A preconception cohort study of sugar-sweetened beverage consumption and semen quality

BACKGROUND

Dietary factors, including high sugar intake, may have adverse effects on male reproduction. Studies of the association between sugar-sweetened beverage (SSB) intake and semen quality have reported inconsistent results.

OBJECTIVE

We estimated the effects of SSB consumption on semen quality in a North American preconception cohort study.

METHODS

We analyzed baseline data from 690 males (n = 1,247 samples) participating in Pregnancy Study Online (PRESTO) during 2015-2022. Participants aged ≥21 years completed a baseline questionnaire on which they reported information about intake of SSBs, including sodas, energy drinks, sports drinks, and fruit juices. After enrollment, we invited U.S. participants to a semen testing substudy, in which they collected and analyzed two samples using an at-home semen testing kit. We used linear regression models to estimate adjusted percent differences (%D) and 95% confidence intervals (CI) for associations of SSB intake with semen volume, sperm concentration, total sperm count (TSC), motility, and total motile sperm count (TMSC). We used modified Poisson regression models to estimate adjusted risk ratios (RRs) and 95% CIs for the association of SSB intake with World Health Organization semen parameter cut points.

RESULTS

Relative to non-consumers of SSBs, those who consumed ≥7 SSBs/week had lower semen volume (%D = -6, 95% CI: -13, 0), sperm concentration (%D = -22, 95% CI: -38, 0), TSC (%D = -22, 95% CI: -38, -2), motility (%D = -4, 95% CI: -10, 2), and TMSC (%D = -25, 95% CI: -43, -2). High SSB consumers also had greater risks of low sperm concentration (≤16 million/mL; RR = 1.89, 95% CI: 1.11, 3.21), low TSC (≤39 million; RR = 1.75, 95% CI: 0.92, 3.33), low motility (≤42%; RR = 1.23, 95% CI: 0.87, 1.75) and low TMSC (≤21 million; RR = 1.95, 95% CI: 1.12, 3.38). Associations were stronger among participants with body mass index ≥ 25 kg/m2 .

CONCLUSION

Greater SSB consumption was associated with reduced semen quality in a North American preconception cohort.

Sugar-sweetened or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in adults: a prospective cohort study

BACKGROUND

Whether physical activity could mitigate the adverse impacts of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) on incident cardiovascular disease (CVD) remains uncertain.

OBJECTIVES

This study aimed to examine the independent and joint associations between SSB or ASB consumption and physical activity and risk of CVD, defined as fatal and nonfatal coronary artery disease and stroke, in adults from 2 United States-based prospective cohort studies.

METHODS

Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs between SSB or ASB intake and physical activity with incident CVD among 65,730 females in the Nurses' Health Study (1980-2016) and 39,418 males in the Health Professional's Follow-up Study (1986-2016), who were free from chronic diseases at baseline. SSBs and ASBs were assessed every 4-y and physical activity biannually.

RESULTS

A total of 13,269 CVD events were ascertained during 3,001,213 person-years of follow-up. Compared with those who never/rarely consumed SSBs or ASBs, the HR for CVD for participants consuming ≥2 servings/d was 1.21 (95% CI: 1.12, 1.32; P-trend < 0.001) for SSBs and 1.03 (95% CI: 0.97, 1.09; P-trend = 0.06) for those consuming ≥2 servings/d of ASBs. The HR for CVD per 1 serving increment of SSB per day was 1.18 (95% CI: 1.10, 1.26) and 1.12 (95% CI: 1.04, 1.20) for participants meeting and not meeting physical activity guidelines (≥7.5 compared with <7.5 MET h/wk), respectively. Compared with participants who met physical activity guidelines and never/rarely consumed SSBs, the HR for CVD was 1.47 (95% CI: 1.37, 1.57) for participants not meeting physical activity guidelines and consuming ≥2 servings/wk of SSBs. No significant associations were observed for ASB when stratified by physical activity.

CONCLUSIONS

Higher SSB intake was associated with CVD risk regardless of physical activity levels. These results support current recommendations to limit the intake of SSBs even for physically active individuals.

"Conscientious Guardian" vs. "Commercialized Jungle": Pharmacists and Pharmacy Design in the Postwar United States

Pharmacists and pharmacies are key drivers in the American marketplace. They serve as an endpoint of the pharmaceutical supply chain and are the dispensers of a range of consumer goods, some nonthreatening and others potentially harmful to public health. In adding pharmacies to the roster of consumerist locales in the postwar period, scholars might draw even deeper connections about the transformation of health, corporate medicine, and American economic power. To understand the interface of consumerism, corporatism, and health in postwar America, this article holds the postwar pharmacy as a key site of commodity exchange and business and positions it within the larger American firmament, paying attention to the design of pharmacies. In particular, the article will add to the knowledge about the tangible ways that medical and health care spaces are constructed, organized, and designed to best generate profits. Besides prescription medications, alcohol, tobacco, and sugar-rich products were also vital elements of the postwar pharmacy and will be featured in this article. What is more, this article focuses on a central debate between pharmacists during the postwar period about how pharmacies were shifting from the role of healer to that of a retailer - from a "conscientious guardian" to a "commercialized jungle" - in order to highlight how the public health role of pharmacies was undermined by industry pressures for profit. Based on unused corporate guides and manuals, company records, photographs, and management documents, this article will spotlight the underexplored interiority of pharmacies - the store's insides, processes of organization, and design features related to potentially habit-changing substances.

Maternal dietary caffeine consumption and risk of birth defects in the National Birth Defects Prevention Study, 1997-2011

BACKGROUND

Caffeine consumption is common during pregnancy, but published associations with birth defects are mixed. We updated estimates of associations between prepregnancy caffeine consumption and 48 specific birth defects from the National Birth Defects Prevention Study (NBDPS) for deliveries from 1997 to 2011.

METHODS

NBDPS was a large population-based case-control study conducted in 10 U.S. states. We categorized self-reported total dietary caffeine consumption (mg/day) from coffee, tea, soda, and chocolate as: <10, 10 to <100, 100 to <200, 200 to <300, and ≥ 300. We used logistic regression to estimate adjusted odds ratios (aORs [95% confidence intervals]). Analyses for defects with ≥5 exposed case children were adjusted for maternal race/ethnicity, age at delivery, body mass index, early pregnancy cigarette smoking and alcohol use, and study site.

