone a nutrition transition characterized by a rise in children's overweight/obesity, which adds new challenges for school-based programs.

Objectives

This article aimed to unpack how school milk programs in the region have fared as of 2022 and what drives their success (or lack thereof).

Methods

Data from the Global Survey of School Meal Programs were analyzed descriptively to broadly summarize the current state of school feeding programs in Latin America and the Caribbean. To probe the status of school milk programs, key informant interviews were conducted with school milk stakeholders in 7 countries (Brazil, Chile, Colombia, the Dominican Republic, Ecuador, Guatemala, and Honduras), and these interviews were analyzed for thematic elements.

Results

Five countries were found to have operational school milk programs, whereas the programs in Guatemala and Honduras have not (thus far) endured. Programs often prioritized and took pride in local milk procurement, although there was sometimes incongruity between objectives to improve children's diets and stimulate local agricultural development. Program implementers grapple with the taste, texture, and safety of milk, and it can be challenging to reconcile concerns over child obesity and the need to ensure the milk is appealing and accepted.

Conclusions

In conclusion, programs seek creatively to overcome the aformentioned challenges wherever there is fiscal capacity and political will.

Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0-2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1-1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

Study Protocol for a Randomized Controlled Trial Investigating the Effects of the Daily Consumption of Ruminant Milk on Digestive Comfort and Nutrition in Older Women: The YUMMI Study

BACKGROUND

Age-related changes can lead to dietary insufficiency in older adults. The inclusion of high-quality, nutrient-dense foods such as ruminant milks can significantly improve health outcomes. However, many older adults worldwide do not meet daily milk intake recommendations because of digestive discomfort and health concerns. Ovine and caprine milks are increasingly popular for their perceived digestive and nutritional benefits. While preclinical studies suggest differences in milk digestion, human studies investigating acute postprandial responses remain inconclusive, and the impacts of sustained milk consumption remain uncertain.

OBJECTIVES

Hence, we present a randomized controlled trial investigating how the sustained consumption of bovine, caprine, or ovine milk influences digestion, nutrition, and metabolism in older women.

METHODS

A total of 165 healthy older women were randomized to receive bovine, caprine, or ovine milk, or no milk, twice daily for 12 weeks. The primary outcome is the impact of milk consumption on digestive comfort assessed via the Gastrointestinal Syndrome Rating Scale (GSRS). Secondary outcomes include changes in nutrient intake, plasma amino acid and lipid appearance, bowel habits, the gut microbiota, cardiometabolic health, physical function, physical activity, sleep, mood, sensory perception, and emotional response.

CONCLUSIONS

The findings could inform dietary recommendations for older women and facilitate the development of targeted functional food products.

Sugar-sweetened beverage consumption in Thailand: Determinants and variation across socioeconomic status

OBJECTIVES

Reducing consumption of sugar-sweetened beverages (SSBs) is a primary public health goal in Thailand, but information on the characteristics of SSB consumers remains limited. This study aims to gain knowledge about the characteristics of SSB consumers in Thailand.

STUDY DESIGN

Secondary analysis of survey data.

METHODS

The study used data from the Health Behaviour of Population Survey conducted by Thailand's National Statistics Office between February and May 2021. SSB consumption was sourced from a survey question about the consumption of prepackaged sugar-sweetened non-alcoholic beverages. The influence of demographic, socioeconomic, behavioural, habitual, and health factors on mean daily intake and daily consumption was assessed using a two-part model and logistic regression analysis, respectively. Decomposition analysis was conducted to understand how the impact of these factors affecting SSB consumption varied across socioeconomic groups.

RESULTS

Frequent SSB consumers exhibited various unhealthy behaviours, including smoking, unhealthy food consumption, low physical activity, and making food selections driven by appetitive motivations. Although higher socioeconomic status was associated with greater consumption of SSBs, it stabilised at elevated income levels. Increased SSB consumption in higher socioeconomic groups was linked to mixed eating habits, being overweight, and occasional drinking, while in lower socioeconomic groups, it was associated with unhealthy behaviours like smoking, regular alcohol drinking, appetitive food choices, and low physical activity.

CONCLUSIONS

SSB consumption in Thailand is multifactorial, varying by socioeconomic status. These insights are crucial for policy formation aimed at reducing SSB consumption in the country. Policymakers should explore interventions that address overall unhealthy behaviours alongside those targeting overconsumption of SSBs.

Amorphous Calcium Carbonate Enhances Fracture Healing in a Rat Fracture Model

Background: Delayed and failed fracture repair and bone healing remain significant public health issues. Dietary supplements serve as a safe, inexpensive, and non-surgical means to aid in different stages of fracture repair. Studies have shown that amorphous calcium carbonate (ACC) is absorbed 2 to 4.6 times more than crystalline calcium carbonate in humans. Objectives: In the present study, we assessed the efficacy of ACC on femoral fracture healing in a male Wistar rat model. Methods: Eighty male Wistar rats were randomly divided into five groups (n = six per group): sham, fracture + water, fracture + 0.5× (206 mg/kg) ACC, fracture + 1× ACC (412 mg/kg), and fracture + 1.5× (618 mg/kg) ACC, where ACC refers to the equivalent supplemental dose of ACC for humans. A 21-gauge needle was placed in the left femoral shaft, and we then waited for three weeks. After three weeks, the sham group of rats was left without fractures, while the remaining animals had their left mid-femur fractured with an impactor, followed by treatment with different doses of oral ACC for three weeks. Weight-bearing capacity, microcomputed tomography, and serum biomarkers were evaluated weekly. After three weeks, the rats were sacrificed, and their femur bones were isolated to conduct an evaluation of biomechanical strength and histological analysis. Results: Weight-bearing tests showed that treatment with ACC at all the tested doses led to a significant increase in weight-bearing capacity compared to the controls. In addition, microcomputed tomography and histological studies revealed that ACC treatment improved callus formation dose-dependently. Moreover, biomechanical strength was improved in a dose-dependent fashion in ACC-treated rats compared to the controls. In addition, supplementation with ACC significantly lowered bone formation and resorption marker levels two-three weeks post-fracture induction, indicating accelerated fracture recovery. Conclusions: Our preliminary data demonstrate that ACC supplementation improves fracture healing, with ACC-supplemented rats healing in a shorter time than control rats.

