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

Detrimental effects of chronic sugar-sweetened carbonated soft drink consumption on inflammatory response and the size of apical periodontitis: An animal-based study

AIM

This study aimed to evaluate the effects of chronic consumption of two sugar-sweetened carbonated soft drinks - one containing caffeine (Coca-Cola®) and one without (Sprite®) - on the progression of periapical lesions and the levels of pro-inflammatory cytokines in rats.

METHODOLOGY

Twelve Wistar rats were divided into three groups (n = 4): Control group, Coca-Cola group and Sprite group. The rats in Coca-Cola and Sprite groups were given ad libitum access to their respective soft drinks for 3 months, while the Control group received filtered water. After 2 months of consumption, the pulps of the lower left first molars were exposed for 28 days to induce periapical lesions. Following euthanasia, the jaws were removed, and the periapical lesions were assessed using micro-computed tomography imaging. Blood samples were collected to analyse the pro-inflammatory cytokines IL-1β, IL-6, IL-2, IL-17 and TNF-α via Luminex assay. Non-parametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, while parametric data were analysed using one-way ANOVA followed by Tukey's test (p < 0.05).

RESULTS

Both the Coca-Cola and Sprite groups exhibited periapical lesions with significantly greater volume and diameter compared to the Control group (p < 0.05). Additionally, both soft drink groups had significantly higher levels of IL-1β, IL-6 and IL-2 compared to the Control group (p < 0.05). The Sprite group displayed significantly higher levels of IL-1β than the Coca-Cola group (p < 0.05), while the Coca-Cola group showed significantly elevated TNF-α levels compared to both the Control and Sprite groups (p < 0.05). No significant differences in IL-17 levels were observed among the groups (p > 0.05).

CONCLUSIONS

The chronic consumption of sugar-sweetened carbonated soft drinks, regardless of caffeine content, has detrimental effects on the inflammatory response and progression of apical periodontitis in rats.

Obesity among college students in Oman: implications for health and academic performance

This study examines the impact of obesity on the current health and academic performance of college students, with potential long-term implications for their overall well-being. Using survey data from 300 students at a university in the Arab Gulf of Oman, the study finds that over 27% of students are classified as overweight or obese. The analysis reveals a significant negative relationship between obesity and academic performance, with obese students showing a 6.6% decrease in academic grades compared to their peers of healthy weight. The findings suggest that the likelihood of earning lower academic grades is 2.54 times higher among obese students than those with normal weight. Additionally, the study indicates that obese students face an 8.5% higher burden of obesity-related health issues and are 5.77 times more likely to develop such conditions compared to normal-weight students. These results highlight that obesity affects both academic achievement and health, with potential long-term consequences for students' well-being. To address these issues, educational institutions and communities should prioritize promoting healthy lifestyles, including proper nutrition and weight management support.

Association between dietary fructose and human colon DNA methylation: implication for racial disparities in colorectal cancer risk using a cross-sectional study

BACKGROUND

An increasing body of evidence has linked fructose intake to colorectal cancer (CRC). African-American (AA) adults consume greater quantities of fructose and are more likely to develop right-side colon cancer than European American (EA) adults.

OBJECTIVES

We examined the hypothesis that fructose consumption leads to epigenomic and transcriptomic differences associated with CRC tumor biology.

METHODS

Deoxyribonucleic acid methylation data from this cross-sectional study was obtained using the Illumina Infinium MethylationEPIC kit (GSE151732). Right and left colon differentially methylated regions (DMRs) were identified using DMRcate through analysis of Food Frequency Questionnaire data on fructose consumption in normal colon biopsies (n = 79) of AA adults undergoing screening colonoscopy. Secondary analysis of CRC tumors was carried out using data derived from The Cancer Genome Atlas Colon Adenocarcinoma, GSE101764, and GSE193535. Right colon organoids derived from AA (n = 5) and EA (n = 5) adults were exposed to 4.4 mM of fructose for 72 h. Differentially expressed genes (DEGs) were identified using DESeq2.

RESULTS

We identified 4263 right colon fructose-associated DMRs [false-discovery rates (FDR) < 0.05]. In contrast, only 24 DMRs survived multiple testing corrections (FDR < 0.05) in matched, left colon. Almost 50% of right colon fructose-associated DMRs overlapped regions implicated in CRC in ≥1 of 3 data sets. Highly significant enrichment was also observed between genes corresponding to right colon fructose-associated DMRs and DEGs associated with fructose exposure in right colon organoids of AA individuals (P = 3.28E-30). Overlapping and significant enrichments for fatty acid metabolism, glycolysis, and cell proliferation pathways were also found. Cross-referencing genes within these pathways to DEGs in CRC tumors reveal potential roles for ankyrin repeat domain containing protein 23 and phosphofructokinase, platelet in fructose-mediated CRC risk for AA individuals.

CONCLUSIONS

Our data support that dietary fructose exerts a greater CRC risk-related effect in the right than left colon among AA adults, alluding to its potential role in contributing to racial disparities in CRC.

Carbonated Beverage Consumption Among Saudi Adults Before and After Implementation of Soft Drink Tax

The prevalence of obesity in Saudi Arabia has increased dramatically, with approximately 35% of the population estimated to be obese. This study assessed the patterns of carbonated beverage consumption and the factors and attitudes influencing consumption before and after implementing new soft drink taxes among Saudi adults. A secondary analysis was conducted on two cross-sectional studies involving Saudi adults aged over 18 years. The studies were conducted in July-September 2016 (Pre taxation, n = 964) and October 2022-March 2023 (post taxation, n = 1931). Data were collected using a validated questionnaire that included sociodemographic information, consumption patterns, influencing factors, and attitudes. A chi-square test compared frequency changes between the two periods, while a linear regression model assessed the impact of taxation on consumption frequency and quantity, along with associated factors and attitudes. Daily carbonated beverage consumption increased from 6% pre-taxation to 8% post-taxation. Significant changes were observed in factors and attitudes toward consumption (P < 0.05). The perceived influence of advertising decreased significantly (-0.320, P < 0.0001), while consumption during meals at home (0.430, P < 0.0001) and while watching TV or using electronic devices (0.231, P < 0.0001) increased post-taxation. The findings indicate that despite taxation, carbonated beverage consumption did not decrease among Saudi adults. These results underscore the need for comprehensive health promotion and intervention programs to address the high consumption of sugar-sweetened beverages and mitigate their health impacts.

Associations Between Sociodemographic Factors and Adolescent Food Consumption During Independent Eating Occasions

Associations were examined between sociodemographic characteristics of a US online survey sample of caregiver/adolescent dyads (n = 533) and food intake during independent eating occasions. Caregivers reported sociodemographic characteristics for dyads. Adolescents reported daily intake frequency of sugar-sweetened beverages, junk foods, sugary foods, fast food, and fruits and vegetables during independent eating occasions. Logistic regression analysis showed increased odds of sugar-sweetened beverage intake by White vs. Asian counterparts, decreased odds of sugary food intake by age (12 vs. 11-year-olds) and increased odds of sugary food intake by weight status (overweight/obesity vs. normal weight). Understanding these relationships may inform future intervention development.

Association Between Different Dietary Carbohydrate and Risk of Depression, Anxiety, and Stress Among Female Adolescents

Purpose

Mental disorders account for a large part of the burden of disease in young population. The present study aimed to investigate the relationship between carbohydrate intakes and the risk of depression, anxiety, and stress among female adolescents.

Methods

In this cross-sectional study, 263 female adolescents aged 15-18 years participated. Depression, anxiety, and stress scores were determined by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire, and dietary intakes were assessed using a validated 168-item food frequency questionnaire. Crude and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were estimated through logistic regression analysis.