RESULTS

Our analysis included 30,285 case and 11,502 control children, with mothers of 52% and 54%, respectively, reporting consuming <100 mg caffeine, and 11% of mothers of both cases and controls reported consuming ≥300 mg per day. Low (10 to <100 mg/day) levels of prepregnancy caffeine consumption were associated with statistically significant increases in aORs (1.2-1.7) for 10 defects. Associations with high (≥300 mg/day) levels of caffeine were generally weaker, except for craniosynostosis and aortic stenosis (aORs = 1.3 [1.1-1.6], 1.6 [1.1-2.3]).

CONCLUSIONS

Given the large number of estimates generated, some of the statistically significant results may be due to chance and thus the weakly increased aORs should be interpreted cautiously. This study supports previous observations suggesting lack of evidence for meaningful associations between caffeine consumption and the studied birth defects.

Behavioral Patterns of Sugary Drink Consumption among African American Adolescents: A Pilot and Feasibility Study Using Ecological Momentary Assessment

BACKGROUND

Sugary drinks (SDs) are the predominant contributors to added sugar intake among adolescents, with the highest intakes reported among African American adolescents. The objective of this pilot study was to examine the feasibility of using mobile phone-based ecological momentary assessment (EMA) to investigate, in real time, behavioral patterns of SD consumption among African American adolescents from low-income households.

METHODS

Adolescents (n = 39, ages 12-17) attended a virtual meeting with a trained research assistant, which involved completion of surveys and training on responding to EMA prompts using a mobile phone application. On the seven subsequent days, adolescents were instructed to respond to researcher-initiated prompts three times daily, which queried their SD intake, location, social context, activities, stress, and mood. They were also asked to complete an analogous self-initiated survey each time they consumed SDs.

RESULTS

SD consumption was reported on 219 of 582 (38%) researcher-initiated surveys and on 135 self-initiated SD consumption surveys, for a total of 354 instances of SD intake over the 7-day assessment period. The majority (69%) of the surveys were completed while at home. SD consumption was reported on 37%, 35%, and 41% of researcher-initiated surveys completed at their home, at the home of a friend or family member, or while in transit, respectively.

CONCLUSIONS

These preliminary data indicate that mobile phone-based EMA is feasible for investigating SD intake behaviors among African American youth from low-income households and support the promise of EMA for investigating SD consumption in this population in larger samples of youth.

Consumption of Sugary Drinks among Urban Adults in Colombia: Association with Sociodemographic Factors and Body Adiposity

INTRODUCTION

Calories from sugar-sweetened beverages (SSBs) contribute to the development of noncommunicable diseases. There is limited knowledge of the intake of SSBs and their correlates in developing countries. Thus, this study aimed to estimate the consumption of multiple SSBs and their sociodemographic correlates in an urban adult population from Colombia, South America.

METHODS

This was a probabilistic, population-level study of adults aged 18 to 75 from five cities representing different regions of Colombia. Dietary intake was assessed employing a 157-item semiquantitative food frequency questionnaire that inquired about intake over the last year. The consumption of regular soda, low-calorie soda, homemade and industrialized fruit juices, energy drinks, sport drinks, malt drinks and traditional sugar cane infusion ("agua de panela") was analyzed for the total sample and subgroups defined by sociodemographic and clinical factors of interest.

RESULTS

The study included 1491 individuals (female: 54.2%, mean age: 45.3, overweight: 38.0%, obese: 23.3%). Sugary beverages contributed, on average, 287 Cal/d among women and 334 Cal/d among men, representing 8.9% of total daily calories (TDC). Women in the lowest SEL consumed 10.6% of their TDC from sugary drinks, as opposed to 6.6% for those in a high SEL. For men, this difference was not present (p-value for interaction = 0.039). Interestingly, a higher educational level correlated with a lower consumption of calories from sugary drinks only among men. Fruit juices were by far the main source of sugary drinks, and their consumption did not change sizably by sex and socioeconomic or educational level. Among women, there was a negative association between socioeconomic level (SEL) and consumption of regular soda, a 50% difference between extreme levels. The intake of low-calorie soda was much higher among men than women, and it more than tripled in the highest vs. lowest SEL among men. The consumption of energy drinks was heavily concentrated in men of low SEL.

CONCLUSION

Colombian urban adults obtain a considerable proportion of their calories from sugary drinks, especially vulnerable groups such as women with lower education. Given the recent acceleration of the obesity epidemic in Latin America, strategies to limit the intake of such liquid calories may provide important public health benefits.

Predictors of sugar-sweetened carbonated beverage consumption and its effect on adiposity parameters of female Saudi students

The prevalence of obesity has recently increased, accompanied by a steep increase in the consumption of sugar-sweetened carbonated beverages (SSCBs). This cross-sectional study was conducted to evaluate the impact of SSCB consumption on adiposity parameters and to identify factors associated with increased SSCB intake among young adult females in Makkah, Saudi Arabia. A validated closed questionnaire including 2 sections, general socioeconomic and behavioral characteristics and anthropometric measurements, was used for data collection of female students (n = 1616) from Umm Al-Qura University, Makkah, Saudi Arabia. Furthermore, height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), and body composition were measured using an Omron HBF-510 body composition analyzer. Overall, 30.2% of the study participants consumed soda regularly. However, the percentages of occasional and never/rare soda intake were 40.1% and 29.7%, respectively. The results showed that BMI, WC, HC, body fat, and visceral fat increased with increasing SSCB intake. Physical inactivity, low income, smoking, low daily water intake, and obesity were associated with increased consumption of SSCB. In conclusion, a high rate of SSCB consumption increased obesity and body fat content in young adult females in Makkah City. Physical inactivity, low income, smoking, low daily water intake, and obesity were identified as predictors of increased SSCB consumption. Specific health education programs and effective public awareness campaigns could be held to address unhealthy SSCB drinking patterns to help improve young women's health.