Sugary beverages intake and risk of chronic kidney disease: the mediating role of metabolic syndrome

Background

Although several studies linked the sugary beverages to chronic kidney disease (CKD), the role of different types of sugary beverages in the development of CKD remained inconsistent. This study aimed to examine the associations of sugar-sweetened beverages (SSBs), artificially-sweetened beverages (ASBs), and natural juices (NJs) with CKD risk, and assess the extent to which the associations were mediated through metabolic syndrome (MetS).

Methods

This is a prospective analysis of 191,956 participants from the UK Biobank. Participants with information on beverage consumption and no history of CKD at recruitment were included. Daily consumptions of SSBs, ASBs and NJs were measured via 24-h dietary recall. Cox models were fitted to calculate the hazard ratios (HRs) and confidence intervals (CIs) of sugary beverages intakes on CKD risk. The causal mediation analyses were conducted to investigate whether MetS explained the observed associations.

Results

We documented 4,983 CKD cases over a median of 10.63 years follow-up. Higher consumption of SSBs and ASBs (>1 units/d compared with none) was associated with an elevated risk of CKD (HR: 1.45; 95% CI: 1.30-1.61, P-trend < 0.001 for SSBs and 1.52, 95% CI: 1.36-1.70 for ASBs). In contrast, we observed a J-shaped association between NJs and CKD with the with lowest risk at 0-1 unit/day (0-1 unit/d vs. 0, HR 0.86; 95% CI 0.81-0.91). The proportions of the observed association of higher intakes of SSBs and ASB with CKD mediated by MetS were 12.5 and 18.0%, respectively.

Conclusions

Higher intakes of ASBs and SSBs were positively associated with the development of CKD, while moderate consumption of NJs was inversely associated with CKD risk. More intensified policy efforts are warranted to reduce intake of SSBs and ASBs for CKD prevention.

[Disability status and consumption of sugar-sweetened beverages: analysis of a Colombian population survey]

Introduction

Introduction: according to the World Health Organization (WHO), obesity has tripled in the world as a result of high caloric intake. People with disabilities are more likely to be overweight and obese. Objectives: this study aimed to estimate the association between disability status and consumption of sugar-sweetened beverages in the population aged 18 years and older in Colombia in 2017. Methods: we conducted a secondary analysis of data from Colombia's 2017 National Quality of Life Survey (ECV). The dependent variable was the consumption of sugar-sweetened beverages, and the independent variable was the disability status. Additionally, confounding variables were incorporated. An ordinal logistic regression was performed to estimate the magnitude of the association. The complex sample design of the 2017 LCS was considered in all results. Results: we included data from 18,957 persons aged 18 years and older; 7.9 % had a disability, and 64.4 % consumed sugar-sweetened beverages. People with moderate and severe disability were 18 % and 41 %, respectively, less likely to have a higher consumption of sugar-sweetened beverages compared to people without disability (OR: 0.82; 95 % CI: 0.72-0.95 and OR: 0.59; 95 % CI: 0.39-0.90). When stratified by age group, this association remained only in those older than 45. Conclusions: in Colombia, in 2017, people with disabilities older than 45 years consumed fewer sugar-sweetened beverages than people without disabilities.

The Consumption of Non-Sugar Sweetened and Ready-to-Drink Beverages as Emerging Types of Beverages in Shanghai

BACKGROUND

The Chinese beverage industry is experiencing rapid growth, particularly in the popularity of non-sugar sweetened beverages (NSSs) and ready-to-drink beverages (RSBs). This study aimed to assess current consumption patterns and determinants of various beverage types among retail visitors.

METHODS

A total of 44 observation points, including 22 supermarkets and 22 convenience stores, were randomly selected across Shanghai. At each location, at least 100 individuals were recruited to participate. Data were collected using an electronic self-administered questionnaire.

RESULTS

The consumption rates of total beverages, sugar-sweetened beverages, NSSs, and RSBs were 57.70%, 56.94%, 19.60%, and 29.50%, respectively; the median consumption amounts among the drinking population were 162.57 mL/day, 137.98 mL/day, 32.85 mL/day, and 32.85 mL/day, respectively. The consumption proportions of NSSs and RSBs ranked 2nd and 3rd. The multifactorial analyses showed that people aged 6-18 years consumed more beverages (p < 0.05). Males were more likely to consume sugar-sweetened beverages and NSSs, but females were more likely to consume RSBs (p < 0.05). Higher educated people and bachelors were more likely to consume beverages (p < 0.05).

CONCLUSIONS

The emerging beverage categories, NSSs and RSBs, warrant attention due to their significant consumption rates. Tailored intervention strategies should be considered for demographic groups varying by age, gender, and educational attainment.

Exploring Sugary Drink Consumption and Perceptions among Primary-School-Aged Children and Parents in Australia

BACKGROUND

Sugar-sweetened beverages (SSBs) account for a significant proportion of sugar in the diet of children and are directly associated with obesity in this group. While there have been many studies on adolescent SSB consumption, few studies have examined the predictors of SSB consumption in primary-school-aged children. The aim of this study was to understand the degree to which a child's consumption across a range of beverages is influenced by their own attitudes and by their parents' attitudes and parents' consumption behaviours.

METHODS

A survey of 1611 Australian parent-child dyads asked children (aged 4-11) and their parents to rate a variety of drinks in terms of healthiness, taste, and cost and indicate the amount of these drinks consumed in a typical week. Zero-inflated regression analyses were conducted to identify the strength of association between children's weekly beverage consumption, their perceptions of each beverage, their parents' perceptions, and their parents' weekly beverage consumption.

RESULTS

Parental consumption of a specific beverage was the strongest predictor of child consumption of that beverage, more so than the children's perceptions of the beverage.

CONCLUSIONS

These findings provide insights for developing parent and child education programmes to reduce SSB consumption.