Results

Adolescents with depression consumed more glucose and sucrose and less lactose compared to adolescents without depression. After adjustment for all confounders, higher intakes of glucose and sucrose were significantly associated with increased risk of depression (OR glu = 1.3, P = 0.035 and OR suc = 1.41, P = 0.034), anxiety (OR glu = 1.3, P = 0.019 and OR suc = 1.81, P = 0.027), and stress (OR glu = 1.41, P = 0.046 and OR suc = 1.8, P = 0.044). In addition, increasing lactose intake was significantly associated with reducing the risk of depression (OR = 0.96, P = 0.013) and stress (OR = 0.96, P = 0.015).

Conclusions

This study found significant associations between dietary carbohydrate intake and mental disorders among female adolescent.

Consumption of Sugar-Sweetened Beverages by Polish Young Adults: A Preliminary Study on the Importance of Sugar Tax Familiarity and Health Effects

Consumption of sugar-sweetened beverages (SSBs) contributes to the risk of developing overweight and obesity in children and adults. Thus, reducing free sugar is a globally recognized public health priority. The implementation of a sugar tax is one way of achieving this goal. This study aimed to investigate the relationship between familiarity with the sugar tax and its importance in reducing obesity, the perceived health consequences of SSBs, situations and reasons for consumption, and the frequency of SSB consumption. A cross-sectional study was conducted in May 2022 among 216 Polish adults (age 18-45). Hierarchical cluster analysis was used to identify three homogeneous clusters with regard to the perceived health consequences of consuming SSBs. A logistic regression model was used to verify the relationship between the frequency of SSB consumption (dependent variable) and other variables. Respondents with higher familiarity with the sugar tax (OR: 0.594; 95% CI: 0.42-0.85) and those in the "Unaware of disease" (OR: 0.437; 95% CI: 0.18-0.94) and "Disease-conscious" (OR: 0.484; 95% CI: 0.24-0.97) clusters were less likely to consume SSBs at least once per week than those in the "Moderately disease-conscious" cluster. Both the place of SSB consumption (i.e., restaurant-OR: 1.847; 95% CI: 1.14-3.64, work or university-OR: 3.217; 95% CI: 1.51-6.88, family home-OR: 2.877; 95% CI: 1.50-5.53) as well as a preference for their taste (OR: 4.54; 95% CI: 1.66-12.45) increased the chance of consuming SSBs at least once a week. In conclusion, it is necessary to continue educating the public about the health consequences of SSB consumption. The use of legislative measures (i.e., sugar tax) also contributes to reducing SSB consumption and can thus counteract the increasing obesity rate.

[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.

Association between Obesity and Dental Caries in Adults: An Analysis of WHR, and DMFT Score

INTRODUCTION

The relationship between obesity and dental caries in adults presents inconsistent findings in current literature, which necessitates further research to clarify this relationship. This study aimed to examine the association between obesity and dental caries in adults using a nationally representative sample.

METHODS

This study employed data of US adults aged >20 years from the National Health and Nutrition Examination Survey (NHANES) pre-pandemic cycle. Obesity was defined using the waist-to-hip ratio (WHR), body mass index (BMI), and waist circumference. Dental caries were assessed using the Decayed, Missing, Filled Teeth (DMFT) scores.

RESULTS

Most participants were categorized as individuals with obesity based on the WHR (74.5%) or BMI (72.7%). A significant difference in the DMFT scores and missing teeth was observed between individuals with normal weight and individuals with obesity. After adjusting for the sociodemographic variables, individuals with obesity had a 0.11 higher DMFT score (95% confidence interval [CI]: -0.01 to 0.23). A significant association was observed between the WHR and DMFT scores when age was excluded from the model, demonstrating a higher coefficient of 0.17 (95% CI: 0.05-0.30).

CONCLUSIONS

A positive association was observed between obesity and dental caries in the US adult population. However, age was found to be a confounding factor in this relationship. This study highlights the relationship between oral and general health, advocating healthcare providers for an integrated health promotion strategy, through comprehensive campaigns addressing obesity, diet, lifestyle, and dental health, aiming for raising awareness and a more effective public health strategy.

Healthy beverage index is associated with metabolic syndrome: insights from the Ravansar non-communicable disease (RaNCD) cohort study

BACKGROUND

Dietary patterns play a crucial role in the development and management of metabolic syndrome (MetS). The Healthy Beverage Index (HBI) is a novel tool that assesses the quality of beverage choices in the diet and provides insights into their potential impact on metabolic health. The aim of this study was to investigate the association between the HBI and the MetS.

METHODS

This cross-sectional study was conducted using data collected at baseline from the Ravansar Noncommunicable Disease Cohort Study. A total of 9,025 participants aged 35 to 65 years were included in the analysis. HBI was calculated using food items from the Food Frequency Questionnaire (FFQ). MetS status was defined according to established criteria, and logistic regression analysis was performed to assess the association between HBI scores and MetS, adjusting for potential confounding variables.

RESULTS

In our study, 41.13% of the population was found to have MetS, with a significant association between MetS and tertiles of HBI. Furthermore, the logistic regression model showed a significant inverse association between HBI scores and the odds of developing a MetS (OR = 0.90; 95% CI: 0.86, 0.94), even after adjusting for confounding factors, emphasizing the potential protective effect of higher HBI scores.

CONCLUSION

Increased HBI scores were associated with lower risk of MetS, emphasizing the importance of choosing health-promoting beverages in controlling MetS. These findings support the association between dietary habits and metabolic health and provide practical guidance for individuals and public health initiatives aimed at improving metabolic outcomes.

Associations between soft drinks intake and primary dysmenorrhea among Chinese undergraduate female students

Primary dysmenorrhea (PD) is a common global health concern. However, limited studies explored the association between soft drinks intake and PD among female undergraduates in China. To determine the association between soft drinks (carbonated soft drinks, etc.) as well coffee intake and the incidence/severity of PD among female undergraduates in China. We performed a cross-sectional study among 1809 female undergraduates in China from September 29, 2020 to October 22, 2020. The demographic information and menstrual information of the participants were collected by a self-administrated questionnaire. Chi-square test, ANOVA test, and logistic regression test were used to investigate the association between soft drinks intake and the incidence/severity of PD. We also conducted stratification analysis among different locations (rural or urban). The prevalence of PD was 47.1% (n = 852). There were 221 (25.9%) participants suffered from severe pain. In the participants with PD, the OR of carbonated soft drinks intake was 1.244 (95% CI 1.010-1.533). Among the participants with PD from rural areas, the OR of carbonated soft drinks intake was 1.402 (95% CI 1.045-1.881), compared with the non-carbonated soft drink group. In the participants with moderate and severe PD, the OR of coffee intake was 0.451 (95% CI 0.228-0.892), compared with the non-coffee-drinking group. There was a significant association between carbonated soft drinks intake frequency and the severity of PD (P < 0.05). Our study showed that carbonated soft drinks intake is a risk factor for PD, especially in participants from rural areas. Coffee intake is a protective factor for the severity of PD. Periodical awareness programs about adverse effects of excessive soft drink consumption should be introduced to reduce the prevalence and exacerbation of PD. Coffee intake might be helpful to relieve the severity of PD.

Health-Related Behaviors and Perceived Health Status According to Water and Sugar-Sweetened Beverage Intake in Korean Adolescents

The objective of this study was to determine the relationship between water and sugar-sweetened beverage (SSB) intake, health behaviors, and self-perceived health status using data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS). The subjects included in this analysis were 57,302 Korean adolescents from the 7th to 12th grades. The intake patterns of water and SSBs were categorized into four groups: Group I, adequate water intake (≥4 cups/day) and low frequency of SSB intake (≤1-2 times/week); Group II, adequate water intake and high frequency of SSB intake; Group III, inadequate water intake (<4 cups/day) and low frequency of SSB intake; Group IV, inadequate water intake and high frequency of SSB intake (≥3 times/week). Complex sample analyses were used for considering strata, clusters, and weights for samples. Significant differences were observed in the distribution of sociodemographic characteristics between the water and SSB intake groups. As grade levels increased or if students were female, there was a significant increase in the proportion of students characterized by low water intake and high consumption of SSB. Adolescents with healthier beverage habits, characterized by adequate water intake and low frequency of SSB consumption (Group I), generally abstained from smoking and alcohol, were more physically active, and maintained a desirable diet, reporting a better perceived health status. In contrast, those with higher SSB consumption and inadequate water intake (Group IV) were more likely to perceive their health as poor, with higher rates of smoking and alcohol use, lower physical activity levels, and poorer dietary habits compared to Group I. In conclusion, adolescents with desirable beverage consumption habits differed by sex and grade and they reported positive health behaviors and better overall health status. This suggests that there is a need for more active education and intervention in schools and families, as well as increased efforts by adolescents to promote healthy beverage habits.