Stop the Pop: A Mixed-Methods Study Examining Children's Physical and Emotional Responses during Three Days of Sugary Drink Cessation

Despite public health efforts to reduce sugary drink consumption, children’s intake continues to exceed recommendations. While numerous barriers to lowering sugary drink consumption have been identified, aversive feelings during sugary drink cessation may further challenge sustained reduction in children’s sugary drink consumption. Herein, we describe “Stop the Pop”, an intervention to examine children’s physical and emotional responses during three days of sugary drink cessation. Children (n = 150) ages 8–14, who reported habitual consumption of ≥12 ounces of sugary drinks daily, were instructed to avoid sweetened beverages for three days. At baseline and on each day of cessation, children completed a daily feelings questionnaire, and a subset of children (n = 30) also completed a qualitative interview following cessation. During sugary drink cessation, children reported physical and emotional improvements, including being less tired, angry, and annoyed; having less trouble sleeping; and less frequently arguing with others, getting in trouble, and getting mad. However, unfavorable responses, such as mood disturbances and having less energy, were reported by some participants. Our results suggest that children who habitually consume sugary drinks may experience physical and emotional improvements during short-term sugary drink cessation, although longer-term examination is needed and inter-individual variability in responses to cessation warrants further study.

Determinants of soft drink consumption among children and adolescents in developed countries - a systematic review

OBJECTIVES

Soft drinks are a major component of daily caloric and sugar intake. This is especially true for children and adolescents. The WHO as well as many other institutions currently recommend to increase research on the determinants of soft drink consumption. We submit a current systematic review on this topic.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we included all quantitative observational studies that comprise samples from developed countries in the age range 0-18 years and are listed in PubMed, Sociological Abstracts and the Social Sciences Citation Index. Publication period was not limited. The second and the last author screened all 10,392 hits independently with both reviewers being blinded. Interrater reliability (agreement and Cohen's kappa) was 97%/0.73 for the selection of titles, 91%/0.83 for abstracts and 91%/0.80 for full texts.

RESULTS

Results of 43 included studies, published between 2001 and 2017, show that children and adolescents consuming soft drinks tend to be older, male and of lower social status. Important contextual factors promoting consumption include constant availability at home, at schools or elsewhere as well as restrictions by parents and rules concerning drinks during meals or generally at home. The association between media consumption and soft drink consumption is particularly striking. Other factors in the food environment (choice of food and alternative drinks at home, having meals together, motivation, knowledge about nutrition and healthy eating) are of minor importance.

CONCLUSIONS

When introducing interventions parents should play a major role because they serve as physical and social gatekeepers for this early risk factor of juvenile obesity.

Different associations of specific non-alcoholic beverages with elevated high-sensitivity C-reactive protein in Korean adults: results from the Korea National Health and Nutrition Examination Survey (2015-2016)

This study examined the associations between specific non-alcoholic beverages and high-sensitivity C-reactive protein (hs-CRP) and their interactions with obesity. The study participants were 4,999 adults aged 19-64 years from the 2015-2016 Korean National Health and Nutrition Examination Survey. The odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using multivariable logistic regression analyses. In women, there was an inverse linear trend between coffee and hs-CRP status (p trend = 0.0137), and a positive linear trend for soda was also found (≥1/week vs never or almost never, OR = 1.79, 95% CI 1.23-2.61, p trend = 0.0127). In the stratification analyses, the associa-tions were only observed in obese women. The associations were inverse for coffee and tea but linearly positive for soda in obese women (p trend<0.05). In men, an inverted J-shaped association between commercial fruit juice/drink and hs-CRP status was found; but after stratification by obesity, the association was linear only in obese men (p trend<0.05, OR = 2.44, 95% CI 1.44-4.16 in ≥1/week vs never or almost never). Coffee and tea in women may be beneficially associated with hs-CRP status, but soda in women and commercial fruit juice/drink in men may be adversely, particularly for obese adults.

Soda Consumption Among Mexican Construction Workers in the Context of the Sugar-Sweetened Beverage Tax

This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.

Sugar-sweetened soft drink consumption acutely decreases spontaneous baroreflex sensitivity and heart rate variability

In healthy humans, fructose-sweetened water consumption increases blood pressure variability (BPV) and decreases spontaneous cardiovagal baroreflex sensitivity (cBRS) and heart rate variability (HRV). However, whether consuming commercially available soft drinks containing high levels of fructose elicits similar responses is unknown. We hypothesized that high-fructose corn syrup (HFCS)-sweetened soft drink consumption increases BPV and decreases cBRS and HRV to a greater extent compared with artificially sweetened (diet) and sucrose-sweetened (sucrose) soft drinks and water. Twelve subjects completed four randomized, double-blinded trials in which they drank 500 mL of water or commercially available soft drinks matched for taste and caffeine content. We continuously measured beat-to-beat blood pressure (photoplethysmography) and R-R interval (ECG) before and 30 min after drink consumption during supine rest for 5 min during spontaneous and paced breathing. BPV was evaluated using standard deviation (SD), average real variability (ARV), and successive variation (SV) methods for systolic and diastolic blood pressure. cBRS was assessed using the sequence method. HRV was evaluated using the root mean square of successive differences (RMSSD) in R-R interval. There were no differences between conditions in the magnitude of change from baseline in SD, ARV, and SV (P ≥ 0.07). There were greater reductions in cBRS during spontaneous breathing in the HFCS (-3 ± 5 ms/mmHg) and sucrose (-3 ± 5 ms/mmHg) trials compared with the water trial (+1 ± 5 ms/mmHg, P < 0.03). During paced breathing, HFCS evoked greater reductions in RMSSD compared with water (-26 ± 34 vs. +2 ± 26 ms, P < 0.01). These findings suggest that sugar-sweetened soft drink consumption alters cBRS and HRV but not BPV.

Ethanol as a Probe for the Mechanism of Bubble Nucleation in the Diet Coke and Mentos Experiment

The Diet Coke and Mentos experiment involves dropping Mentos candies into carbonated beverages to produce a fountain. This simple experiment has enjoyed popularity with science teachers and the general public. Studies of the physicochemical processes involved in the generation of the fountain have been largely informed by the physics of bubble nucleation. Herein, we probe the effect of ethanol addition on the Diet Coke and Mentos experiment to explore the impact that beverage surface tension and viscosity have on the heights of fountains achieved. Our results indicate that current descriptions of the effects of surface tension and viscosity are not completely understood. We also extend and apply a previously reported, simplified version of Brunauer–Emmett–Teller theory to investigate kinetic and mechanistic aspects of bubble nucleation on the surface of Mentos candies in carbonated beverages. A combination of this new theory and experiment allows for the estimation that the nucleation sites on the Mentos candy that catalyze degassing are 1–3 μm in size, and that between 50,000 and 300,000 of these sites actively nucleate bubbles on a single Mentos candy. While the methods employed are not highly sophisticated, they have potential to stimulate fresh investigations and insights into bubble nucleation in carbonated beverages.