Overall glycaemic index and dietary glycaemic load and all-cause and cause-specific mortality in women from the Mexican Teachers' Cohort

Previous studies have found direct associations between glycaemic index (GI) and glycaemic load (GL) with chronic diseases. However, this evidence has not been consistent in relation to mortality, and most data regarding this association come from high-income and low-carbohydrate-intake populations. The aim of this study was to evaluate the association between the overall GI and dietary GL and all-cause mortality, CVD and breast cancer mortality in Mexico. Participants from the Mexican Teachers' Cohort (MTC) study in 2006-2008 were followed for a median of 10 years. Overall GI and dietary GL were calculated from a validated FFQ. Deaths were identified by the cross-linkage of MTC participants with two national mortality registries. Cox proportional hazard models were used to estimate the impact of GI and GL on mortality. We identified 1198 deaths. Comparing the lowest and highest quintile, dietary GI and GL appeared to be marginally associated with all-cause mortality; GI, 1·12 (95 % CI: 0·93, 1·35); GL, 1·12 (95 % CI: 0·87, 1·44). Higher GI and GL were associated with increased risk of CVD mortality, GI, 1·30 (95 % CI: 0·82, 2·08); GL, 1·64 (95 % CI: 0·87, 3·07) and with greater risk of breast cancer mortality; GI, 2·13 (95 % CI: 1·12, 4·06); GL, 2·43 (95 % CI: 0·90, 6·59). It is necessary to continue the improvement of carbohydrate quality indicators to better guide consumer choices and to lead the Mexican population to limit excessive intake of low-quality carbohydrate foods.

Updating trends in sweetened beverages consumption in Brazil from 2007 to 2021

OBJECTIVE

To analyze the time trend of sweetened beverages consumption among Brazilian adults in 26 capitals and the Federal District, from 2007 to 2021, with focus on the most recent period (2015 to 2021).

METHODS

Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey)were used to conduct a time-series analysis (n = 731,683). The prevalence of regular consumption (five or more days/week), average daily consumption (milliliters) and nonconsumption of sweetened beverages were analyzed. Prais-Winsten regression models were used to calculate temporal trends of the indicators for the complete set of the evaluated population and by sociodemographic characteristics (sex, age group, schooling and development level of the geographic region of residence).

RESULTS

Between 2007 and 2021, a reduction in the prevalence of regular consumption (-1.23 pp/year) and daily average consumption (-8.62 milliliters/year) of sweetened beverages was observed. However, between 2015 and 2021, this downward trend did not continue. The prevalence of adults who reported not consuming sweetened beverages increased (1.14 pp/year, for 2007-21), although this trend was not significant in the most recent period.

CONCLUSIONS

The consumption of sweetened beverages among Brazilian adults decreased in the 15 years studied. However, this reduction was not observed more recently, suggesting that further actions must be adopted in the country so that the trend observed in the total period is maintained.

Consumption of sucrose in maternal and postnatal stages leads to kidney affectation in adult male rats

High sugar-sweetened beverage intake has been related to human kidney disease and metabolic alterations. We determine the impact of high sucrose intake from pregnancy until early postnatal days and post-weaning on kidneys from adult male offspring rats. Wistar female rats were mated and assigned into two groups: one control drinking tap water (CM) and another drinking 5 % sucrose diluted in water (SM). Two offspring per mother were randomly allocated into two experimental groups at weaning. One had free access to simple water (CO) and the other to 5 % sucrose (SO) for 14 weeks. After treatment, levels of relative aquaporin-2 (AQP2), glomerulosclerosis index (GI), collecting tube area, perirenal fat, blood creatinine, and blood ureic nitrogen concentration (BUN) were determined. Two-way ANOVA followed by Bonferroni post-hoc test was used, considering P ≤ 0.05 as a significant statistical difference. Sucrose consumption during gestation/lactation and interaction increased AQP2 expression in the renal cortex and BUN concentration. In contrast, gestation/lactation consumption increased collecting tube area, post-weaning consumption favored perirenal fat, and finally, gestation/lactation, post-weaning, and the interaction caused glomerulosclerosis. Our results suggest that the consumption of sucrose water during gestation/lactation or post-weaning or combination triggers pathological changes in the kidneys of adult rats.

Carbonated Beverage, Fruit Drink, and Water Consumption and Risk of Acute Stroke: the INTERSTROKE Case-Control Study

BACKGROUND AND PURPOSE

Cold beverage intake (carbonated drinks, fruit juice/drinks, and water) may be important population-level exposures relevant to stroke risk and prevention. We sought to explore the association between intake of these beverages and stroke.

METHODS

INTERSTROKE is an international matched case-control study of first stroke. Participants reported beverage intake using food frequency questionnaires or were asked "How many cups do you drink each day of water?" Multivariable conditional logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with stroke.

RESULTS

We include 13,462 cases and 13,488 controls; mean age was 61.7±13.4 years and 59.6% (n=16,010) were male. After multivariable adjustment, carbonated beverages were linearly associated with ischemic stroke (OR 2.39 [95% CI 1.64-3.49]); only consumption once/day was associated with intracerebral hemorrhage (ICH) (OR 1.58 [95% CI 1.23-2.03]). There was no association between fruit juice/drinks and ischemic stroke, but increased odds of ICH for once/day (OR 1.37 [95% CI 1.08-1.75)] or twice/day (OR 3.18 [95% CI 1.69-5.97]). High water intake (>7 cups/day) was associated ischemic stroke (OR 0.82 [95% CI 0.68-0.99]) but not ICH. Associations differed by Eugeographical region-increased odds for carbonated beverages in some regions only; opposing directions of association of fruit juices/drinks with stroke in selected regions.

CONCLUSION

Carbonated beverages were associated with increased odds of ischemic stroke and ICH, fruit juice/drinks were associated with increased odds of ICH, and high water consumption was associated with reduced odds of ischemic stroke, with important regional differences. Our findings suggest optimizing water intake, minimizing fruit juice/drinks, and avoiding carbonated beverages.

Intake of sugar sweetened beverages among children and adolescents in 185 countries between 1990 and 2018: population based study

OBJECTIVE

To quantify global intakes of sugar sweetened beverages (SSBs) and trends over time among children and adolescents.

DESIGN

Population based study.

SETTING

Global Dietary Database.

POPULATION

Children and adolescents aged 3-19 years in 185 countries between 1990 and 2018, jointly stratified at subnational level by age, sex, parental education, and rural or urban residence.

RESULTS

In 2018, mean global SSB intake was 3.6 (standardized serving=248 g (8 oz)) servings/week (1.3 (95% uncertainly interval 1.0 to 1.9) in south Asia to 9.1 (8.3 to 10.1) in Latin America and the Caribbean). SSB intakes were higher in older versus younger children and adolescents, those resident in urban versus rural areas, and those of parents with higher versus lower education. Between 1990 and 2018, mean global SSB intakes increased by 0.68 servings/week (22.9%), with the largest increases in sub-Saharan Africa (2.17 servings/week; 106%). Of 185 countries included in the analysis, 56 (30.3%) had a mean SSB intake of ≥7 servings/week, representing 238 million children and adolescents, or 10.4% of the global population of young people.