Fermentation of Pyropia spp. seaweed: a comprehensive review on processing conditions, biological activities and potential applications in the food industry

Pyropia spp. seaweeds are delicious and nutritious red algae widely consumed for a long history. However, due to the non-digestibility of cell wall components by the human intestinal tract, the bioaccessibility of the intracellular bioactive compounds is low. The current industrial processing of Pyropia spp. food by drying and roasting cannot break down the cell wall; however, studies indicate that fermentation of Pyropia spp. by food-derived microorganisms is an efficient processing method to solve this problem. This paper reviews research on the fermentation of Pyropia spp., including the manufacturing process, alterations in chemical composition, flavor properties, bioactivities, and mechanisms. Furthermore, the limitations and opportunities for developing Pyropia spp. fermentation food are explored. Studies demonstrated that key metabolites of fermented Pyropia spp. were degraded polysaccharides, released phenolic compounds and flavonoids, and formed amino acids, which possessed bioactivities such as antioxidant, anti-glycation, anti-diabetic, lipid metabolism regulation beneficial to human health. The increased bioactivities implied the promoted bioaccessibility of intracellular components. Notably, fermentation positively contributed to the safety of Pyropia spp. food. In conclusion, benefits in nutrition, flavor, bioactivity, and safety suggest that fermentation technology has a promising future for application in Pyropia spp. food industry.

Individuals' perceptions of the factors linked to everyday soft drink consumption among university students: qualitative study

Background

Soft drink consumption is continuing to grow worldwide, posing an increasing threat to people's health and general wellbeing. Consequently, we must understand the factors driving soft drink consumption to support improvements to nutrition. This paper adopts a qualitative research approach to explore individuals' perceptions of the factors linked to daily soft drink consumption among university students in Saudi Arabia.

Materials and methods

This research employed purposive sampling to recruit a total of 19 students attending university in Al Madinah Province, Saudi Arabia, all of whom reported that they had previously consumed soft drinks. Over 3 months, data was gathered through a mixture of online and in-person semi-structured interviews. Once completed, the interviews were then transcribed and analyzed using inductive thematic analysis to identify the themes that emerged from the data.

Results

This study reveals five core themes: taste, habit, price, environment and social context, and health concerns. Regarding health concerns, this study finds that the public's increasing concerns about health can reduce people's consumption of soft drinks. Significantly, this research reveals that the rise in health concerns among the public is being driven by the growing conversation about healthy food and the negative impact of consuming sugary soft drinks occurring in wider society.

Conclusion

To conclude, this research underlines the value of adopting a holistic approach to promoting healthier drink choices (and thus reducing soft drink consumption). Interventions that focus on factors associated with soft drink consumption, such as habits, price, environment, social settings, health concerns, and taste, will be better able to decrease soft drink consumption and improve people's nutritional intake.

Development and Validation of the Meiji Nutritional Profiling System per Serving Size

Serving size may be the appropriate reference for calculating food nutritional value. We aimed to assess the nutritional values of Japanese foods based on serving sizes rather than per 100 g by adapting the Meiji Nutritional Profiling System (Meiji NPS). Given the variability in serving sizes across countries, we used Japanese serving sizes to calculate the Meiji NPS scores. We confirmed the convergent validity of the Meiji NPS scores per serving size with the Nutrient-Rich Food Index 9.3 using Spearman's correlation coefficients (r = 0.51, p < 0.001). Food groups recommended by official guidelines, such as pulses, nuts and seeds, fish and seafood, fruits, vegetables, and milk and milk products, scored relatively high. Furthermore, the nutrient density scores of food items with small serving sizes, such as mushrooms, algae, seasonings, and fats and oils, were moderated when calculated by per serving size, despite having considerably higher or lower scores per 100 g. These results indicate that calculating NPS per serving size allows for the assessment of the nutritional value of food items in accordance with actual consumption quantities. Therefore, the Meiji NPS calculated per serving size, alongside the per 100 g version, may be useful for dietary management depending on specific purposes.

To assess the effect of selected locally available beverages on salivary pH, flow rate, and oral clearance rate among adults

Aim

The aim of this study is to assess the effect of selected locally available beverages on salivary pH, flow rate, and oral clearance rate among adults.

Materials and Methods

A quantitative diagnostic method for dental caries would improve oral health, which directly affects the quality of life. The pH scale measures how acidic or basic a solution is, with 7 being neutral. When the pH of plaque drops below normal, or <5.5, the acidity starts to dissolve minerals and destroy the tooth's enamel. This clinical trial will be conducted on 40 subjects. Test beverages will be Red Bull, mixed fruit juice, tea, and sweetened milk. Unstimulated salivary samples will be collected for each study subject at least 1 h after their breakfast. After the collection of baseline salivary samples, the subjects will be given one beverage to drink, and then stimulated saliva samples will be collected at fixed time intervals. A digital pH meter will be used to measure the pH at every step.

Statistical Analysis

This will be carried out using SPSS version 17, one-way ANOVA, and post hoc Tukey's test will be applied in the statistical tests.

Results

The maximum drop in pH was seen in the case of carbonated beverage (Red Bull), the oral clearance for all the liquid food items was achieved at 14 minutes.

Conclusions

Liquids had a considerable cariogenic and erosive potential despite their quick clearance from the mouth cavity. it is always recommended to limit beverage consumption to maintain good dental health.

Evaluating attitudes toward soft drink consumption among adults in Saudi Arabia: Five years after selective taxation implementation

Objective

Saudi Arabia (SA) ranked first in soft drink consumption in the Middle East. A decrease in consumption was recorded after a selective 50% increased taxation policy in 2018. This study aimed to assess soft drinks consumption patterns among Saudi Arabian adults and examine the association between different attitudes and patterns post-taxation.

Methods

This cross-sectional study was conducted from October 2022 to March 2023, involving 1,935 Saudi adults aged 20-60 residing in Saudi Arabia. Participants completed online surveys using a validated questionnaire assessing sociodemographic characteristics, soft drink consumption patterns, and attitudes toward soft drinks. Chi-square and odds ratio (OR) tests were used to assess associations between sociodemographic characteristics, soft drink consumption frequency/quantity, and change in consumption patterns owing to selective taxation. Additionally, t-tests, Spearman's coefficient, and hierarchical multiple linear regression were used to measure differences in attitudes and linear relationships.

Results

Overall, 7.5% of the participants reported daily soft drink consumption, with 51.8% of these consuming less than one can per day and 41.2% consuming one can per day. Most (66.2%) reported no change in consumption post-taxation. Attitudes toward soft drink consumption varied significantly, with most agreeing on its health risks but also enjoying the drinks. Multiple regression analysis identified age, education, income, consumption frequency/quantity, and impact of taxation as significant predictors of overall attitudes toward soft drinks.

Conclusions

After taxation, 20% of participants reduced soft drink consumption, underscoring the importance of addressing taxation and intrinsic motivations to foster lasting changes in attitudes and behaviors towards soft drinks.