Acute diet soda consumption alters brain responses to food cues in humans: A randomized, controlled, cross-over pilot study

BACKGROUND

Diet soda consumption has frequently been linked to obesity and its comorbidities in epidemiological studies. Whether this link is causal and a potential mechanism remains to be determined.

AIM/METHODS

This randomized, cross-over, controlled pilot study sought to determine whether there may be changes in reward-related brain activations to visual food cues after acute consumption of diet soda versus regular soda or carbonated water using functional magnetic resonance imaging.

RESULTS

Diet soda as compared to carbonated water consumption increased activation of reward-related caudate to highly versus less desirable food cues. Diet soda as compared to regular soda increased reward-related insula and decreased activation of cognitive control-related dorsolateral prefrontal cortex to food cues versus non-food cues. No changes in ratings of hunger an hour after beverage consumption were observed.

CONCLUSIONS

These results may suggest a potential mechanism for diet soda to increase food palatability through activation of the reward system and suppression of inhibitory control that remains to be confirmed by future studies.

Childhood emotional and behavioral characteristics are associated with soda intake: A prospective study in Mexico City

OBJECTIVES

To evaluate whether childhood emotional and behavioral characteristics are associated with soda intake.

METHODS

The study population included 391 Mexico City adolescents enrolled in a birth cohort study. When children were between 6 and 12 years of age, the Behavioral Assessment System for Children (BASC)-2 was administered. Nondiet soda intake was measured concurrently and again when participants were of peripubertal ages via food frequency questionnaire. Linear regression models were run with soda mL/day (cross-sectional and change in soda over time) as the outcome and BASC composite scores as predictors (in separate models), adjusting for confounders.

RESULTS

At baseline, children were 8.3 (SD 1.3) years (49% males). Three scales out of 18 examined had statistically significant associations. Parent-reported adaptive skills were inversely associated with concurrent soda intake (β = -2.29 with 95% CI -4.27 to -0.31). Parent-reported internalizing problems (higher = more problems) were related to higher change in soda intake from childhood to adolescence (β = 5.83 with 95% CI 0.98-10.68; N = 191). Self-reported school problems were associated with a higher change in soda intake over time (β = 9.46 with 95% CI 2.10-16.82; N = 122).

CONCLUSIONS

Parent- and self-reported emotional and behavioral difficulties in childhood were associated with soda consumption and changes in soda consumption over time.

The effects of soda taxes on adolescent sugar intake and blood sugar

Intake of added sugars is high in the US adolescent population, with sugar-sweetened beverages being the primary source. We contribute to the literature by providing the first estimates of the impacts of soda sales taxes, which are commonly levied in the US states, on the total daily sugar intake and blood sugar of adolescents aged 12-19 years. Using a restricted-use version of the 1999-2014 National Health and Nutrition Examination Survey (NHANES) and exploiting within-state variation in soda sales tax rates over time, our results indicate that adolescent soft drink demand is tax-sensitive. Consistent with prior research using NHANES data, we find that adolescents reduce calories consumed from soft drinks when faced with a rise in soda sales taxes, but they offset this reduction with an increase in calorie intake from milk drinks. In accordance with this substitution behavior, we find that soda sales taxes cause small and insignificant changes in the total daily calorie intake, total daily sugar intake, or blood sugar levels of adolescents.

The Joint Effects of Some Beverages Intake and Smoking on Chronic Obstructive Pulmonary Disease in Korean Adults: Data Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2015

Some beverages and smoking cause an inflammatory response in the lungs and airways in a similar way, ultimately affecting chronic obstructive pulmonary disease (COPD) occurrence. Using a nationally representative health survey database, this study investigates the individual and joint effects of consumption of different beverages and smoking on COPD. This study is a cross-sectional analysis of 15,961 Korean adults in the Korea National Health and Nutritional Examination Survey of 2008–2015. COPD was defined as forced expiratory volume in 1 s (FEV₁) divided by forced vital capacity (FVC) <0.70. We used multiple linear and logistic regression models to examine the association of beverage consumption and smoking with an FEV₁/FVC ratio and odds ratio (OR) for COPD. The mean FEV₁/FVC ratio decreased with increasing soda intake (p = 0.016), coffee intake (p = 0.031), and smoking status; however, the mean FEV₁/FVC ratio increased with increasing green tea intake frequency (p = 0.029). When soda intake increased to 10 times/month, the OR of having COPD increased to 1.04 times (95% CI: 1.01, 1.07). The positive joint effect of soda intake and smoking on COPD was marginally significant (p = 0.058). We found that soda intake, coffee intake, and smoking increased airflow limitation while green tea intake decreased it. In addition, soda intake and smoking had a positive joint effect on COPD in the Korean population.

Parental Concerns about Child and Adolescent Caffeinated Sugar-Sweetened Beverage Intake and Perceived Barriers to Reducing Consumption

Sugar-sweetened beverage (SSB) consumption contributes to obesity and chronic disease. SSB intake in children and adolescents remains well above recommendations and reducing intake is challenging. In addition to high sugar content, SSBs are the predominant source of caffeine among youth. However, whether caffeine in SSBs presents unique barriers to reducing consumption is unknown. Herein, we examine parental concerns about child caffeinated-SSB (CSSB) intake and describe parent-reported barriers to lowering their child’s consumption. In-depth qualitative interviews were conducted with 21 parents of children and adolescents 8–17 years of age. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded using Nvivo™, and key themes were identified. Most parents expressed concern about child CSSB consumption, primarily with regard to dietary (e.g., excess sugar), health (e.g., obesity, diabetes) and/or behavioral (e.g., hyperactivity) consequences of frequent intake. Several key barriers to CSSB restriction were reported, encompassing six emergent themes: widespread availability and accessibility; child non-compliance when asked not to drink CSSBs; peer and cultural influences; negative child response to CSSB restriction; family eating behaviors; and, child preferences for CSSBs versus other beverages. Consideration of these barriers, along with the development of novel approaches to address these challenges, will likely bolster success in interventions aimed at reducing CSSB intake among children and adolescents.