CONCLUSION

This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

OBJECTIVES

This study aims to update the relevant epidemiological information of untreated caries in permanent teeth.

METHODS

Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049.

RESULTS

The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049.

CONCLUSIONS

Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period.

CLINICAL SIGNIFICANCE

The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.

Adaptation and Validation of a Modified Broth Microdilution Method for Screening the Anti-Yeast Activity of Plant Phenolics in Apple and Orange Juice Models

Yeasts are the usual contaminants in fruit juices and other beverages, responsible for the decrease in the quality and shelf-life of such products. Preservatives are principally added to these beverages to enhance their shelf-life. With the increasing consumer concern towards chemical food additives, plant-derived antimicrobials have attracted the attention of researchers as efficient and safer anti-yeast agents. However, the methods currently used for determining their anti-yeast activity are time- and material-consuming. In this study, the anti-yeast effect of plant phenolic compounds in apple and orange juice food models using microtiter plates has been evaluated in order to validate the modified broth microdilution method for screening the antimicrobial activity of juice preservative agents. Among the twelve compounds tested, four showed a significant in vitro growth-inhibitory effect against all tested yeasts (Saccharomyces cerevisiae, Zygosaccharomyces bailii, and Zygosaccharomyces rouxii) in both orange and apple juices. The best results were obtained for pterostilbene in both juices with minimum inhibitory concentrations (MICs) ranging from 32 to 128 μg/mL. Other compounds, namely oxyresveratrol, piceatannol, and ferulic acid, exhibited moderate inhibitory effects with MICs of 256-512 μg/mL. Furthermore, the results indicated that differences in the chemical structures of the compounds tested significantly affected the level of yeast inhibition, whereas stilbenes with methoxy and hydroxy groups produced the strongest effect. Furthermore, the innovative assay developed in this study can be used for screening the anti-yeast activity of juice preservative agents because it saves preparatory and analysis time, laboratory supplies, and manpower in comparison to the methods commonly used.

Association of Beverage Consumption during Pregnancy with Adverse Maternal and Offspring Outcomes

BACKGROUND

As the global consumption of sugary and non-sugar sweetened beverages continues to rise, there is growing concern about their health impacts, particularly among pregnant women and their offspring.

OBJECTIVE

This study aimed to investigate the consumption patterns of various beverages among pregnant women in Shanghai and their potential health impacts on both mothers and offspring.

METHOD

We applied a multi-stage random sampling method to select participants from 16 districts in Shanghai. Each district was categorised into five zones. Two towns were randomly selected from each zone, and from each town, 30 pregnant women were randomly selected. Data were collected through face-to-face questionnaires. Follow-up data on births within a year after the survey were also obtained.

RESULT

The consumption rates of total beverages (TB), sugar-sweetened beverages (SSB), and non-sugar sweetened beverages (NSS) were 73.2%, 72.8%, and 13.5%, respectively. Logistic regression analysis showed that compared to non-consumers, pregnant women consuming TB three times or less per week had a 38.4% increased risk of gestational diabetes mellitus (GDM) (OR = 1.384; 95% CI: 1.129-1.696) and a 64.2% increased risk of gestational hypertension (GH) (OR = 1.642; 95% CI: 1.129-2.389). Those consuming TB four or more times per week faced a 154.3% higher risk of GDM (OR = 2.543; 95% CI: 2.064-3.314) and a 169.3% increased risk of GH (OR = 2.693; 95% CI: 1.773-4.091). Similar results were observed in the analysis of SSB. Regarding offspring health, compared to non-consumers, TB consumption four or more times per week was associated with a substantial increase in the risk of macrosomia (OR = 2.143; 95% CI: 1.304-3.522) and large for gestational age (LGA) (OR = 1.695; 95% CI: 1.219-2.356). In the analysis of NSS, with a significantly increased risk of macrosomia (OR = 6.581; 95% CI:2.796-13.824) and LGA (OR = 7.554; 95% CI: 3.372-16.921).

CONCLUSION

The high level of beverage consumption among pregnant women in Shanghai needs attention. Excessive consumption of beverages increases the risk of GDM and GH, while excessive consumption of NSS possibly has a greater impact on offspring macrosomia and LGA.

Sucrose Solution Ingestion Exacerbates Dinitrofluorobenzene-Induced Allergic Contact Dermatitis in Rats

Allergic dermatitis is a skin disease with growing prevalence worldwide that has been associated with diets high in fats and sugars. Regular consumption of sucrose-containing beverages may increase the risk for several health problems, including allergic diseases and particularly asthma, but the association between sucrose consumption and allergic dermatitis is understudied. We investigated the effects of sucrose solution intake on allergic contact dermatitis in rats and found early exacerbation of 2,4-dinitrofluorobenzene (DNFB)-induced disease symptoms and altered composition of the gut microbiota after 14 d of intake. The levels of short-chain fatty acids-produced by fermentation by the intestinal microbiota-were not affected in the cecal contents and feces but decreased in the blood; this effect was especially notable for acetate. To restore blood acetate concentrations, triacetin was mixed with a 10% sucrose solution and fed to the rat model. This strategy prevented the early exacerbation of DNFB-induced symptoms. The decreased absorption of short-chain fatty acids from the intestinal lumen was not linked to the decreased expression of short-chain fatty acid transporters in the small intestine; instead, the mechanism involves a reduction in the sodium concentration in the intestinal lumen due to increased expression of sodium-glucose transporter 1 (SGLT1).

Older Chinese adults' milk consumption habits: A study across 5 cities

Milk consumption in China has experienced a rapid growth over the past few decades. This study explored milk consumption habits of older Chinese adult regular milk consumers, by investigating what, where, when, with whom, why, and how milk was consumed. This study (n = 1,000) was conducted in 5 cities in China (first tier: Beijing, Shanghai and Guangzhou; second tier: Chengdu and Shenyang) with participants balanced by sex and age groups (45-55 and 65-75 yr old). Given different economies, general dietary habits, and lifestyles, differences in milk consumption habits between cities were hypothesized. The results showed that almost all participants consumed cow milk, at home and by direct drinking. Most participants consumed milk during breakfast, with their family and for nutrition and health purposes. However, variations by city were found in what type of, what fat level of, what brand of, when and how milk was consumed. Multiple factor analysis showed that "what" variable differentiated cities between tiers and among the first-tier cities, and that "when" and "how" variables also separated the 2 second-tier cities and from the first-tier cities. Although variation in how milk was consumed was also observed between sexes and age groups, hierarchical cluster analysis revealed that the 4 clusters of milk consumption habits derived were mainly differentiated by city: Beijing and Shanghai, Guangzhou, Chengdu, and Shenyang. This study provides comprehensive insights into the milk consumption habits of older Chinese adults and highlights the significant heterogeneity in milk consumption habits in China by city.