Dietary practice and nutritional status of low-income earners in a rural adult population in Delta State, Nigeria: a cross-sectional study

Introduction

due to the inability of low-income populations to access nutritious foods or basic education, these groups usually consume unhealthy diets, which frequently lead to nutrition issues like obesity, malnutrition, and other health morbidities. The purpose of the study was to evaluate the nutritional knowledge, dietary practices, nutritional status, and factors influencing the dietary habits of low-income persons living in a rural constituency in Southern Nigeria.

Methods

a cross-sectional study was carried out on 419 consenting low-income adults (18 years and older) using a simple random technique, in order to collect data on their socio-demographic traits, nutritional knowledge, dietary practices, and nutritional status. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyze the data generated.

Results

the respondents´ the average age was 40.9 ± 15.68 years while 224 (53.5%) of those surveyed were females. The proportion of responders with a secondary education was highest 279 (66.6%). The most common occupation among respondents was farming 151 (36.1%) and petty trading 135 (32.2%). Overall, 314 (74.9%) of low-income adults had poor dietary habits, and 245 (60.6%) had poor nutrition knowledge. Occupation and gender were significantly associated with nutritional status P<0.05. The majority of respondents 56.2% (235) were overweight or obese, and multivariate logistic regression analysis shows that respondents with concern about gaining weight were more likely to be overweight or obese (OR=1.065, 95% CI=0.832-1.363).

Conclusion

the findings from the study indicate that inadequate nutritional knowledge and poor dietary habits, reflected in respondents' body weight are likely to increase the risk of non-communicable diseases, necessitating the need for nutritional education among rural populations.

Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies

BACKGROUND

The prevalence of type 2 diabetes mellitus (DM) and pre-diabetes mellitus (pre-DM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth pre-DM/DM data.

OBJECTIVE

We aimed to first build a high-quality, comprehensive epidemiological data set focused on youth pre-DM/DM. Subsequently, we aimed to make these data accessible by creating a user-friendly web portal to share them and the corresponding codes. Through this, we hope to address this significant gap and facilitate youth pre-DM/DM research.

METHODS

Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to pre-DM/DM (fasting plasma glucose level ≥100 mg/dL or glycated hemoglobin  ≥5.7%) for youth aged 12-19 years (N=15,149). We identified individual factors associated with pre-DM/DM risk using bivariate statistical analyses and predicted pre-DM/DM status using our Ensemble Integration (EI) framework for multidomain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth Online Dashboard (POND) to share the data and codes.

RESULTS

We extracted 95 variables potentially relevant to pre-DM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of pre-DM/DM (P<.001, Bonferroni adjusted), including race or ethnicity, health insurance, BMI, added sugar intake, and screen time. Among these factors, 16 factors were also identified based on the EI methodology (Fisher P of overlap=7.06×10-6). In addition to those, the EI approach identified 11 additional predictive variables, including some known (eg, meat and fruit intake and family income) and less recognized factors (eg, number of rooms in homes). The factors identified in both analyses spanned across all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND.

CONCLUSIONS

Using NHANES data, we built one of the largest public epidemiological data sets for studying youth pre-DM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of pre-DM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth pre-DM/DM studies.

Longitudinal association between soft drink consumption and handgrip strength in adults: a prospective analysis from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study

Soft drink consumption has become a highly controversial public health issue. Given the pattern of consumption in China, sugar-sweetened beverage is the main type of soft drink consumed. Due to containing high levels of fructose, a soft drink may have a deleterious effect on handgrip strength (HGS) due to oxidative stress, inflammation and insulin resistance. However, few studies show an association between soft drink consumption and HGS in adults. We aimed to investigate the association between soft drink consumption and longitudinal changes in HGS among a Chinese adult population. A longitudinal population-based cohort study (5-year follow-up, median: 3·66 years) was conducted in Tianjin, China. A total of 11 125 participants (56·7 % men) were enrolled. HGS was measured using a handheld digital dynamometer. Soft drink consumption (mainly sugar-containing carbonated beverages) was measured at baseline using a validated FFQ. ANCOVA was used to evaluate the association between soft drink consumption and annual change in HGS or weight-adjusted HGS. After adjusting for multiple confounding factors, the least square means (95 % CI) of annual change in HGS across soft drink consumption frequencies were -0·70 (-2·49, 1·09) for rarely drinks, -0·82 (-2·62, 0·97) for < 1 cup/week and -0·86 (-2·66, 0·93) for ≥ 1 cup/week (Pfor trend < 0·05). Likewise, a similar association was observed between soft drink consumption and annual change in weight-adjusted HGS. The results indicate that higher soft drink consumption was associated with faster HGS decline in Chinese adults.

Self -reported knowledge and understanding of added sugars by consumers in Ghana

The consumption of added sugars has been a major concern among consumers and researchers around the world. Some of these added sugars pose health threats such as obesity, and liver diseases to consumers. Therefore, consumers' understanding and knowledge of added sugars is important in regulating the intake of food items that contain different types and levels of added sugar. In this study, the knowledge and understanding of staff (consumers) of the University of Energy and Natural Resources, Ghana, was assessed through survey The results showed that about 38.5 % of consumers always read food labels whereas 3.1 % never read the labels of food they purchased. However, only about 20 % of consumers considered added sugars as most important information on food labels while most (about 38 %) were concerned about the calorie level in food items purchased. Based on the consumer's knowledge of sugars and sweeteners, there was a high level of disparity in classifying sugars in food as sugars and sweeteners. In addition, most consumers reported that they would adversely avoid food items containing lactose, isoglucose, and saccharin. The awareness of the consumers to the WHO recommendation for sugar reduction, the gender (P = 0.278), age (P = 0.959), level of education (P = 0.888), and staff category (P = 0.944) did not influence their decisions on purchasing food items with added sugars Most consumers were interested in issues of food and nutrition. Therefore, it is recommended that staff are taken through aspects of food nutrition as well as the consumption of added sugar towards the recommended levels.

Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage

INTRODUCTION

Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES.

METHODS

Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower).

RESULTS

Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type.

CONCLUSION

This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.

Relationship Between Caffeine Consumption and Young Athletes' Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram

BACKGROUND

Caffeine consumption causes diverse physiologic effects that can affect athletes both positively and negatively. There is a lack of research investigating the long-term effects of caffeine intake on exercise and on overall cardiovascular health in young athletes.

HYPOTHESIS

Certain characteristics such as age, body mass index (BMI), race, and medical diagnoses are associated with increased caffeine use, and there is a relationship between caffeine consumption and symptoms during exercise and cardiovascular abnormalities in young athletes.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

This study utilized the HeartBytes National Youth Cardiac Registry to collect data related to demographics, caffeine use, and physical examination and electrocardiogram (ECG) findings of 7425 12- to 20-year-olds (60.6% male, 39.4% female) who attended a Simon's Heart cardiac screening event between 2014 and 2021. Univariable and multivariable logistic regression models were used for analysis.

RESULTS

Persons who consumed caffeine were more likely to have attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio [aOR], 1.43; CI, 1.15-1.76]; P < 0.01) and more likely to have a BMI ≥30 kg/m2 (aOR, 1.69; CI, 1.27-2.25]; P < 0.01) compared with nondrinkers. After controlling for age, gender, race, and BMI, there were no significant differences in symptoms during exercise (aOR, 1.27; CI, 0.97-1.66; P = 0.08) or abnormal ECG findings (OR, 0.93; CI, 0.66-1.31; P = 0.70) between those who consume caffeine and those who do not.

CONCLUSION

Caffeine consumption was associated with increased BMI and increased likelihood of having ADHD; however, caffeine use overall was not associated with increased risk of symptoms during exercise or ECG abnormalities.

CLINICAL RELEVANCE

Whereas caffeine consumption overall did not increase risk of exercise-related symptoms, soda drinkers were at higher risk for symptoms during exercise, and coffee drinkers were at higher risk of syncope with exercise. Prospective studies with longitudinal follow-up and more specific outcomes data is the next step in qualifying the impact of caffeine on young athletes.

