Sociodemographic, lifestyle, behavioral, and parental factors associated with sugar-sweetened beverage consumption in children in China

Global trends in research on eating behaviors among overweight/obese children and adolescents: a bibliometric study from 2003 to 2023

Background

Despite the widespread interest in overweight/obese children and adolescents, there is a lack of bibliometric research on the factors influencing eating behaviors.

Methods

Collated and screened research papers published between 2003 and 2023 on eating behaviors in children and adolescents affected by overweight or obesity, searched on January 1, 2024. The primary data, comprising complete records and referenced citations of publications, was extracted from the Web of Science Core Collection. Analysis of data using Bibliometrix of R package, CiteSpace, and VOSviewer.

Results

A total of 2,142 articles were included. The United States had the most publications in the field and was also the center point for world collaborations. Harvard University had the most affiliated publications, while Luis Moreno was the most prolific author. NUTRIENTS was the most published journal. High-frequency keywords included Children, overweight, physical activity, body mass index, and childhood obesity. Research trends include Epidemiology and Environment factors of obesity; Health risks associated with childhood obesity; Key eating habits and interventions for childhood obesity; Prevention and treatment of childhood and adolescent obesity.

Conclusion

This research provides a comprehensive overview of global trends and key areas in studying dietary behaviors among overweight/obese children and adolescents. It offers a detailed summary of recent advancements, emphasizing this field's critical principles and practices. By exploring these developments, the study highlights the growing importance of this research within global healthcare and suggests pathways for future research and applications.

Spatiotemporal variations in body mass index among Han adolescents aged 18 years across 27 provinces of China, 1985-2019: Results from eight successive national cross-sectional surveys

OBJECTIVES

To investigate the spatiotemporal variations in body mass index among Han adolescents aged 18 years across 27 provinces of China from 1985 to 2019.

STUDY DESIGN

Cross-sectional epidemiological study.

METHODS

A total of 141,406 adolescents aged 18 years were included from eight Chinese National Surveillance on Students' Constitution and Health from 1985 to 2019. Body mass index data were extracted from 27 provinces in each CNSSCH. All provinces were categorized into seven regions. Linear regression was used to assess the trends.

RESULTS

The population-based national body mass index of boys and girls aged 18 years from 27 provinces increased by 2.35 kg/m2 and 1.40 kg/m2, respectively (all p < 0.001). Body mass index has been greater and the increase was larger in North China and East China during the 34-year period. Body mass index has been smaller and the increase was smaller in South China and Southwest China. The Northeast China had the largest increase in body mass index, becoming the region with the largest body mass index through 2019.

CONCLUSION

The body mass index among Chinese adolescents aged 18 years across provinces increased from 1985 to 2019. Further national and local efforts are needed to address spatiotemporal variations in body mass index.

Caffeine intake from foods and beverages and trends among Chinese children and adolescents: 2004-2018

BACKGROUND

The popularity of caffeinated foods and beverages poses risks of high caffeine exposure among Chinese children and adolescents. Nevertheless, there is a lack of national assessments on their caffeine consumption.

OBJECTIVE

To estimate daily caffeine intake and analyze time trends among Chinese children and adolescents.

METHODS

The study subjects were participants of the China Health and Nutrition Survey in 2004, 2006, 2009 and 2011, and the National Food and Beverage Consumption Survey in 2014 and 2018. Caffeine content was determined using chromatographic instrument. The Monte Carlo simulation was utilized to estimate daily caffeine intake and the Kruskal-Wallis test was used to analyze differences between population characteristics. To examine yearly trends in caffeine intake from 2004 to 2018, the partial Mann-Kendall test was applied.

RESULTS

The median daily caffeine intake of Chinese children and adolescents was 0.17 (95%CI: 0.15-0.20) mg/kg BW/day. Main contributors were tea (55.52%), sodas (19.52%) and tea beverages (10.37%). Approximately 4.68% of individuals consumed caffeine exceeding 2.5 mg/kg BW/day. Higher caffeine intake was observed in adolescents aged 12-17 years, males, and consumers residing in northeastern China. While no significant overall yearly trends in caffeine intake were detected from 2004 to 2018, there was an increase in intake driven by beverage consumption between 2006 and 2014.