The impact of heat treatment of bovine milk on gastric emptying and nutrient appearance in peripheral circulation in healthy females: a randomized controlled trial comparing pasteurized and ultra-high temperature milk

BACKGROUND

Heat treatments of dairy, including pasteurization and ultra-high temperature (UHT) processing, alter milk macromolecular structures, and ultimately affect digestion. In vitro, animal, and human studies show faster nutrient release or circulating appearance after consuming UHT milk (UHT-M) compared with pasteurized milk (PAST-M), with a faster gastric emptying (GE) rate proposed as a possible mechanism.

OBJECTIVES

To investigate the impact of milk heat treatment on GE as a mechanism of faster nutrient appearance in blood. We hypothesized that GE and circulating nutrient delivery following consumption would be faster for UHT-M than PAST-M.

METHODS

In this double-blind randomized controlled cross-over trial, healthy female (n = 20; 27.3 ± 1.4 y, mean ± SD) habitual dairy consumers, consumed 500 mL of either homogenized bovine UHT-M or PAST-M (1340 compared with 1320 kJ). Gastric content volume (GCV) emptying half-time (T50) was assessed over 3 h by magnetic resonance imaging subjective digestive symptoms, plasma amino acid, lipid and B vitamin concentrations, and gastric myoelectrical activity were measured over 5 h.

RESULTS

Although GCV T50 did not differ (102 ± 7 min compared with 89 ± 8 min, mean ± SEM, UHT-M and PAST-M, respectively; P = 0.051), GCV time to emptying 25% of the volume was 31% longer following UHT-M compared with PAST-M (42 ± 2 compared with 32 ± 4 min, P = 0.004). Although GCV remained larger for a longer duration following UHT-M (treatment × time interaction, P = 0.002), plasma essential amino acid AUC was greater following UHT-M than PAST-M (55,324 ± 3809 compared with 36,598 ± 5673 μmol·min·L-1, P = 0.006). Heat treatment did not impact gastric myoelectrical activity, plasma appetite hormone markers or subjective appetite scores.

CONCLUSIONS

Contrary to expectations, GE was slower with UHT-M, yet, as anticipated, aminoacidemia was greater. The larger GCV following UHT-M suggests that gastric volume may poorly predict circulating nutrient appearance from complex food matrices. Dairy heat treatment may be an effective tool to modify nutrient release by impacting digestion kinetics.

CLINICAL TRIAL REGISTRY

www.anzctr.org.au (ACTRN12620000172909).

Lead, Cadmium, and Arsenic in Raw Milk Produced in the Vicinity of a Mini Mineral Concentrator in the Central Andes and Health Risk

The bovine milk quality, safety, and security are of great concern mainly due to the dispersion of toxic substances from various anthropogenic activities and poor practices for organophosphates in agriculture use. This study evaluated the potential risk to human health from lead (Pb), cadmium (Cd), and arsenic (As) from the consumption of milk produced in an area of the Central Andes valley near a mini mineral concentrator by estimating the weekly intake (WI), dietary risk quotient (DRC), hazard quotient (THQ), and hazard index (HI) for the Peruvian population aged 2 to 85 years, in three scenarios of milk consumption by age (minimum, average, and maximum). Toxic element quantification was performed by flame atomic absorption spectrometry following standardized procedures. The mean amount ± standard deviation of Pb, Cd, and As in soils was 292±60.90, 3.54±1.58, and 5.60±2.20 mg/kg, the order of importance being Pb>As>Cd. The contents of Pb, Cd, and As in pastures were 23.17±10.02, 0.25±0.57, and 0.06±0.09 mg/kg, being from highest to lowest Pb>Cd>As. The means of Pb, Cd, and As content in 19 milk samples were 0.029±0.022, 0.007±0.006, and 0.010±0.004 mg/kg. Pb and Cd exceeded the maximum permissible limits (MPL), and the As was below the MPL. At all ages and milk consumption levels, the WI for Pb and Cd were below the estimated tolerable intake (TWI). The WI for As in < 19 years was higher than the TWI. The DRC for Pb and Cd at all three milk intake levels and all ages was < 1, and for As, it was > 1 in < 19 years, being the risk group. The TQH and HI for Pb and Cd were also > 1, signifying no health risk, and for As, the values were > 1 in < 11 years. Our results are valuable for preventing adverse health impacts from safe and innocuous milk consumption.

Assessing the Health Risk and Trophic Transfer of Lead and Cadmium in Dairy Farming Systems in the Mantaro Catchment, Central Andes of Peru

This study investigated lead (Pb) and cadmium (Cd) transfer in three dairy farming areas in the Mantaro river headwaters in the central Peruvian Andes and at varying distances from the mining complex at La Oroya. At each of these sites, the transfer of trace metals from the soil to raw milk was estimated, and a hazard assessment for lead and cadmium was carried out in scenarios of minimum, average, and maximum milk consumption in a Peruvian population aged 2-85. Pb and Cd were quantified by flame atomic absorption spectrometry. Significantly, the concentrations of lead and cadmium were found to exceed the maximum limits recommended by the World Health Organization, with a positive geospatial trend correlated with the distance from mining activity. Both Pb and Cd were found to be transferred through the soil-pasture-milk pathway, with the primary source of Cd being phosphate-based fertilizers used in pasture improvement. Pb was found to be the most significant contributor to the Hazard Index (HI) with those under 19 years of age and over 60 recording an HI of >1, with infants being the most vulnerable group due to their greater milk consumption in relation to their body weight. A marginal increase in contamination was observed in the dry season, indicating the need for studies to be expanded over several annual cycles.