High-fructose corn syrup-sweetened soft drink consumption increases vascular resistance in the kidneys at rest and during sympathetic activation

We first tested the hypothesis that consuming a high-fructose corn syrup (HFCS)-sweetened soft drink augments kidney vasoconstriction to sympathetic stimulation compared with water (study 1). In a second study, we examined the mechanisms underlying these observations (study 2). In study 1, 13 healthy adults completed a cold pressor test, a sympathoexcitatory maneuver, before (preconsumption) and 30 min after drinking 500 mL of decarbonated HFCS-sweetened soft drink or water (postconsumption). In study 2, venous blood samples were obtained in 12 healthy adults before and 30 min after consumption of 500 mL water or soft drinks matched for caffeine content and taste, which were either artificially sweetened (Diet trial), sucrose-sweetened (Sucrose trial), or sweetened with HFCS (HFCS trial). In both study 1 and study 2, vascular resistance was calculated as mean arterial pressure divided by blood velocity, which was measured via Doppler ultrasound in renal and segmental arteries. In study 1, HFCS consumption increased vascular resistance in the segmental artery at rest (by 0.5 ± 0.6 mmHg·cm^-1·s^-1, P = 0.01) and during the cold pressor test (average change: 0.5 ± 1.0 mmHg·cm^-1·s^-1, main effect: P = 0.05). In study 2, segmental artery vascular resistance increased in the HFCS trial (by 0.8 ± 0.7 mmHg·cm^-1·s^-1, P = 0.02) but not in the other trials. Increases in serum uric acid were greater in the HFCS trial (0.3 ± 0.4 mg/dL, P ≤ 0.04) compared with the Water and Diet trials, and serum copeptin increased in the HFCS trial (by 0.8 ± 1.0 pmol/L, P = 0.06). These findings indicate that HFCS acutely increases vascular resistance in the kidneys, independent of caffeine content and beverage osmolality, which likely occurs via simultaneous elevations in circulating uric acid and vasopressin.

A Randomized Study of the Effect of Replacing Sugar-Sweetened Soda by Reduced Fat Milk on Cardiometabolic Health in Male Adolescent Soda Drinkers

Soda consumption in adolescents has been linked to poorer metabolic outcomes. We tested whether replacing soda with reduced fat milk would improve features of atherogenic dyslipidemia and other cardiometabolic risk factors. Thirty overweight and obese adolescent boys who were habitual consumers of sugar-sweetened beverages were randomly assigned to consume 24 oz/day of sugar-sweetened soda or an energy equivalent of reduced fat (2%) milk for 3 weeks with crossover to the alternate beverage after a ≥ 2 weeks washout. Plasma lipids and lipoproteins and other laboratory measures were assessed after each beverage period. Lipid and lipoprotein measurements, C-reactive protein, and serum transaminases did not differ significantly between the soda and milk phases of the study. Systolic blood pressure z-score and uric acid concentration were significantly lower after consuming milk compared to soda. Milk consumption also significantly decreased plasma glucosyl ceramide (d18:1/C16:0) and lactosylceramides (d18:1/C16:0 and d18:1/C18:0). While no effects of replacing soda with milk on lipid and lipoprotein measurements were observed in these normolipidemic weight-stable adolescent boys, decreases in systolic blood pressure, uric acid, and glycosphingolipids suggest that an overall favorable effect on cardiometabolic risk can be achieved following a short-term dietary intervention.

Effects of Exposure to Cola-Based Soft Drink on Bleaching Effectiveness and Tooth Sensitivity of In-Office Bleaching: A Blind Clinical Trial

OBJECTIVE

The purpose of this single-blind (evaluators) and parallel design study was to evaluate whether exposure to a cola-based soft drink during bleaching treatment with 35% hydrogen peroxide (HP) affects color change and bleaching-induced tooth sensitivity.

MATERIAL AND METHODS

Forty-four patients with central incisors darker than A2 were selected. Participants who did not drink cola-based soft drinks were assigned to the control group (CG), while participants who drank a cola-based soft drink at least twice a day were assigned to the experimental group (EG). For the CG, foods with staining dyes were restricted. For the EG, there was no restriction on food and patients were asked to rinse their mouths with a cola-based soft drink for 30 s, 4 times daily. For both groups, 2 sessions with three 15 min applications of 35% HP were performed. Shade evaluation was assessed via subjective (VITA classical and VITA bleacheguide shade guides) and objective methods (Easyshade spectrophotometer) at baseline, during bleaching (first, second, and third weeks), and post bleaching (1 week and 1 month). Patients recorded their sensitivity perceptions using a numerical rating scale and 0-10 visual analog scales. Variation in shade guide units and the 2 colors (DE) were evaluated with a Student's t-test (α = 0.05) and Mann-Whitney test (α = 0.05). Absolute risk of tooth sensitivity and intensity of tooth sensitivity were evaluated by a Chi-square test (α=0.05).

RESULTS

Effective bleaching was observed for both groups after 30 days, without statistical difference (p > 0.08). There was no significant difference in absolute risk of bleaching-induced tooth sensitivity between the 2 groups (p = 0.74). Higher and significant scores in pain scales were detected for the EG in comparison to the CG (p < 0.05).

CONCLUSION

Even that the cola-based soft drink exposure during in-office bleaching treatments did not affect the bleaching's effectiveness; patients reported a higher intensity in bleaching-induced tooth sensitivity.

Associations of Added Sugar from All Sources and Sugar-Sweetened Beverages with Regional Fat Deposition in US Adolescents: NHANES 1999-2006

BACKGROUND

The relative distribution of upper- versus lower-body fat may be an important determinant of cardiometabolic disease risk in youths. Dietary components associated with adolescent regional body fat distribution require further investigation.

OBJECTIVE

To evaluate associations of added sugar intake overall and from sugar-sweetened beverages (SSBs) with relative upper-body fat deposition in US adolescents.

METHODS

This was a cross-sectional analysis of data from 6585 adolescents (aged 12-19 y) in the NHANES cycles 1999-2006. Trunk, leg, and total fat mass were assessed by DXA. Participants were grouped into categories of total and SSB added sugar intake as a percentage of total energy intake (TEI) in 5% increments. Stepwise multivariable linear regression was used to examine associations of added sugar intake with truncal-to-leg fat ratio (TLR) and truncal-to-total fat ratio (TTR).