CONCLUSION

This study provided a national assessment of caffeine consumption among Chinese children and adolescents. Caffeinated beverages like tea, soda, and tea beverages emerged as major contributors to caffeine intake. These findings could contribute to the regulation of caffeine consumption and the promotion of healthy habits among children and adolescents.

The effects of nutrition education on nutritional knowledge and dietary behaviours in primary school students in Zhongshan city

BACKGROUND

Adequate nutritional knowledge and healthy dietary behaviours are essential for promoting rational nutrition for children. However, lack of nutritional knowledge and unhealthy dietary behaviours are common among Chinese children. Therefore, we developed a school-based nutrition education (NE) program to assess its impacts on nutritional knowledge and dietary behaviours in pupils.

METHODS

In this trial, one school was assigned as an intervention group (n = 199) and the other two schools were designated as a control group (n = 140). Children in the intervention group received the NE program in addition to their regular health curriculum, whereas the control group continued with their usual health curriculum without any NE program materials.

RESULTS

Concerning nutritional knowledge, the mean difference (follow-up minus baseline) of average knowledge scores in the intervention group was significantly higher than that in the control group (1.99 ± 3.22 vs. 0.66 ± 3.60, p = 0.001). However, subgroup analysis revealed that this difference disappeared among boys and students with malnutrition status. Regarding dietary behaviours, the NE program significantly increased the proportion of children exhibiting high frequencies of meat and nuts consumption in the intervention group, along with diverse food choice at breakfast. Additionally, it markedly reduced the proportion of children exhibiting high frequencies of sugar-sweetened beverages and fast food consumption. Structural equation modelling analyses indicated a significant direct effect of NE intervention on nutritional knowledge and an indirect effect on dietary behaviours.

CONCLUSIONS

The NE program effectively enhanced nutritional knowledge scores and further improved dietary behaviours among Chinese primary school students. Future NE programs should pay more attention to boys and children with malnutrition.

Trend in physical growth among Chinese urban students: Results from five national successive cross-sectional surveys within the past two decades

OBJECTIVES

To examine the orientation, magnitude, and pace of secular trends in body height, weight, and body mass index (BMI) among Chinese urban students aged 7-18 years from 2000 to 2019.

METHODS

Data were extracted from Chinese urban students aged 7-18 years from the Chinese National Surveillance on Students' Constitution and Health in 2000, 2005, 2010, 2014, and 2019. The height, weight, and BMI of 548 419, 548 408, and 548 365 urban students aged 7-18 years, respectively, were tested. The mean differences across survey years were tested by one-way analysis of variance (ANOVA). The pace of secular trends is expressed as the change every 5 years between every two adjacent survey years.

RESULTS

Height increments between 1.9 and 6.2 cm, weight increments between 2.7 and 8.6 kg, and BMI increments between 0.9 and 1.9 kg/m2 were observed in boys. For girls, height increments between 1.5 and 4.9 cm, weight increments between 2.2 and 6.0 kg, and BMI increments between 0.7 and 1.7 kg/m2 were observed. The pace of secular trends in height decreased in the last 5 years, and the secular trends in weight and BMI have accelerated in the last 9 years compared with the previous 10 years.

CONCLUSIONS

Although the secular trend in height among Chinese urban students has slowed, it has not yet reached its genetic potential and continues to increase. The rapid increase in weight and BMI was a cause for concern. Our findings provide a basis for the future formulation of public health interventions in China.

Decomposing Socioeconomic Inequality in Early Childhood Caries Among 3 to 5-Year-Old Children in China

INTRODUCTION AND AIMS

Early childhood caries (ECC) is a widespread oral disease that harms children's health in China. Although previous studies have linked ECC prevalence to socioeconomic status, few have measured the degree of socioeconomic inequality. This study aimed to evaluate the socioeconomic inequality of ECC in children aged 3 to 5 years in China and identify the contributor to the inequality.

METHODS

We extracted data on 3 to 5-year-old children from the fourth National Oral Health Survey. We measured the inequality of ECC by the average household income per capita. We used the average household income per capita to measure the inequality of ECC. To describe inequality both qualitatively and quantitatively, we used the following methods: concentration curve, Erreygers-corrected concentration index, relative index of inequality and slope index of inequality. We also applied a decomposition based on the probit model to identify the factors that contributed to inequality.