Own price elasticities of the demand for sugar-sweetened beverages in Bangladesh

BACKGROUND

Consumption of sugar-sweetened beverages (SSB) is a major global public health problem. Increasing the price of SSBs through taxation is an effective tool to reduce SSB consumption. Price-elasticity estimates are useful in measuring the effect of taxation on consumption. We estimated the own price elasticities of demand for SSBs in Bangladesh, which will inform how SSB taxes could affect behaviour.

METHODS

We used Household Income and Expenditure Survey (HIES) 2016 data, which is a nationally representative dataset at the household level across the country and is conducted using stratified random sampling method. Deaton's method was used to estimate the price elasticities for SSBs in Bangladesh.

RESULTS

We found that the own price elasticity for SSBs varied between - 0.53% to -1.17% by types of SSBs in Bangladesh. The price elasticity for soft drinks was - 1.17, indicating that if the price of soft drinks increases by 10% via taxes, the quantity consumed of these beverages would reduce by 11.7%.

CONCLUSION

This is the first study that estimates the own price elasticities of demand for SSBs in Bangladesh. Our results suggest to raise SSB prices through increased taxation in order to reduce SSB consumption and ensure public health gains in Bangladesh.

Three approaches to assessing dietary quality in Mexican adolescents from 2006 to 2018 with data from national health and nutrition surveys

OBJECTIVE

To assess trends in the dietary quality of Mexican adolescents from 2006 to 2018, both overall and by sociodemographic indicators, using adaptations of the EAT-Lancet Planetary Health (PH) recommendations, optimal intake estimated by the Global Burden of Disease (GBD) and 2015 Mexican Dietary Guidelines (MDG) in nationally representative samples.

DESIGN

Using dietary data from a semi-quantitative FFQ, dietary quality indexes were constructed as adaptations of three dietary intake recommendations. Trends in adherence to recommendations were evaluated with multivariate quantile regression models with survey year as the main independent variable and adjusted for age, sex, energy intake, dwelling area, geographical region, household assets condition, and student/non-student status. P values and CI were Bonferroni-corrected.

SETTING

Mexico.

PARTICIPANTS

Non-pregnant or lactating adolescents aged 12-19 years (n 16 520).

RESULTS

Adherence to the PH index was about 40 %, GBD was nearly 35 % and MDG was about 37 %. The lowest adherences were for added sugars, sugar-sweetened beverages, nuts and seeds, red meats, processed meats, and legumes (<28 %). No 2006-2018 trends in total adherence were found in any index. Nevertheless, negative adherence trends were identified for poultry (β = -2·4), and saturated fats (β = -0·93), and positive for unsaturated oils (β = 1·23), in the PH. In MDG, relevant trends were found for plain water (β = 1·63) and foods rich in fats (β = -1·24).

CONCLUSIONS

Mexican adolescents have demonstrated poor dietary quality by these three approaches. Therefore, this population has a high-risk profile for diet-associated chronic diseases. Further research and appropriate public policies are needed.

The impact of taxing sugar-sweetened beverages on diabetes: a critical review

The global burden of type 2 diabetes is increasing at an alarming rate, fuelled by the obesity epidemic, with significant associated health and economic consequences and apparent inequalities. Sugar-sweetened beverages (SSBs) are a major source of added sugars in diets worldwide and have been linked to an increased risk of type 2 diabetes through a variety of mechanisms, including excess weight. Taxing SSBs has become a promising public health strategy to reduce consumption and mitigate the burden of type 2 diabetes. A substantial body of evidence suggests that SSB taxes lead to increased prices and subsequent reduced consumption, with a potentially greater effect among lower socioeconomic groups. This highlights the potential for tax policies to have an impact on type 2 diabetes and address health inequalities. Evidence from several ongoing SSB tax schemes, including sales and excise taxes, indicates positive effects on improving consumption patterns, and modelling studies point to health gains by averting type 2 diabetes and other cardiometabolic diseases. In contrast, evidence from empirical evaluation of the impact of SSB tax is scarce. Continued monitoring and the strengthening of evaluation research to develop context-tailored policies are required. In addition, there is a need to implement complementary efforts to amplify the impact of SSB taxation and effectively address the global burden of type 2 diabetes.

Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study

BACKGROUND

An association between sweetened beverages and several cardiometabolic diseases has been reported, but their association with atrial fibrillation (AF) is unclear. We aimed to investigate the associations between consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) and risk of consumption with AF risk and further evaluate whether genetic susceptibility modifies these associations.

METHODS

A total of 201 856 participants who were free of baseline AF, had genetic data available, and completed a 24-hour diet questionnaire were included. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During a median follow-up of 9.9 years, 9362 incident AF cases were documented. Compared with nonconsumers, individuals who consumed >2 L/wk of SSB or ASB had an increased risk of AF (HR, 1.10 [95% CI, 1.01-1.20] and HR, 1.20 [95% CI, 1.10-1.31]) in the multivariable-adjusted model. A negative association was observed between the consumption of ≤1 L/wk of PJ and the risk of AF (HR, 0.92 [95% CI, 0.87-0.97]). The highest HRs (95% CIs) of AF were observed for participants at high genetic risk who consumed >2 L/wk of ASB (HR, 3.51 [95% CI, 2.94-4.19]), and the lowest HR were observed for those at low genetic risk who consumed ≤1 L/wk of PJ (HR, 0.77 [95% CI, 0.65-0.92]). No significant interactions were observed between the consumption of SSB, ASB, or PJ and genetic predisposition to AF.

CONCLUSIONS

Consumption of SSB and ASB at >2 L/wk was associated with an increased risk for AF. PJ consumption ≤1 L/wk was associated with a modestly lower risk for AF. The association between sweetened beverages and AF risk persisted after adjustment for genetic susceptibility to AF. This study does not demonstrate that consumption of SSB and ASB alters AF risk but rather that the consumption of SSB and ASB may predict AF risk beyond traditional risk factors.

Self-Reported Nutritional Status and Breakfast Characterization in Latin American University Students

OBJECTIVE

To associate breakfast consumption frequency with self-reported nutritional status and dietary patterns of Latin American university students by human development.

MATERIAL AND METHODS

This was a cross-sectional, multicenter observational study. University students from 11 Latin American countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, Peru, Paraguay, Panama and Uruguay) were invited to participate by answering an online self-administered questionnaire on food consumption and sociodemographic indicators, associations were investigated using logistic regression.