RESULTS

There were no associations of total added sugar intake with TLR or TTR. For SSB added sugar, compared with the lowest category of intake (<2% TEI), the highest category (>22% TEI) was associated with higher log-TLR [β (95% CI): >22% TEI versus <2% TEI: 0.05 (0.01, 0.09)] and TTR [1.30 (0.53, 2.07)] in the partially adjusted model with sex, age, race/ethnicity, income, physical activity, and smoking status as covariates (P-trend = 0.0001 for both). When BMI z-score and TEI were added as covariates, the magnitude of the associations were attenuated, but remained significant [log-TLR β (95% CI): 0.03 (0.005, 0.06), P-trend = 0.0018; TTR β (95% CI): 0.75 (0.27, 1.23), P-trend = 0.0004].

CONCLUSIONS

These findings support that added sugar from beverages is associated with higher upper-body adiposity, though the magnitude and clinical significance of the associations may be small, especially when adjusted for BMI and TEI. Additional studies are needed to elucidate the underlying biological mechanisms to explain these findings.

Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys

BACKGROUND

Adolescence presents an opportunity to influence diet, which impacts present and future health outcomes, yet adolescent diets globally are poorly understood.

OBJECTIVE

We generate evidence on adolescent diets globally and explore patterns and trends by subpopulation.

METHODS

We estimated mean frequency of consumption and prevalence of less-than-daily fruit and vegetable consumption, at-least-daily carbonated beverage consumption, and at-least-weekly fast-food consumption among school-going adolescents aged primarily 12 to 17 years from the Global School-based Student Health Surveys in Africa, Asia, Oceania, and Latin America between 2008 and 2015. Random-effects meta-analysis was used to pool estimates globally and by subgroup.

RESULTS

On average, adolescents consumed fruit 1.43 (95% confidence interval [CI] 1.26-1.60) times per day, vegetables 1.75 (1.58-1.92) times per day, carbonated soft drinks 0.99 (0.77-1.22) times per day, and fast food 1.05 (0.78-1.32) times per week. Overall, 34.5% (95% CI 29.4-39.7) consumed fruit less than once per day, 20.6% (15.8-25.9) consumed vegetables less than once per day, 42.8% (35.2-50.7) drank carbonated soft drinks at least once per day, and 46.1% (38.6-53.7) consumed fast food at least once per week. Mean daily frequency of fruit consumption was particularly low in South and East Asia (1.30 [1.02-1.58]); carbonated soft drink consumption high in Latin America (1.54 [1.31-1.78]), high-income countries (1.66 [1.29-2.03]), and modern food system typologies (1.44 [0.75-2.12]); and mean weekly fast food consumption high in mixed food system typologies (1.29 [0.88-1.71]).

CONCLUSIONS

School-going adolescents infrequently consume fruits and vegetables and frequently consume carbonated soft drinks, but there is wide variability by subpopulation.

Beverage intake during alternate-day fasting: Relationship to energy intake and body weight

BACKGROUND

Alternate-day fasting (ADF) involves a 'famine day' (25% energy intake) and a 'feast day' (ad libitum intake). This secondary analysis examined changes in beverage intake in relation to energy intake and body weight during 12 months of ADF versus daily calorie restriction (CR).

METHODS

Obese subjects (n = 100 enrolled, n = 69 completers) were randomized to one of three groups for 12 months: (a) ADF; (b) CR; or (c) control.

RESULTS

At baseline, intakes of diet soda, caffeinated beverages, sugar-sweetened soda, alcohol, juice, and milk were similar between groups. There were no statistically significant changes in the intake of these beverages by month 6 or 12 between ADF (feast or famine day), CR, or control groups. Beverage intake was not related to energy intake or body weight at month 6 or 12 in any group.

CONCLUSION

These pilot findings suggest that intermittent fasting does not impact beverage intake in a way that affects energy intake or body weight.

A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk

BACKGROUND

Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals.

OBJECTIVE

The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM).

METHODS

We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed.

RESULTS

In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation.

CONCLUSIONS

Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

Caffeine in the Diet: Country-Level Consumption and Guidelines

Coffee, tea, caffeinated soda, and energy drinks are important sources of caffeine in the diet but each present with other unique nutritional properties. We review how our increased knowledge and concern with regard to caffeine in the diet and its impact on human health has been translated into food-based dietary guidelines (FBDG). Using the Food and Agriculture Organization list of 90 countries with FBDG as a starting point, we found reference to caffeine or caffeine-containing beverages (CCB) in 81 FBDG and CCB consumption data (volume sales) for 56 of these countries. Tea and soda are the leading CCB sold in African and Asian/Pacific countries while coffee and soda are preferred in Europe, North America, Latin America, and the Caribbean. Key themes observed across FBDG include (i) caffeine-intake upper limits to avoid risks, (ii) CCB as replacements for plain water, (iii) CCB as added-sugar sources, and (iv) health benefits of CCB consumption. In summary, FBDG provide an unfavorable view of CCB by noting their potential adverse/unknown effects on special populations and their high sugar content, as well as their diuretic, psycho-stimulating, and nutrient inhibitory properties. Few FBDG balanced these messages with recent data supporting potential benefits of specific beverage types.

Diet Soda and Sugar-Sweetened Soda Consumption in Relation to Incident Diabetes in the Northern Manhattan Study

BACKGROUND

Artificially (diet) and sugar-sweetened (regular) soda consumption have been associated with an increased risk of diabetes, but the literature on diet soda is inconsistent and the mechanisms unclear.

OBJECTIVE

We examined the relation between diet soda and regular soda consumption with the risk of incident diabetes in a longitudinal multiethnic population-based cohort.

METHODS

The study population included 2019 participants (mean ± SD age:  69 ± 10 y; 64% women; 23% white, 22% black, 53% Hispanic) in the Northern Manhattan Study who were free of diabetes and stroke at baseline. Soda consumption was assessed by a food-frequency questionnaire at baseline and examined continuously and categorically (<1/mo: sugar-sweetened = 908, diet = 1615; 1/mo-6/wk: sugar-sweetened = 830, diet = 298; daily: sugar-sweetened = 281, diet = 106). Weibull regression models were used to estimate the associations between soda consumption and incident diabetes, adjusting for demographics and vascular risk factors including body mass index (BMI) and calorie consumption.

