Impact of individual and worksite environmental factors on water and sugar-sweetened beverage consumption among overweight employees

Introduction

The worksite environment may influence employees’ dietary behaviors. Consumption of water and sugar-sweetened beverages (SSBs) affect weight management; however, little research has evaluated the influence of worksite factors on beverage consumption. Our purpose was to determine whether individual and worksite factors are associated with water and SSB intake among overweight and obese employees.

Methods

Data were collected as part of baseline assessments for a worksite-based, weight-management intervention trial. Height and weight of participants (N = 1,482; 74% female; mean age = 47 y [standard deviation (SD) = 11y]; mean weight = 208 lbs [SD = 46 lbs]) were assessed, and participants completed a validated beverage intake questionnaire. Environmental characteristics of worksites (N = 28) were audited. A qualitative comparative analysis (QCA) was used to identify worksite conditions that may support healthier beverage intake patterns.

Results

Most participants were white (75% of sample) with at least some college education or a college degree (approximately 82% of sample). Mean water and SSB intake were 27 fl oz (SD = 18 fl oz) and 17 fl oz (SD = 18 fl oz), respectively; SSB intake (191 kcal [SD = 218 kcal]) exceeded the recommended discretionary energy intake. Statistical models did not identify any significant predictors of water intake. Female sex and increasing level of education and household income were associated with lower SSB intake; baseline body weight and greater number of worksite water coolers and vending machines were associated with higher SSB intake. The QCA identified worksite type (ie, not manual labor) as a condition necessary for healthier beverage consumption; a worksite break policy of 2 or more per day may lead to unhealthy beverage consumption.

Lower SSB consumption was noted among older participants, female participants, and among participants with higher education and income levels.

Conclusion

Workplace factors influence beverage consumption among overweight employees. Limiting vending machine availability and implementing policies that promote weight management may improve employee health.

A rapid beverage intake questionnaire can detect changes in beverage intake

Attention on beverage intake, specifically sugar-sweetened beverages (SSB), has increased in recent years. A brief valid, reliable and sensitive assessment tool for quantifying beverage consumption and determining its influence on weight status could help to advance research on this topic. The valid and reliable 15-item beverage questionnaire (BEVQ-15) estimates mean daily intake of water, SSB and total beverages (g, kcal) across multiple beverage categories.

OBJECTIVE

to determine the ability of the BEVQ-15 to detect changes in beverage intake over time. Participants (n=70; age=37±2 yr; BMI=24.5±0.4 kg/m(2)) underwent two randomly assigned 30-day periods (intervention, increased water and fruit juice consumption; control, increased solid fruit consumption), with a 30-day washout phase between feeding periods. The BEVQ-15 was administered at the beginning and end of each period. Reliability was assessed by Pearson's correlations, paired sample t tests and Cronbach's alpha. Paired sample t tests and repeated measures ANOVA were used to evaluate sensitivity to change. Sixty-nine participants completed all study sessions. Reliability was acceptable for most beverages (range: R(2)=0.52-0.95, P<0.001), but not for energy drinks. Increases in water (g), juice (kcal, g) and total beverage (g) were detected during the intervention period (P<0.001); no changes in these variables were detected in the control period. The BEVQ-15 demonstrates the ability to detect changes in beverage intake over time. This brief (~2 min), self-administered, valid, reliable and sensitive beverage intake assessment tool may be used by researchers and practitioners who evaluate and intervene upon beverage intake patterns in adults.

Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): sugar-sweetened beverages and total beverage energy intake

INTRODUCTION

Energy-containing beverages, specifically sugar-sweetened beverages, may contribute to weight gain and obesity development. Yet, no rapid assessment tools are available which quantify habitual beverage intake (grams, energy) in adults.

OBJECTIVE

Determine the factorial validity of a newly developed beverage intake questionnaire (BEVQ) and identify potential to reduce items.

METHODS

Participants from varying economic and educational backgrounds (n=1,596, age 43±12 years, body mass index [calculated as kg/m(2)] 31.5±0.2) completed a 19-item BEVQ (BEVQ-19). Beverages that contributed <10% to total beverage, or sugar-sweetened beverages, energy and grams were identified for potential removal. Factor analyses identified beverage categories that could potentially be combined. Regression analyses compared BEVQ-19 outcomes with the reduced version's (BEVQ-15) variables. Inter-item reliability was assessed using Cronbach's α. Following BEVQ-15 development, a subsequent study (n=70, age 37±2 years; body mass index 24.5±0.4) evaluated the relative validity of the BEVQ-15 through comparison of three 24-hour dietary recalls' beverage intake.