RESULTS

The prevalence of ECC in Chinese preschool children was 63.11% (95% CIs: 60.54%, 65.61%). The negative value of the Erreygers-corrected concentration index (-0.0459; 95% CIs: -0.0594, -0.0324), slope index of inequality (-0.0674; 95% CIs: -0.0876, -0.0471) and the positive value of relative index of inequality (0.7484; 95% CIs: 0.6856, 0.8169) all indicated that ECC prevalence was higher among children from low-income families. The main factors contributing to inequality were average household income, parents' educational level and living areas.

CONCLUSION

There is a pro-poor inequality in ECC among 3 to 5-year-old children in China.

CLINICAL RELEVANCE

To improve oral health equality, policymakers should focus more on children from low-income families, with less educated parents and living in rural areas.

Associations between sugar-sweetened beverages consumption, duration of physical exercise, and depressive symptoms among Tibetan university students at high altitude

Background

Depressive symptoms have become a public health issue of common concern in countries all over the world, and have many negative impacts on university students' study and life. Depressive symptoms are influenced by many factors, including sugar-sweetened beverages (SSBs) consumption and duration of physical activity. However, no study has been conducted on the association between sugar-sweetened beverage consumption, duration of physical exercise, and depressive symptoms among Tibetan university students at high altitudes.

Methods

In this study, a self-assessment survey of SSBs consumption, duration of physical exercise, and depressive symptoms was conducted on 6,259 (2,745 boys, 43.86%) Tibetan university students aged 19-22 years in Lhasa and Ganzi areas, China, using stratified whole population sampling. The associations were also analyzed using one-way analysis of variance, binary logistic regression analysis, and ordered logistic regression analysis in the generalised linear model.

Results

The proportions of mild depression symptoms, moderate depression symptoms, and major depressive symptoms among Tibetan boys university students in high-altitude areas of China were 18.0, 22.9, and 1.5%, respectively; the proportions of girls students were 20.1, 21.9, and 1.5%, respectively, 1.5%, and the differences in the detection rates of depressive symptoms between sex were statistically significant (χ 2 value = 14.253, p < 0.01). Ordered logistic regression analyses showed that using duration of physical exercise >60 min/d and SSBs ≤1 times/week as the reference group, the duration of physical exercise <30 min/d and SSBs ≥5 times/week groups had the highest risk of developing depressive symptoms was the highest risk (OR = 6.98, 95% CI: 5.05-9.65; p < 0.001).

Conclusion

This study confirmed that there was a positive association between SSBs consumption and depressive symptoms and a negative association between the duration of physical exercise and depressive symptoms among Tibetan university students at high altitudes in China. In the future, SSBs consumption should be effectively controlled and the duration of physical exercise should be increased to reduce the occurrence of depressive symptoms and promote the physical and mental health of Tibetan university students in high-altitude areas.

Criterion-Related Validity of the Sugar-Sweetened Beverage (SSB) Questionnaire Among Children and Adolescents in Malaysia

Sugar-sweetened beverages (SSBs) are a major source of dietary sugar, and their consumption is on the rise among children and adolescents. Excessive sugar intake is a significant contributor to overweight, obesity, and non-communicable diseases (NCDs). The consumption of SSBs, particularly that of children and adolescents, has been of interest as of late, as they are implicated in affecting body weight status. Thus, the goal of this study was to determine the predictive criterion-related validity of the SSB questionnaire that was administered to children and adolescents to assess their SSB and non-SSB intake. A nationwide cross-sectional study involving 5211 respondents aged 7-17 years old and their parents was conducted. The self-administered Malay questionnaire was distributed to collect information on socioeconomic background, the frequency of eating out at restaurants or other food premises, the availability of SSBs at home, and SSB consumption patterns of children and adolescents within a week. The predictive criterion-related validity was determined by using six hypotheses that can differentiate between two independent sample means of SSB consumption based on age, gender, locality, monthly household income, frequency of eating out at restaurants or other food premises, and availability of SSBs at home. The independent samples t-test and one-way ANOVA were used to conduct the validation process. Five out of six hypotheses were accepted. Significant mean differences were observed between sociodemographic factors, such as age (t=-10.56, p<0.001), localities (t=-5.37, p<0.001), monthly household income (F=26.83, p<0.001), and SSB consumption. Behavioural factors, including eating out at restaurants or other food premises (t=9.93, p<0.001) and environmental factors such as the availability of SSBs at home (F=136.24, p<0.001) also showed a significant difference with SSB consumption. The SSB questionnaire demonstrated the ability to differentiate between groups. Thus, this SSB questionnaire appears to be valid to measure the SSB consumption of children and adolescents.