RESULTS

During a mean ± SD follow-up of 11 ± 5 y, 368 participants developed diabetes. Sugar-sweetened soda was positively associated with incident diabetes (per soda per day HR = 1.15, 95% CI:  1.02, 1.31). The observed association between diet soda and elevated risk of diabetes was largely explained by BMI at the time of diet assessment, though the association remained strong and independent of BMI among those who were overweight or obese (daily compared to <1/mo: HR = 1.63, 95% CI:  1.04, 2.55).

CONCLUSIONS

This study supports the importance of sugar-sweetened beverage consumption in the diabetes epidemic. However, the results support previous studies suggesting that switching to artificially sweetened diet beverages may not lower the risk of diabetes, as diet soda consumption cannot be ruled out as an independent diabetes risk factor.

Increased Cellular Aging by 3 Years of Age in Latino, Preschool Children Who Consume More Sugar-Sweetened Beverages: A Pilot Study

BACKGROUND

Previous studies in adults and older children find that sugar-sweetened beverage (SSB) consumption increases risk for obesity and cellular aging, as measured by leukocyte telomere length (LTL).

METHODS

In a previously described, San Francisco-based Latino birth cohort, where telomere length was measured at birth, we evaluate the relationship between beverage consumption (including SSB and 100% fruit juice), obesity, and LTL at 2-3 years old, as well as change in LTL from birth. LTL (T/S Ratio) was measured in 61 children (mean 2.4 years ±0.6 standard deviation). Multivariable linear regression models are used to ascertain beverage type and obesity as independent predictors of LTL and change in LTL.

RESULTS

Mean telomere length was 1.58 ± 0.20 (T/S Ratio) and mean yearly change was -0.08 ± -0.09 (T/S Ratio). Predictors of shorter telomere length at age 2-3 included increased consumption of SSB (Beta Coeff = -0.009 95% CI [-0.02 to -0.0008]; p = 0.03). Telomere length at birth was the strongest predictor of rate of attrition from birth to 2-3 years of age and males tended to have more rapid attrition.

CONCLUSION

Excessive SSB consumption impacts early childhood immune system health adversely, possibly before the development of obesity.

Soda Intake Is Directly Associated with Serum C-Reactive Protein Concentration in Mexican Women

Background

Soda intake is associated with an increased risk of cardiovascular disease. Consumption of diet sodas, often considered healthy alternatives to sodas, could also increase the likelihood of cardiovascular outcomes.

Objective

This study aims to evaluate the relation between soda and diet soda and biomarkers of cardiovascular risk.

Methods

We conducted a cross-sectional analysis among 825 Mexican women free of diabetes, cardiovascular disease, and cancer, and for whom serum concentrations of C-reactive protein (CRP), C-peptide, adiponectin, and leptin were available. Mean ± SD age was 45.9 ± 6.6 y, the majority of women were premenopausal (60.4%), and the prevalence of obesity was 35%. We estimated the adjusted percentage differences in biomarkers and 95% CIs by performing multiple linear regression models comparing categories of consumption for soda and diet soda adjusting for age, family history of heart disease, menopause, menopausal hormone therapy, socioeconomic status, region, smoking, physical activity, alcohol intake, and dietary patterns.

Results

In the entire study sample we observed a 50% higher serum CRP concentration in women in the highest soda intake quartile (median intake: 202.9 mL/d, IQR: 101.4, 304.3 mL/d) compared to those in the lowest (median intake: 11.8 mL/d, IQR: 0.0, 152.1 mL/d). After stratification by menopausal status, results remained significant only for premenopausal women. Premenopausal women in the highest quartile of soda intake had 56% higher CRP concentration relative to women in the lowest quartile. We observed no significant association with the other biomarkers. After further adjustment for body mass index, a potential mediator, results remained significant only for CRP. Diet soda consumption was not associated with any of the biomarkers.

Conclusions

Consumption of soda was associated with adverse levels in a biomarker of inflammation and cardiovascular risk, serum CRP, in Mexican women. These results add to the accumulating evidence on soda and cardiovascular risk. More research is necessary to understand the potential impact of artificially sweetened sodas.

College Cafeteria Signage Increases Water Intake but Water Position on the Soda Dispenser Encourages More Soda Consumption

OBJECTIVES

To evaluate the effects of improved water location visibility and water dispenser position on the soda dispenser on undergraduate students' beverage choices.

METHODS

Two focus groups with pilot intervention surveys before and after, adding a small sign above the soda dispensers' water button for 6 weeks in a large US university's all-you-can-eat, prepaid dining hall (measured with chi-square tests and logistic and ordinal logistic regression).

RESULTS

Focus groups included 15 students. Survey participants included 357 students before and 301 after the intervention. After the intervention, more students reported ever having drunk water with the meal (66.4% to 77.0%; P = .003) and water consumption frequency increased (P = .005). Postintervention, the odds of drinking water increased by 1.57. Preference for other drinks was the main reason for not drinking water. A total of 59% of students had ever changed their preference from water to soda.

CONCLUSIONS AND IMPLICATIONS

The clear indication of the water's location increased students' reported water consumption. Further investigation is needed into how a non-independent water dispenser influences students' beverage choice. Clearly labeled, independent water dispensers are recommended.

Beliefs, Behaviors, and Contexts of Adolescent Caffeine Use: A Focus Group Study

BACKGROUND

Caffeinated products are widely available to adolescents, and consumption of caffeine products-energy drinks and coffee in particular-is on the rise in this age group (Branum, Rossen, & Schoendorf, 2014). Yet, little is known about the psychosocial context of caffeine use. Previous studies on adolescent caffeine use have focused on caffeine's acute physiological effects, rather than the psychosocial contexts and beliefs regarding different types of caffeinated beverages (e.g., coffee, energy drinks, soda).

OBJECTIVES

The current research examines the contexts and beliefs associated with adolescents' use of caffeinated beverages (e.g., coffee, energy drinks, soda) using a focus group approach.

METHODS

Eleven focus group interviews (49 total participants) addressed adolescents' motivations for and patterns of caffeine use; they were transcribed and axial coding was used to identify common themes.