RESULTS

The logistic regression analysis showed significant associations between breakfast consumption and the crude model, models 2 and 3 in countries with very high and upper-middle/high human development. However, after adjustment in the most comprehensive model, the association is no longer statistically significant. In the fully adjusted model of the variables, a significant relationship was observed between breakfast consumption and both healthy and unhealthy dietary patterns. Specifically, students who typically consume breakfast exhibit greater consumption of oatmeal and fruits, as well as healthier dinner choices. Conversely, they exhibit lower consumption of fast food, sugary drinks, and juices. In particular, in highly developed countries, along with the mentioned foods, consumption of dairy was linked to breakfast consumption in a positive way, while alcohol consumption was negatively associated.

CONCLUSION

University students who eat breakfast on a regular basis maintain a healthier diet in comparison to those who do not, irrespective of their country's level of human development.

A 30-year trend of dairy consumption and its determinants among income groups in Iranian households

Introduction

Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups.

Methods

The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software.

Results

Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas.

Discussion

The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

Effectiveness of a school-based behavioural change intervention in reducing chronic disease risk factors in Chandigarh, India: a cluster-randomised controlled trial

Background

Early behavioural risk factors such as unbalanced diets, physical inactivity and tobacco and alcohol consumption lead to chronic diseases in later life. We conducted a cluster-randomised controlled trial to measure the effect of a school-based health-promotion intervention in reducing the behavioural risk factors of chronic diseases.

Methods

Twelve public schools in the Chandigarh, India were randomised to the intervention and control arm. Adolescents studying in eighth grade (n = 453), their parents (n = 395) and teachers (n = 94) were recruited for the current study. The Precede-Proceed Model was followed for intervention development. Intervention in each cluster comprised of one classroom session, four physical activity (PA) sessions every week for adolescents and four separate sessions for parents and teachers. Primary outcomes were eight binary or continuous measures of behavioural risk factors among adolescents (n = 359). Physical Activity Questionnaire-Adolescents (PAQ-A) scores were used to estimate physical activity. The ANCOVA based on cluster proportions or means was used to estimate the intervention effect accounting for baseline data.

Findings

Among adolescents, the intervention reduced salt intake by 0.5 g/d (95% CI: -0.9, -0.1), proportion of current alcohol users by 5% (95% CI: -9, -0.007), and increased fruit consumption by 18 g/d (95% CI: 5, 30) and PA by 0.2 PAQ-A score (95% CI: 0.07, 0.3). However, the intervention had no effect on the sugar and vegetable intake and on smokers and tobacco chewers. Exploratory analysis revealed that among parents, PA increased by 205 metabolic equivalents task (MET) units (95% CI: 74.5, 336), fruits intake by 20 g/d (95% CI: 6, 34), and vegetable intake by 117 g/d (95% CI: 50.5, 183). Whereas salt consumption decreased by 0.5 g/d (95% CI: 0.15, 0.9) and the proportion of current alcohol users declined by 5% (95% CI: 9, -1) among parents. Vegetable consumption increased by 149 g/d (95% CI: 12, 286) among teachers.

Interpretation

The intervention package implemented among adolescents by involving parents and teachers is an effective model for school-based behaviour-change interventions.

Funding

MK received partial funding from the George Institute for Global Health, Hyderabad, India for the salt-reduction component of the study.

Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017

BACKGROUND

Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide.

METHODS

We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders.

RESULTS

Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values.

CONCLUSION

The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

Sugar sweetened beverages, natural fruit juices, and cancer: what we know and what still needs to be assessed

Cancer is known as one of the leading causes of death in the world. In addition to early mortality, cancer is associated with disability in affected patients. Among environmental risk factors, special attention has been paid to the role of dietary factors. In recent decades, the consumption of sugar-sweetened beverages (SSBs) and natural fruit juices has increased. Several studies have assessed the effects of these beverages on human health and found that a higher intake of SSBs is associated with a greater risk of obesity, diabetes, cardiovascular diseases, hypertension, and non-alcoholic fatty liver disease. However, current evidence for cancer incidence and mortality is not conclusive. In the current review, we concluded that SSBs intake might be positively associated with cancer incidence/mortality through their increasing effects on obesity, inflammatory biomarkers, serum levels of insulin-like growth factor-I (IGF-I), and advanced glycation end-products. Such a positive association was also seen for natural fruit juices. However, types of natural fruit juices were not considered in most previous studies. In addition, some types of cancer including brain, lung, and renal cancers were not assessed in relation to SSBs and natural fruit juices. Therefore, further studies are needed in this regard.

Understanding the behavioral determinants of adolescents' water consumption: A cross-country comparative study

Substituting the consumption of sugar-sweetened beverages (SSB) with that of water can have a positive effect on adolescents' health. However, despite the attention on this topic in the Global North, it is relatively understudied in other regions of the world, such as the Caribbean. To guide the development of future interventions, understanding the factors determining water consumption among Caribbean adolescents is important. This study examined the behavioral determinants of water consumption among adolescents in Aruba (the Caribbean) and compared them to those in the Netherlands (Western Europe). We used a theoretical model that integrates the dominant theoretical perspectives in the field of public health, including theories of planned behavior, social norms, and intrinsic motivation. This cross-country study included 1,584 adolescents from Aruba and the Netherlands (52% girls; M = 12.34 years; SD = 2.14). The data were analyzed using regression analyses. This study found that in Aruba, adolescents with higher scores of intrinsic motivation, friends' descriptive norms, attitudes, and behavioral control regarding water consumption drank more water. Moreover, the associations between water consumption and both intrinsic motivation as well as friends' descriptive norms for adolescents in Aruba were stronger than those found in the Netherlands. These associations imply that it is even more important for Aruban adolescents than Dutch adolescents to be intrinsically motivated or to perceive their friends often consuming water to drink more water. The cross-country comparison implies that future interventions in Aruba aimed at increasing adolescents' water consumption as an alternative to SSB should focus on enhancing their intrinsic motivation while considering their friends' social norms.