Hypokalaemia associated with excessive cola-flavoured drinks consumption

We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.

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.

National taxation on sugar-sweetened beverages and its association with overweight, obesity, and diabetes

BACKGROUND

Consumption of sugar-sweetened beverages (SSBs) has been linked to several adverse health outcomes, thus many countries introduced taxation to reduce it.

OBJECTIVES

To summarize national SSB taxation laws and to assess their association with obesity, overweight and diabetes.

METHODS

We conducted a systematic scoping review up to January 2022 on PubMed, Web of Science, Embase, and Google Search to identify taxes on SSBs. An interrupted time series analysis (ITSA) was conducted on 17 countries with taxation implemented in 2013 or before to evaluate the level and slope modifications in the rate of change of standardized prevalence rates of overweight, obesity, and diabetes. Random-effects meta-regression was used to assess whether year of entry into force of the law, national income, and tax design affected observed results.

RESULTS

We included 76 tax laws issued between 1940 and 2020 by 43 countries, which were heterogeneous in terms of tax design, amount, and taxed products. Among children and adolescents, ITSA showed level or slope reduction for prevalence of overweight and obesity in 5 (Brazil, Samoa, Palau, Panama, Tonga) and 6 (El Salvador, Uruguay, Nauru, Norway, Palau, Tonga) countries out of 17, respectively. No clear pattern of modification of results according to investigated factors emerged from the meta-regression analysis.

CONCLUSIONS

Taxation is highly heterogeneous across countries in terms of products and design, which might influence its effectiveness. Our findings provide some evidence regarding a deceleration of the increasing prevalence rates of overweight and obesity among children occurring in some countries following introduction of taxation. PROSPERO registration number: CRD42021233309.

Sustaining Healthy Habits: The Enduring Impact of Combined School-Family Interventions on Consuming Sugar-Sweetened Beverages among Pilot Chinese Schoolchildren

This study assesses the enduring impact of combined school- and family-based interventions on reducing the consumption of sugar-sweetened beverages (SSBs) among schoolchildren in China. Two primary schools were assigned at random to either the Intervention Group or the Control Group, in Nanjing, eastern China. All students were in grade three and received an invitation to participate. In the first year, students in the Intervention Group received one-year intervention measures, including monthly monitoring, aiming to decrease the consumption of SSBs. Students in the Control Group only received regular monitoring without interventions. In the second year, both groups received only regular monitoring, without active interventions. A generalized estimating equations model (GEE) was used to assess the intervention effects. After two years, relative to the Control Group, the Intervention Group had a significantly improved knowledge of SSBs and an improved family environment with parents. In the Intervention Group, 477 students (97.3%) had adequate knowledge about SSBs, compared to 302 students (83.2%) in the Control Group (X2 = 52.708, p < 0.001). Two years later, the number of students who stated 'my home always has SSBs' in the Intervention Group (7.8%) was fewer than that in the Control Group (12.4%), which was a statistically significant finding (p < 0.05). One year later, both the frequency and the quantity of SSB consumption in the Intervention Group were less than those in the Control Group; such differences between the groups remained statistically significant for the quantity but not for the frequency of SSB consumption two years later. In the Intervention Group, the frequency of SSB consumption was significantly reduced by 1.0 times per week, compared to a reduction of 0.1 times per week in the Control Group in the first year (p < 0.05). In the second year, the frequency of SSB consumption was reduced by 0.8 times per week in the Intervention Group, compared to 0.5 times per week in the Control Group (p > 0.05). In the first year, the volume of SSB consumption was significantly reduced by 233 mL per week in the Intervention Group, compared to an increase of 107 mL per week in the Control Group (p < 0.05). In the second year, the volume of SSB consumption was reduced by 122 mL per week in the Intervention Group compared to an increase of 31 mL per week in the Control Group (p > 0.05). The combined school-based and family-based interventions had a positive effect on the students' knowledge of SSBs and their family dynamics during the first and second year. Relative to the Control Group, the Intervention Group had a statistically significant reduction in SSB consumption after 1 year, but not after 2 years.

Impact of a School-Based Intervention on Sugar-Sweetened Beverage Intake Substitution by Water in Mexican Scholars

INTRODUCTION

The prevalence of overweight and obesity in children has increased in recent years, associated with substituting plain water intake with sugar-sweetened beverages. The aim of the study was to evaluate the impact of a school-based intervention that aimed to replace sugar-sweetened beverages with water on Mexican scholars.

METHODS

We included 314 children aged 9-11 from three public schools of the State of Hidalgo, Mexico, randomized to intervention (two schools from the municipality of Apan; six classes with 146 participants) or control group (one school from the municipality of Emiliano Zapata; six classes with 168 participants) and followed for 6 months. The intervention consisted of placing drinking fountains at schools and classrooms with nutritional education lessons to increase water consumption and decrease sugar-sweetened beverages. Mixed models for repeated measures were used to assess the impact of the intervention.

RESULTS

At the end of the study, water consumption was higher (200 mL/day, p = 0.005), and flavored milk consumption was lower (94 mL/day, p = 0.044) in the intervention group compared with the control group. There was also a statistically significant reduction in energy (p = 0.016) and sugar intake (p = 0.007).

CONCLUSIONS

The school-based intervention favorably modified the consumption pattern of sugar-sweetened beverages and water in Mexican students.

Interoceptive abilities impairment correlates with emotional eating and taste abnormalities in children with overweight and obesity

Weight problems in children are associated with emotional eating, which has been linked to interoceptive abilities. Previous research also shows altered olfactory and gustatory perception in children with obesity and overweight. Therefore, we aimed to investigate the connection of alterations in olfactory and gustatory perception to interoceptive abilities and emotional eating among children with obesity and overweight. 23 children with overweight and obesity and age-matched controls with normal weight (12-16 years old) underwent olfactory and gustatory testing. Interoceptive abilities were assessed, focusing on interoceptive accuracy and interoceptive sensibility. Children with overweight and obesity showed significantly higher accuracy for detection of sweet taste, but descriptively lower accuracy for all other taste qualities compared to normal weight children. We found no changes in olfactory abilities in children with overweight and obesity. Emotional eating scores were elevated for children with overweight and obesity, and interoceptive accuracy scores were significantly lower. In both groups, interoceptive accuracy was inversely correlated with emotional eating. Our results support prior findings of altered gustatory abilities in children with overweight and obesity. The observed link between impaired interoceptive processes and heightened emotional eating in this group implies that interventions for overweight in children could benefit from targeting interoceptive abilities. This study provides meaningful grounds for further investigations into the roles of taste, emotional eating, and interoceptive abilities for overweight in children and adolescents.

Substitution of sugar-sweetened beverages with non-caloric alternatives and weight change: A systematic review of randomized trials and meta-analysis

BACKGROUND

Intake of sugar-sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar-sweetened beverages with non-caloric beverages results in long-term reduction in body weight.

OBJECTIVE

The objective of this study is to explore if a long-term reduction in body weight can be achieved by replacing an existing intake of sugar-sweetened beverages with non-caloric beverages.

METHODS

Systematic review and meta-analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a "substitution" design were included, that is, studies where subjects substituted an existing intake of sugar-sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow-up of weight change were included.

RESULTS

Six trials with a total of 1729 participants were included in the meta-analysis. Replacing an existing intake of sugar-sweetened beverages with a non-caloric beverage resulted in a long-term BMI reduction of 0.31 kg/m2 compared with the sugar-sweetened beverage-group (95% CI; 0.17-0.44). One study with 1 year's intervention and 2 years follow-up showed a regression towards baseline BMI after the intervention had ended.

CONCLUSION

Replacing an existing use of sugar-sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long-term 0.31 kg/m2 reduction in BMI equivalent to 0.5-1 kg in children and adults, respectively, as long as the interventions lasted.