RESULTS

Three beverage items were identified for elimination (vegetable juice, meal replacement drinks, and mixed alcoholic drinks); beer and light beer were combined into one category. Regression models using BEVQ-15 variables explained 91% to 99% of variance in the four major outcomes of the BEVQ-19 (all P<0.001). Cronbach's α ranged .97 to .99 for all outcomes. In the follow-up study, BEVQ-15 and three 24-hour dietary recalls' variables were significantly correlated with the exception of whole milk; BEVQ-15 sugar-sweetened beverages (R(2)=0.69), and total beverage energy (R(2)=0.59) were more highly correlated with three 24-hour dietary recalls' than previously reported for the BEVQ-19. The BEVQ-15 produced a lower readability score of 4.8, which is appropriate for individuals with a fourth-grade education or greater.

CONCLUSIONS

The BEVQ-19 can be reduced to a 15-item questionnaire. This brief dietary assessment tool will enable researchers and practitioners to rapidly (administration time of ∼2 minutes) assess habitual beverage intake, and to determine possible associations of beverage consumption with health-related outcomes, such as weight status.

Association of δ¹³C in fingerstick blood with added-sugar and sugar-sweetened beverage intake

A reliance on self-reported dietary intake measures is a common research limitation, thus the need for dietary biomarkers. Added-sugar intake may play a role in the development and progression of obesity and related comorbidities; common sweeteners include corn and sugar cane derivatives. These plants contain a high amount of ¹³C, a naturally occurring stable carbon isotope. Consumption of these sweeteners, of which sugar-sweetened beverages are the primary dietary source, might be reflected in the δ¹³C value of blood. Fingerstick blood represents an ideal substrate for bioassay because of its ease of acquisition. The objective of this investigation was to determine if the δ¹³C value of fingerstick blood is a potential biomarker of added-sugar and sugar-sweetened beverage intake. Individuals aged 21 years and older (n = 60) were recruited to attend three laboratory visits; assessments completed at each visit depended upon a randomly assigned sequence (sequence one or two). The initial visit included assessment of height, weight, and dietary intake (sequence one: beverage intake questionnaire, sequence two: 4-day food intake record). Sequence one participants completed a food intake record at visit two, and nonfasting blood samples were obtained via routine fingersticks at visits one and three. Sequence two participants completed a beverage intake questionnaire at visit two, and provided fingerstick blood samples at visits two and three. Samples were analyzed for δ¹³C value using natural abundance stable isotope mass spectrometry. δ¹³C value was compared to dietary outcomes in all participants, as well as among those in the highest and lowest tertile of added-sugar intake. Reported mean added-sugar consumption was 66 ± 5 g/day, and sugar-sweetened beverage consumption was 330 ± 53 g/day and 134 ± 25 kcal/day. Mean fingerstick δ¹³C value was -19.94‰ ± 0.10‰, which differed by body mass index status. δ¹³C value was associated (all P < 0.05) with intake of total added sugars (g, r = 0.37; kcal, r = 0.37), soft drinks (g, r = 0.26; kcal, r = 0.27), and total sugar-sweetened beverage (g, r = 0.28; kcal, r = 0.35). The δ¹³C value in the lowest and the highest added-sugar intake tertiles were significantly different (mean difference = -0.48‰; P = 0.028). Although there are several potential dietary sources for blood carbon, the δ¹³C value of fingerstick blood shows promise as a noninvasive biomarker of added-sugar and sugar-sweetened beverage intake based on these findings.

Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults

Water consumption acutely reduces meal energy intake (EI) among middle-aged and older adults. Our objectives were to determine if premeal water consumption facilitates weight loss among overweight/obese middle-aged and older adults, and to determine if the ability of premeal water consumption to reduce meal EI is sustained after a 12-week period of increased water consumption. Adults (n = 48; 55-75 years, BMI 25-40 kg/m(2)) were assigned to one of two groups: (i) hypocaloric diet + 500 ml water prior to each daily meal (water group), or (ii) hypocaloric diet alone (nonwater group). At baseline and week 12, each participant underwent two ad libitum test meals: (i) no preload (NP), and (ii) 500 ml water preload (WP). Meal EI was assessed at each test meal and body weight was assessed weekly for 12 weeks. Weight loss was ~2 kg greater in the water group than in the nonwater group, and the water group (beta = -0.87, P < 0.001) showed a 44% greater decline in weight over the 12 weeks than the nonwater group (beta = -0.60, P < 0.001). Test meal EI was lower in the WP than NP condition at baseline, but not at week 12 (baseline: WP 498 +/- 25 kcal, NP 541 +/- 27 kcal, P = 0.009; 12-week: WP 480 +/- 25 kcal, NP 506 +/- 25 kcal, P = 0.069). Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle-aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.