Urinary perchlorate, thiocyanate, and nitrate and their associated risk factors among Chinese pregnant women

Perchlorate, nitrate, and thiocyanate are well-known inhibitors of iodide uptake and thyroid-disrupting chemicals. Widespread human exposure to them has been identified, whereas studies on their internal exposure levels among Chinese pregnant women are scarce and factors associated with them are not well recognized. The objective of this study is to determine their levels and identify the associated factors among pregnant women (n = 1120), based on a prospective birth cohort in Wuhan, central China, using repeated urine samples of three trimesters. Urinary perchlorate, thiocyanate, and nitrate were 100% detected in the samples, and specific gravity-adjusted median concentrations of them in all the samples were 12.6 ng/mL, 367 ng/mL, and 63.7 μg/mL, respectively. Their concentrations were weakly-to-moderately correlated with each other, with Spearman correlation coefficients ranging from 0.27 to 0.54. Poor reproducibility were observed for the three analytes over the three trimesters, with intraclass correlation coefficient of 0.07, 0.19, 0.04 for perchlorate, thiocyanate, and nitrate, respectively. The women who were overweight or used tap water as drinking water had significantly higher perchlorate concentrations, while those with excessive gestational weight gain had significantly higher thiocyanate concentrations (p < 0.05). The women with a college degree or above had lower nitrate concentrations (p < 0.05). Meanwhile, the median concentration of perchlorate in urine samples collected in spring, thiocyanate in those collected in winter, and nitrate in those collected in autumn, was significantly higher compared to their median concentrations in the samples collected in other three seasons (p < 0.05), respectively. Urinary perchlorate and nitrate concentrations of pregnant women in this study were higher than the concentrations of pregnant women in other countries, while thiocyanate concentrations were lower than that of most other countries. This study suggested potential covariates for future epidemiological analyses.

Food contributing to fermentable oligosaccharide, disaccharide, monosaccharide, and polyols intake in Korean adults

BACKGROUND/OBJECTIVES

The dietary intake of foods with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is known to adversely affect patients with irritable bowel syndrome (IBS). However, the effects of FODMAP have been studied predominantly among Western populations. This study aimed to identify foods high in FODMAP content which form a part of the Korean adult diet and obtain basic data for the preparation of IBS guidelines.

SUBJECTS/METHODS

An online survey of 1,000 adults from the general population in the age group of 20 to 40 years was performed. Data from 787 participants (men, 386; women, 401) were analyzed. The general characteristics of the participants, health status, IBS diagnosis using the Rome III diagnostic criteria, semi-quantitative food frequency questionnaire findings, and food items causing symptoms were analyzed.

RESULTS

Overall, 169 participants (21.5%) had IBS. The contribution of the FODMAP nutrients in both IBS and healthy groups was as follows: fructan > lactose > excess fructose > sorbitol > mannitol > galacto-oligosaccharides (GOS). The fructan intake was 4.6 ± 2.2 g/day and 4.3 ± 2.5 g/day in the IBS and healthy groups (P = 0.014), respectively. In the IBS group, the ratio of the intake of fructan to the total FODMAP intake was 39.5%, 29.8%, and 5.8% through onions, garlic, and bananas, respectively.

CONCLUSIONS

Fructan was the FODMAP nutrient most consumed by Korean adults. Therefore, given the difference in the dietary habits of each country's population, the dietary guidelines for IBS should be country specific.

Attitudes of Chinese residents toward sugar-sweetened beverage tax and their willingness to pay: a cross-sectional survey

Background

Excessive consumption of sugar-sweetened beverages (SSBs) is associated with increased risks of obesity and chronic diseases. To effectively control SSB consumption, several countries including Mexico, France, and the United Kingdom have implemented SSB taxes. However, research on SSB taxes in China is limited.

Objective

To assess the attitudes of Chinese residents toward the SSB tax and their willingness to pay the tax. Methods: Data were collected through a questionnaire survey among 881 respondents. The generalized ordered logit regression model and marginal effect analysis were used to analyze Chinese participants' attitudes toward SSB tax and their willingness to pay it.

Results

The average monthly expenditure on SSBs was 44.8 ± 45.3 Yuan (RMB) (6.95 ± 7.02$), and 54.6% of residents supported the SSB tax; they were willing to pay, on average, 1.19 times the original price after additional tax. Age, physical exercise, self-rated health status, weight control plan, awareness of SSBs, children's consumption of SSBs, and proximity to the nearest SSB outlet significantly influenced attitudes toward tax. Notably, SSB awareness had the greatest effect on tax attitudes, with a 17% increase in the probability of supporting SSB tax for every one-level increase in SSB awareness among residents.

Conclusion

Residents in China have attained a certain level of awareness of, support for, and willingness to pay SSB tax. However, promoting knowledge about the health effects of SSBs and conducting further research to evaluate the effect of SSB tax on obesity prevention in China is still essential.

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.

Sugar-sweetened beverages consumption increases the risk of metabolic syndrome and its components in adults: Consistent and robust evidence from an umbrella review

BACKGROUND & AIMS

Sugar-sweetened beverages (SSBs) are potential modifiable risk factors for reducing the risk of metabolic syndrome (MetS); however, there is a lack of an umbrella review that robustly synthesizes the evidence. This review aims to synthesize the evidence linking habitual SSBs intake with MetS in adults, emphasizing the need for policy and regulatory actions.

METHODS

Four databases were comprehensively searched for relevant meta-analyses of prospective studies up to July 2023. Two authors independently conducted the screening for eligibility, data extraction, and quality assessment. The outcome of interest was MetS in adults, encompassing its component conditions. The present review was registered with PROSPERO (CRD42023402549).

RESULTS

Of the 16 eligible meta-analyses identified, 30 summary estimates were obtained for the impact of SSBs consumption on obesity, type 2 diabetes, hypertension, and MetS. Seven were rated as 'High' methodological quality, with the rest classified as 'Moderate' and 'Low' quality, consisting of three and six references, respectively. A comparison of the highest and lowest levels of SSBs consumption revealed an increased risk of 18% (95% CI: 13%-24%), 12% (95% CI: 11%-14%), 29% (95% CI: 25%-32%), and 29% (95% CI: 7%-52%) for obesity, hypertension, type 2 diabetes, and MetS, respectively. Consistently, the findings from dose-response analyses are in agreement with and corroborate the existing evidence that SSBs are a significant risk factor for the development of MetS and its related conditions. Noticeably, the quality of evidence was predominantly deemed as highly suggestive and convincing. Moreover, consensus on specific criteria to identify studies related to SSBs in literature searching was lacking, and most primary studies were conducted in developed countries and Europe.

CONCLUSIONS

Our findings suggest that more rigorous and targeted policy interventions are warranted to curtail SSBs consumption, in order to alleviate the global burden of MetS.

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

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