Temporal Trends of Obesity Among Nebraska Adults: EMR Data Shows a More Rapid Increase Than Projected

INTRODUCTION/OBJECTIVES

Obesity data is typically obtained from national population surveys, while the use of more accurate electronic medical record (EMR) data is underutilized. The objective of this study is to calculate current obesity prevalence and weight trends using EMR data and compare the results to prior survey-based obesity prevalence projections for the state.

METHODS

This retrospective study analyzed Body Mass Index (BMI) from deidentified EMR data from 16,491 adult patients in urban midwestern primary care clinics between January 2017 and October 2021 for obesity prevalence and weight trajectories, stratified by age and gender.

RESULTS

There was a large discrepancy between the survey-based self-reported rates of obesity (35.5%) and those calculated from baseline EMR data (47.6%), along with a smaller discrepancy in females (47.9%) compared to males (47.2%). Young adults aged 20 to 29 years showed a larger increase in BMI over time compared to other age groups.

CONCLUSIONS

EMR-derived data indicates a prevalence of obesity greater than projections that have been based on self-reported survey data as well as higher weight trends than projected for this midwestern state. As evident from our study, cohorts such as at-risk young adults with a more rapid weight gain trajectory should be prioritized for enhanced obesity management.

Ultra-processed Food Intake and Risk of Type 2 Diabetes in Korean Adults

BACKGROUND

Several studies from the United States and European countries reported a positive association between ultra-processed food intake and diabetes risk. However, little is known about the association in Asian populations. It is also unknown about the individual ultra-processed food items that are most unfavorably associated with diabetes risk.

OBJECTIVE

We examined the associations of ultra-processed food intake (combined, as well as individual ultra-processed food items) with the risk of type 2 diabetes.

METHODS

This prospective analysis included 7438 participants aged 40-69 y from the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Dietary intake was assessed at baseline using a 103-item semiquantitative food-frequency questionnaire. Ultra-processed foods were classified using the Nova definition. Incident type 2 diabetes cases were identified via follow-up interviews and health examination. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.

RESULTS

During the follow-up (2001-2019; median: 15 y), a total of 1187 type 2 diabetes cases were identified. Compared with the lowest quartile of ultra-processed food intake, the highest quartile was positively associated with diabetes risk [HR (95% CI) = 1.34 (1.13, 1.59), P-trend = 0.002]. The association did not change after additional adjustment for diet quality or BMI. Among individual ultra-processed food items, a higher consumption of ham/sausage [per 1% increase in the weight ratio: HR (95% CI) = 1.40 (1.05, 1.86)], instant noodles [1.07 (1.02, 1.11)], ice cream [1.08 (1.03, 1.13)], and carbonated beverages [1.02 (1.00, 1.04)] were associated with an increased risk of type 2 diabetes, whereas a higher intake of candy/chocolate was associated with a decreased risk [0.78 (0.62, 0.99)].

CONCLUSIONS

Our data suggest that the high intake of ultra-processed foods, particularly ham/sausage, instant noodles, ice cream, and carbonated beverages, is associated with an increased risk of type 2 diabetes in Korean adults.

Taxing sugar sweetened beverages in Indonesia: Projections of demand change and fiscal revenue

The global trend of diets high in sugar sweetened beverages (SSB) is associated with a high risk of obesity and non-communicable diseases (NCDs). To reduce SSB consumption on a population level, SSB taxes have become a popular policy solution. In Indonesia, although the prevalence of obesity has doubled in the past decade (11.7% in 2010 to 21.8% in 2018), SSB taxes have not yet been implemented. Utilizing the 2021 Indonesian household socioeconomic survey (SUSENAS), this study estimated price elasticities and projected the plausible effects of implementing an SSB tax on consumers' demand for SSBs and the associated government revenue using the Quadratic Almost Ideal Demand System (QUAIDS) model. Five SSB groups were studied: 1) manufactured liquid milk; 2) sweetened condense milk; 3) instant coffee; 4) tea drinks and fizzy drinks with CO2; 5) fruit juices, "health" drinks, and energy drinks. The overall results showed that the non-milk SSB groups were price elastic. Probing deeper into the substitutions for SSB across categories, we found both substitutionary and complementary effects. Our analysis revealed that increasing SSB prices by 20% would reduce the demand for SSBs on average by 17.5% (14.3%-18.6% for each SSB group) and generate additional state revenue up to IDR 3,628.3 billion per year (approximately US$ 238.5 million or 0.2% of total tax revenue in 2022). Considering the health and economic impacts of high consumption of SSBs, this study provides empirical evidence that imposing taxes on SSBs could be an effective measure to reduce public consumption and to generate tax revenue for financing health programs that address obesity and NCDs in Indonesia.

Conflicts of Interest in the Assessment of Chemicals, Waste, and Pollution

Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.

Soft and energy drinks consumption and associated factors in Saudi adults: a national cross-sectional study

Introduction

The consumption of soft and energy drinks poses a significant risk for non-communicable diseases, such as diabetes and heart disease. Studies in Saudi Arabia have reported elevated consumption of soft/energy drinks, but nation-wide data is not available. Therefore, this study aims to explore the prevalence of soft and energy drinks consumption and its associated factors among a representative sample of Saudi adults.

Methods

The present research is a secondary data analysis of the 2021 Sharik Diet and Health National Survey (SDHNS). Current analysis used data on socio-demographics, anthropometrics, physical activity, and soft and energy drink consumption. The frequency of soft and energy drinks consumption is assessed on a weekly basis.

Results

Of the 5,194 Saudi adults, 3,928 were analyzed. Overall, 67% consumed soft drinks weekly, while 30% consumed energy drinks weekly. In multiple logistic regression, consumption of either soft drinks or energy drinks was associated with males, a younger age, lower income, and lower physical activity. Individuals with overweight or obesity were less likely to consume energy drinks [OR (95%CI): 0.83 (0.71, 0.99) and 0.73 (0.60, 0.90), respectively] than those with healthy weight. However, education level was not associated with either soft or energy drink consumption. These findings highlight the need for targeted interventions designed to reduce soft and energy drinks consumption in Saudi adults.

Seattle's sweetened beverage tax implementation and changes in interior marketing displays

Policymakers aim sugar-sweetened beverage (SSB) taxes at decreasing SSB consumption; however, little is known about their impact on beverage marketing in the retail environment. We assessed changes in interior marketing displays within large food stores before and after the implementation of Seattle's SSB tax. We used Poisson difference-in-difference (DID) models to estimate whether presence and variety of interior beverage marketing displays in Seattle changed from before to after the tax compared to displays in non-taxed comparison area stores, overall, and by beverage type. We found no significant changes in overall SSB or non-SSB interior marketing displays in Seattle versus the comparison area. There was less of an increase in displays for diet soda (DID 0.79, 90% CI 0.65, 0.97), and more of an increase in displays for diet energy drinks (DID 1.78, 90% CI 1.03, 3.09) in Seattle versus comparison area. There was mixed evidence that stores changed interior marketing displays in response to the SSB tax.

Soda expansion in the tropics: The effect on obesity rates among women without piped water at home

Obesity rates and soda consumption are increasing at a worrisome pace in developing countries. In particular, soda companies seem to be targeting areas with poor access to clean water. This paper exploits a natural experiment in Peru and finds evidence that changes in the price of soda generate important effects in terms of obesity among individuals without piped water at home. These significant effects are driven by a combination of a large effect in the consumption of soda and an effect close to zero in the consumption of potential substitutes high in calories. This paper also provides some evidence that a reduction in price of soda reduces diarrhea prevalence, suggesting that some individuals substitute away contaminated water. This evidence suggests that soda taxes might be particularly beneficial among this population in terms of the prevention of obesity and possibly related diseases such as diabetes and cardiovascular diseases. The potential trade-off between obesity and diarrhea needs to be investigated in greater depth.