Magnitude of sugar-sweetened beverage consumption and associated factors among women aged 15-49 years old in two Sub-Saharan African countries

BACKGROUND

The consumption of Sugar-Sweetened Beverages (SSBs) has been linked to the global epidemic of obesity and chronic disease. Following the economic growth, urbanization, and attractive market for beverage companies, the consumption of SSBs is a rising public health challenge in low and middle-income countries. Hence, this study aimed to assess the magnitude of SSBs consumption and associated factors among women of reproductive age group in two SSA countries.

METHODS

This cross-sectional study used data from Integrated Public Use Micro Data Series-Performance Monitoring for Action (IPUMS-PMA) with a total sample of 3759 women aged 15-49 years old in Burkina Faso and Kenya. The data was collected on June - August 2018 in Burkina Faso, and May -August 2018 in Kenya. SSBs consumption was measured by asking a woman if she drank SSBs yesterday during the day or night, whether at home or anywhere else. A mixed-effect logistic regression model was employed to identify associated factors.

RESULT

Half (50.38%) [95%CI; 46.04, 54.71] of women consumed SSBs. Sociodemographic characteristics like primary education (AOR = 1.35; 95%CI: 1.05-1.74), secondary education (AOR = 1.46; 95%CI: 1.13-1.90), being employed (AOR = 1.28; 95%CI: 1.05-1.56),and dietary characteristics like consumption of savory and fried snack (AOR = 1.61; 95%CI = 1.24-2.09), achieved minimum dietary diversity (AOR = 1.67; 95%CI: 1.38-2.01), moderate household food insecurity (AOR = 0.74, 95% CI: 0.58, 0.95), and sever household food insecurity (AOR = 0.71, 95% CI: 0.56, 0.89) had significant statistical association with SSBs consumption.

CONCLUSION

Consumption of SSBs among women in two Sub-Saharan African countries (Burkina Faso and Kenya) is high. Having higher educational status, being employed, achieved minimum dietary diversity, and having low/no household food in-security were found to be significantly associated with SSBs compared with their counterparts. We recommend for further study in other African countries using objective measurements of SSBs consumption.

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16-19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.

Prospective association of family members' sugar-sweetened beverages intake with children's sugar-sweetened beverages consumption in China

PURPOSE

We aimed to investigate whether parental and siblings' sugar-sweetened beverage (SSB) intake had prospective impact on children's SSB consumption, and the potential sex difference in these associations.

METHODS

This study included a total of 904 children and their parents enrolled from 2004 to 2011 China Health and Nutrition Survey (CHNS) cohort study. SSB consumption information was estimated using a short dietary questionnaire and total energy intake was assessed with three-day 24-h dietary assessments at recruitment and follow-up surveys. Multivariate logistic or linear regression analyses were used to assess the association for SSB consumption between parents, siblings and children after adjusting for age, body mass index (BMI) z-score, household income and parental educational level.

RESULTS

In this study, a majority (87.6%) of children consumed SSB. Among them, the median consumption of SSB was 70.3 ml/day per capita and 205.4 ml/day per consumer. Parental SSB consumption was relevant to children's SSB consumption, and this association was more pronounced in boys than in girls. Meanwhile, fathers seemed to have a stronger impact on whether children consume SSB than mothers which was reflected by lower P and higher OR. Additionally, children's SSB intake was prospectively associated with their older siblings' SSB consumption (P _{for trend} < 0.03).

CONCLUSIONS

Parental and older siblings' SSB consumption was relevant to children's SSB intake. Particularly, boys were more susceptible to parental impact than girls, and fathers seemed to have a greater influence on children than mothers.

Association of sugar-sweetened beverage consumption with psychological symptoms among Chinese university students during the COVID-19 pandemic

BACKGROUND

Mental health of college students has become a public health issue of common concern worldwide. Especially during the COVID-19 pandemic, the problem has become even more acute. The aim of this study was to assess the association between sugar-sweetened beverages (SSB) consumption and psychological symptoms among Chinese college students in order to promote their mental health.