Effect of emotion-based nutrition messages on consumption of calcium-rich foods among early adolescents in Ogbomoso, Nigeria

Introduction

Calcium is a vital micronutrient for several physiological processes, yet it remains one of the significant shortfall nutrients among Nigerian adolescents.

Objective

This study was designed to assess the effect of emotion-based nutrition messages on the consumption of calcium-rich foods among early adolescents in Ogbomoso, Nigeria.

Methodology

The quasi-experimental study involved 220 adolescents (experimental: 110 and control: 110) selected using a three-stage sampling procedure. A semi-structured, interviewer-administered questionnaire was used to collect socio-demographic characteristics, dietary practice, calcium-rich foods consumption pattern, calcium intake, and anthropometric parameters. Second, calcium-rich foods consumption pattern was assessed using a food frequency questionnaire, and intake was evaluated using the multi-pass 24-hour dietary recall to define adequacy at intake level ≥1,300 mg per day. Third, the experimental group had five weeks of nutrition education using emotion-based nutrition messages. Data were analyzed using descriptive statistics and the Chi-square test at p < 0.05.

Results

The age of respondents (years) in experimental (12.88±1.41) and control (13.4±1.03) groups was similar. Primary dietary calcium sources were meat, chicken, egg, white beans, cheese, soy milk, oranges, and locust beans at baseline. At post-intervention, intake of other calcium-rich foods such as milk, yogurt, ice cream, okra, sardine, and unripe plantain increased, however, calcium intake remains similar in both control (238.41±92.4 mg; 235.40±92.92 mg) and experimental groups (239.76±51 mg; 241.46±100.89 mg) at baseline and post-intervention, respectively. The overall calcium intake of the adolescents remains below the recommended intake level of 1,300 mg.

Conclusion

Emotion-based nutritional messages did not significantly increase the total calcium intake among early adolescents.

The Potential Effect of Sugar-Sweetened Beverages Tax on Obesity Prevalence in Tanzania

Background

Obesity and the associated non-communicable diseases contribute significantly to the disease burden in Tanzania. Obesity can be attributed to the consumption of Sugar Sweetened Beverages (SSB) due to their high sugar content that leads to high caloric intakes. This study estimates the effect of SSB tax on the prevalence of obesity.

Methods

A mathematical model that compares the reference population which is unchanged and a counterfactual population in which tax intervention has been introduced is developed. Changes in price and consumption of SSBs, and subsequent changes in energy intake are applied to estimate the body mass change by age groups. The change in body mass by age groups is merged with the reference population to estimate changes in body mass index and obesity.

Results

Imposing a 20% SSB tax in Tanzania is estimated to reduce the average overall energy intake by 76.1 kJ per person per day. This change is associated with an overall reduction of prevalence of obesity by 6.6%; and by 12.9% and 5.2% in adult males and adult females, respectively. The number of obese people will potentially decrease by about 47,000 among adult males and about 85,000 among adult females from the current levels.

Conclusions

The SSB tax is a potential strategy to complement efforts to reduce obesity prevalence in Tanzania. The revenue generated from the tax should be channelled towards public health promotion programs.

Analysis of the Influence of Socio-Demographic Variables and Some Nutrition and Lifestyle Habits on Beverage Consumption in the Spanish Population

Beverages and drinks play a significant role in maintaining the integral health of individuals. The aim of this study is to discover the pattern of beverage consumption in different groups of the Spanish population and to investigate its relationship with other nutritional variables and habits. To achieve the objectives, an observational, descriptive and cross-sectional study was conducted. For data collection, a questionnaire was designed and validated that explored different beverage and food consumption variables as well as socio-demographic and lifestyle variables. The instrument was disseminated, among the Spanish young adult population, through snowball sampling using social networks, collecting a sample of 17,541 valid surveys. Bivariate comparative analyses and correlation analyses were performed, and finally, the principal component analysis (PCA) method was used in order to study the relationships between variables related to drinking and health. The main results show significant differences in the pattern of beverage consumption between the socio-demographic variables of sex, age and educational level, as well as between different areas of Spain, while the PCA model shows the relationship between the consumption of sugar-sweetened beverages with the Healthy Nutrition Index of the population and sport practice. Based on the results of the study, the following conclusions were reached: the beverage consumption pattern of the Spanish population is affected by socio-demographic variables. Healthier drinking habits affect the nutrition and health of the population.

Assessment of Beverage Trends and Replacing Nondairy Caloric Beverages with Milk at Meals across Childhood Improves Intake of Key Nutrients at Risk of Inadequate Consumption: An NHANES Modeling Study

Background

Milk is a key source of important nutrients including the nutrients of public health concern. However, most Americans do not meet current (dairy) United States Department of Agriculture (USDA) dietary guideline recommendations, and the intake has been declining.

Objective

The aim of this study was to investigate milk and beverage intake trends and nutrient intakes from these products in United States children aged 6-18 y and to model the effect of isocaloric substitution of nondairy beverages with milk.

Methods

Data from National Health and Nutrition Examination Survey (NHANES) 2001-2018 for children age 6-8 (N = 4696), 9-13 (N = 8117) and 14-18 y (N = 8514) were used with milk and other beverage intakes determined from the first 24-h in-person dietary recall. Nutrient intake was determined using the NHANES cycle-specific total nutrient intake files. Nutrient modeling was performed by isocaloric substitution with milk of all nondairy beverages consumed during lunch and dinner meals combined. Sample-weighted analyses were performed using SAS 9.4.

Results

Between ages 6-8 and 14-18 y, daily intake of milk and flavored milk decreased by 10% and 62%, respectively, while daily intake of caloric beverages excluding milk increased by 96%. Daily intake from caloric beverages and milk combined decreased for fiber, protein, fat, saturated fat, calcium, magnesium, potassium, vitamin A, and vitamin D and increased for energy, carbohydrates, added sugars, and folate between ages 6-8 y and 14-18 y. Isocaloric substitution of all caloric nondairy beverages at meals with milk (using nutrient contribution of USDA milk, not further specified (NFS)) resulted in increases in protein, fat, saturated fat, calcium, magnesium, potassium, sodium, vitamin A, folate, vitamin B12, and vitamin D and decreases in carbohydrate, fiber, and added sugar.

Conclusion

These findings provide additional evidence to support dietary recommendations for milk, and efforts should be made on behalf of leading health professionals and childhood meal programs to highlight milk as a beverage of choice in children and adolescents.

Proposition of an Energy Intake Estimating Scale through Item Response Theory

BACKGROUND

Traditional methods for assessing individual energy consumption often involve lengthy and intricate procedures. This study aims to introduce an Energy Consumption Estimation Scale, utilizing Item Response Theory (IRT) for adolescents aged 18-19 years.

METHODS

This psychometric investigation applies IRT to 93 items extracted from a validated food frequency questionnaire. The study encompasses a representative sample of 2515 adolescents from the São Luís birth cohort in Brazil. The latent trait, energy intake, is derived using IRT and subsequently validated through hierarchical multiple linear regression modeling. Significance was established at p < 0.05.

RESULTS

A Samejima's model was successfully fitted (CFI and TLI > 0.9 and RMSEA < 0.08), effectively capturing variations across all energy consumption levels. Factors associated with the latent trait demonstrate consistent behavioral patterns. Adolescents with higher energy intake exhibited increased consumption of dairy products, artificially sweetened beverages, and seasonal fruits and vegetables.

CONCLUSIONS

The proposed Energy Consumption Estimation Scale demonstrates a reliable measurement of energy intake and serves as a practical and concise alternative for assessing energy consumption among adolescents. These findings suggest the potential for adapting similar models for different age groups and incorporating diverse food items based on the obtained results.

Use of sugar in coffee and tea and long-term risk of mortality in older adult Danish men: 32 years of follow-up from a prospective cohort study

BACKGROUND

Tea and coffee are the most consumed beverages worldwide and very often sweetened with sugar. However, the association between the use of sugar in tea or coffee and adverse events is currently unclear.

OBJECTIVES

To investigate the association between the addition of sugar to coffee or tea, and the risk of all-cause mortality, cardiovascular mortality, cancer mortality and incident diabetes mellitus.

METHODS

Participants from the prospective Copenhagen Male Study, included from 1985 to 1986, without cardiovascular disease, cancer or diabetes mellitus at inclusion, who reported regular coffee or tea consumption were included. Self-reported number of cups of coffee and tea and use of sugar were derived from the study questionnaires. Quantity of sugar use was not reported. Primary outcome was all-cause mortality and secondary endpoints were cardiovascular mortality, cancer mortality and incident diabetes mellitus, all assessed through the Danish national registries. The association between adding sugar and all-cause mortality was analyzed by Cox regression analysis. Age, smoking status, daily alcohol intake, systolic blood pressure, body mass index, number of cups of coffee and/or tea consumed per day and socioeconomic status were included as covariates. Vital status of patients up and until 22.03.2017 was assessed. Sugar could be added to either coffee, tea or both.

RESULTS

In total, 2923 men (mean age at inclusion: 63±5 years) were included, of which 1007 (34.5%) added sugar. In 32 years of follow-up, 2581 participants (88.3%) died, 1677 in the non-sugar group (87.5%) versus 904 in the sugar group (89.9%). Hazard ratio of the sugar group compared to the non-sugar group was 1.06 (95% CI 0.98;1.16) for all-cause mortality. An interaction term between number of cups of coffee and/or tea per day and adding sugar was 0.99 (0.96;1.01). A subgroup analysis of coffee-only drinkers showed a hazard ratio of 1.11 (0.99;1.26). The interaction term was 0.98 (0.94;1.02). Hazard ratios for the sugar group compared to the non-sugar group were 1.11 (95% CI 0.97;1.26) for cardiovascular disease mortality, 1.01 (95% CI 0.87;1.17) for cancer mortality and 1.04 (95% CI 0.79;1.36) for incident diabetes mellitus.

CONCLUSION

In the present population of Danish men, use of sugar in tea and/or coffee was not significantly associated with increased risk of mortality or incident diabetes.

Dietary Habits and Gaming Behaviors of Portuguese and Brazilian Esports Players

As the esports industry grows, marketing campaigns for fast food, soft drinks, alcoholic and energy drinks, and dietary supplements at related events intensify. Portuguese and Brazilian esports players' dietary patterns remain unexplored. This study aimed to characterize the dietary and gaming habits of esports players. We applied an anonymous, open online survey to a convenience sample of esports players that included the PREDIMED and the Internet Gaming Disorder Scale. The survey was shared through email and social media platforms, including Facebook, Twitter, Instagram, Discord, WhatsApp, and Twitch. The sample (n = 579) was predominantly male (91.4%), averaged 26.1 (SD = 7.0) years, and 25.9 (SD = 5.5) kg/m2. Most reported a weak (53.7%) adherence to the Mediterranean diet. Almost a third (32.3%) consumed dietary supplements. Our sample presented a low adhesion to the Mediterranean dietary pattern, low consumption of fruit and vegetables, and high consumption of fast food, red and processed meat, soft drinks, and dietary supplements, including caffeine-based supplements. Dietary supplement consumption was related to a higher adhesion to the Mediterranean diet, and a higher level of professionalization and internet gaming disorder correlated with a lower adhesion. In conclusion, we infer that Portuguese and Brazilian esports players follow an unbalanced diet.

Fluid intake at work in foresters working in different thermal conditions

The primary aim of this study was to assess the impact of fluid intake on hydration status indices in men at work. The secondary aim was to determine the type of fluids drunk at work in different thermal conditions. Fifty-nine male foresters were examined before and after one working day during summer, autumn, and winter. Before and after work, urine and blood samples were obtained from foresters. Immediately after a shift, participants completed a questionnaire regarding fluid intake during one working day. The amount of fluid consumed affects the hydration urine indices. Urine specific gravity and urine osmolality significantly decreased with increasing fluid intake (r = - 0.385 and r = - 0.405, respectively). Moreover, an impact of season on the type of fluids consumed by workers was observed. Tea was significantly more often chosen by workers to drink in winter (68%) than in summer (32%) (p = 0.026). The consumption of any non-alcoholic fluids contributes to the daily total water intake, but it is necessary to create individualized fluid replacement plans. Workers should know how much and what types of drinks to consume at work.

Drink Tap: A Multisector Program to Promote Water Access and Intake in San Francisco Parks

Taxes on sugar-sweetened beverages (SSBs), or drinks with added sugars, show promise in decreasing purchases and consumption of SSBs. Some have called for coupling such taxes with improvements in access to safe drinking water as a strategy for reducing inequities in SSB intake, yet no studies have examined such an approach. Drink Tap is a San Francisco-based program in which public tap water stations were installed in parks and public spaces (winter 2017) and promotional efforts (fall and winter 2018) encouraged water intake. At the same time, San Francisco and surrounding communities were also implementing SSB taxes. We conducted a quasi-experimental study to examine whether water access and promotion combined with SSB taxes affected beverage intake habits more than SSB taxes alone. We conducted 1-hour observations (N = 960) at 10 intervention parks (Drink Tap plus SSB taxes) and 20 comparison parks (SSB taxes only) in San Francisco Bay Area cities before (July-September 2016) and after (June-August 2019) implementation of Drink Tap. We found significant adjusted percentage increases in drinking water among visitors to intervention parks, compared with comparison parks: water from park water sources (+80%, P < .001) and water from reusable bottles (+40%, P = .02). We found no significant reductions in visitors observed drinking bottled water, juices, or SSBs. The Drink Tap intervention led to increases in water intake from park sources and reusable bottles across parks that surpassed increases achieved through SSB taxes alone. Jurisdictions should consider coupling tap water access and promotion with policies for reducing intake of SSBs.

Appetitive traits and food groups consumption in school-aged children: prospective associations from the Generation XXI birth cohort

PURPOSE

Appetite can influence children's dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age.

METHODS

The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children's Eating Behaviour Questionnaire was used to evaluate children's appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders.

RESULTS

Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13-1.58) and salty snacks (OR = 1.28; 99% CI 1.08-1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages.

CONCLUSIONS

Children's appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption).

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal

The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.

Healthy beverage index could decrease odds of metabolic syndrome: A cross-sectional study

Some studies indicated that sugar-sweetened beverages (SSBs) were related to MetS risk, and others found no relationship between MetS and SSBs. Therefore, the present study aimed to investigate the relationship between healthy beverage index (HBI) and MetS in Iranian adults. This cross-sectional study was performed on baseline data FASA cohort. Out of 10,127 participants in the FASA cohort study, 8838 participants were included in this study. The National Cholesterol Education Program's Adult Treatment Panel (ATP) III was used for MetS definition. The HBI was calculated by a 125-item food frequency questionnaire with standard criteria. The association between HBI and MetS and its components was evaluated by univariate regression. Multivariate regression with the backward method was used for adjusting confounders. p < .05 was considered as statistically significant. Compared to the first quartile, it was observed that HBI in the last quartile was significantly related to lower odds of MetS in the multivariate analysis (odds ratio [OR] = 0.72; 95% confidence interval [CI]: 0.60-0.87, p < .001). Also, we observed a significant association between the last quartile of HBI with lower odds of high waist circumference (WC) (OR = 0.55; 95% CI: 0.45-0.67, p < .002). Our findings showed that the higher HBI score reduced MetS odds and WC. Therefore, to reduce the odds of MetS, a healthy pattern of beverage consumption, including drinking water, low-fat milk, unsweetened tea, and coffee, and reducing the consumption of SSB are recommended. More studies are needed to confirm the findings.