METHODS

The study population was 6,120 college students aged 19-22 years from Anhui, Henan and Xinjiang, China. Basic demographic information, covariates and SSB Consumption data were collected through a self-assessment questionnaire. The "Multidimensional Sub-health Questionnaire of Adolescents" was used to assess the psychological symptoms of college students. The Chi-square test, one-way ANOVA and logistic regression analysis were used to investigate the differences and associations between SSB consumption and psychological symptoms among Chinese college students.

RESULTS

The detection rate of psychological symptoms among Chinese college students was 8.1%. The detection rate of boys students was 9.4% and that of girls students was 7.1%, and the difference was statistically significant in comparison (χ 2-value was 11.08, p < 0.001). After controlling for covariates, Model 2 analysis showed that compared to SSB consumption <2 time/week, college students with SSB consumption ≥2 time/week (OR = 2.96, 95% CI: 2.36, 3.70) had a higher risk of psychological symptoms (p < 0.001). The same trend was found for emotional symptoms, behavioral symptoms, and social adaptation difficulties dimensions.

CONCLUSION

There is an association between SSB consumption and the occurrence of psychological symptoms among Chinese college students. Future measures should be taken to reduce both SSB consumption and the incidence of psychological symptoms.

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

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

The Association between Sugar-Sweetened Beverages and High-Energy Diets and Academic Performance in Junior School Students

This study aimed to understand the consumption frequency of sugar-sweetened beverages (SSBs) and high-energy diets in junior school students in China and to explore the relationship between SSBs and high-energy diets and academic performance. Information about 9251 junior school students was retrieved from the China Education Panel Survey (CEPS) database. The Mann−Whitney U test and the Kruskal−Wallis test were used to compare differences in academic performance based on the variables of interest. Generalized linear mixed models were used to analyze the association between the consumption frequency of SSBs and high-energy diet and student academic performance, fixed and random effects were included to control for confounding factors. The proportions of the “often” consumption group of SSBs and high-energy diets were 21.5% and 14.6%, respectively. For SSBs, the total score of the “often” consume group was 4.902 (95%CI: −7.660~−2.144, p < 0.001) points lower than that of the “seldom” consume group. Scores of Chinese math, and English were 0.864 (95%CI: −1.551~−0.177, p = 0.014), 2.164 (95%CI: −3.498~−0.831, p = 0.001), and 1.836 (95%CI: −2.961~−0.710, p = 0.001) points lower, respectively. For high-energy diets, the scores of total, Chinese and English in the “sometimes” consume group were 2.519 (95%CI: 0.452~4.585, p = 0.017), 1.025 (95%CI: 0.510~1.540, p < 0.001) and 1.010 (95%CI: 0.167~1.853, p = 0.019) points higher than that of the “seldom” consume group, respectively. Our findings suggested that consumption of SSBs was often negatively associated with academic performance in junior school students, while medium consumption of high-energy diets had a positive correlation. The positive association between high-energy diets and academic performance may be related to the food items included in the high-energy diets consumed by Chinese students. Schools and families should pay more effort to reduce the consumption of SSBs, and for high-energy diets, the focus should be on food selection and avoiding excessive intake. Longitudinal studies are needed to further test these findings among adolescents.

Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing

The excessive consumption of sugar-sweetened beverages (SSBs) has been proven to be critical for obesity among preschoolers. This study aimed to describe the SSB consumption rates among preschoolers in the Dongcheng District of Beijing, China, and to explore the association between obesogenic environmental determinants and consumption. We applied a stratified cluster sampling method and recruited 3057 primary caregivers of preschoolers in June 2019 to participate in the survey. The caregivers reported their children’s consumption rates of six categories of SSBs and their exposure rates to SSB-related obesogenic environments. The associations between them were tested using multivariate logistic regression models. The mean (SD) age of the children was 5.6 (0.6) years and nearly half (48.3%) were girls. About 84.5% of the children had consumed SSBs over the past three months, and sugar-sweetened milk beverages had the highest consumption rate. Higher exposure to advertisements for the corresponding SSB categories in children, higher frequency rates of consuming SSBs and of taking children to fast-food restaurants in caregivers, and lower frequency rates of reading the Nutrition Facts Panels by caregivers were associated with higher SSB consumption rates among children (p < 0.05 in all of the SSB categories investigated, except for the Nutrition Facts Panel reading behaviors for the sports and energy beverages). SSB consumption among preschoolers is of concern, and comprehensive policy actions and education are urgently needed.