RESULTS

Coffee and energy drinks were perceived to be the most popular caffeinated beverages. Reasons for consuming caffeine included the effect of caffeine as a stimulant, the pleasant feelings experienced when drinking it, and the fact that caffeine was available. As for contexts, coffee was consumed in more diverse social contexts than other caffeinated beverages. Friends and sports were the most popular contexts for energy drink use.

CONCLUSIONS

The present findings inform adolescent health promotion efforts and provide researchers and practitioners alike detailed information in adolescents' own words about how and why they use caffeine. Adolescents' beliefs about caffeinated products are not uniform; the reasons adolescents articulate regarding their use of coffee, soda, and energy drinks are different across contexts and beverage type.

Dietary Sources of Phosphorus among Adults in the United States: Results from NHANES 2001-2014

Interest in the health effects of dietary phosphorus is burgeoning, yet sources and trends in phosphorus consumption have not been well characterized. We describe trends in and primary sources of dietary phosphorus in a nationally representative sample of 34,741 US adults, 20+ years old (NHANES 2001–2014). Dietary sources of phosphorus were estimated in nine food groups and 26 food categories. Phosphorus consumption was expressed in absolute intake, phosphorus density, and proportion contributed by dietary sources. Between 2001 and 2014, dietary phosphorus intake increased from 1345 to 1399 mg/day (p-trend = 0.02), while calorie intake slightly declined (p-trend = 0.1). Grains were the largest dietary phosphorus source, followed by meats, and milk products. Soft drinks accounted for just 3.3% of total dietary phosphorus. Phosphorus intake from grains increased 68 mg/day (p < 0.001), 25 mg/day from meats (p = 0.02), and decreased 75 mg/day (p < 0.001) from milk products. Dietary phosphorus intake and the phosphorus density of the diet are increasing. Grains are an important dietary phosphorus source that has increased in total consumption and phosphorus density. Further research is needed to determine if this is due to individuals’ selection of grains or the composition of those available.

Sugar and Type 2 diabetes

BACKGROUND

Consumption of sugar, specifically sugar-sweetened beverages, has been widely held responsible by the media for the global rise in Type 2 diabetes (T2DM).

SOURCES OF DATA

Systematic reviews and dietary guidelines relating dietary sugars to T2DM.

AREAS OF AGREEMENT

Weight gain and T2DM incidence are associated with diet and lifestyle patterns characterized by high consumptions of any sweetened beverages. High sugar intakes impair risk factors for macrovascular complications of T2DM.

AREAS OF CONTROVERSY

Much of the association between sugars and T2DM is eliminated by adjusting data for body mass index (BMI). However, BMI adjustment does not fully account for adiposity (r²=0.65-0.75). Excess sugar can promote weight gain, thus T2DM, through extra calories, but has no unique diabetogenic effect at physiological levels.

GROWING POINTS

Ethical concerns about caffeine added to sweetened beverages, undetectable by consumers, to increase consumption.

AREAS TIMELY FOR DEVELOPING RESEARCH

Evidence needed for limiting dietary sugar below 10% energy intake.

Soda consumption and hospital admissions among Californian adults with asthma

INTRODUCTION

Asthma prevalence has been increasing consistently since 1995 in California. Recent studies have found that consuming soda and sugar-containing drinks may pose a risk for asthma. Research that examines the relationship between soda intake and asthma among adult asthmatics is limited.

OBJECTIVE

This study investigated the relationship between sugar-sweetened soda consumption and asthma hospitalization among adult asthmatics in California.

METHODS

This cross-sectional study was based on the 2011-2012 California Health Interview Survey (CHIS) data and included 3,784 adults who were diagnosed with asthma by a doctor and who currently reported either that they still had asthma, or that they had suffered from an asthma attack in the last 12 months. The analysis was survey weighted. The exposure variable was soda intake measured as the number of times soda was consumed in the last week. The health outcome measure was overnight hospital admission due to asthma. Logistic regression was used to examine the association between soda consumption and overnight hospital admission after adjusting for age, education, sex, race/ethnicity, weight status, smoking status, and self-rated health.

RESULTS

Adults with asthma who drank soda three or more times per week reported higher odds of overnight hospitalization (adjusted odds ratio = 2.77, 95% CI: 1.51-5.10, p = 0.001).

CONCLUSIONS

Our findings suggest that efforts designed to limit soda consumption would benefit asthma suffers by reducing hospital admissions. This, however, needs further research to confirm a direct causal association.

Worksite nutrition supports and sugar-sweetened beverage consumption

Objective

This study examined the link between worksite environmental supports for nutrition behaviours and sugar‐sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity.

Methods

Perceived worksite supports for healthy nutrition and self‐reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW‐ME) study.

Results

Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption.

Conclusions

This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets.

Use of food and packaging model matrices to investigate the antioxidant properties of biorefinery grass lignins

The antioxidant properties of grass lignins recovered from an alkaline industrial process and from different ethanol organosolv pretreatment processes were compared using two types of tests: (i) classical radical 2,2'-diphenyl-1-picrylhydrazyl (DPPH(•)) scavenging tests in dioxane/water or ethanol and (ii) tests involving multiphasic systems (lipid dispersion in water or cellulose film suspended in ethanol). These multiphasic systems were representative of food and packaging matrices in view of high-value applications. All lignins, in solution or in the film, effectively scavenged radicals. Moreover, they were competitive with a food commercial rosemary extract to protect linoleic acid against oxidation. Whereas the DPPH(•) test in dioxane was not discriminant, differences appeared between lignins when the test was performed in ethanol or with the multiphasic systems. Moreover, radical scavenging activity was preserved in the film even after its immersion in ethanol. Structural analysis of lignins revealed that low-molar-mass phenolics, namely p-hydroxycinnamic acids and lignin depolymerization products, governed lignin antioxidant properties in the multiphasic systems.

Correlates of University Students' Soft and Energy Drink Consumption According to Gender and Residency

This study assessed personal and environmental correlates of Belgian university students' soft and energy drink consumption and investigated whether these associations were moderated by gender or residency. Four hundred twenty-five university students completed a self-reported on-line questionnaire assessing socio-demographics, health status, soft and energy drink consumption, as well as personal and environmental factors related to soft and energy drink consumption. Multiple linear regression analyses were conducted. Students believing soft drink intake should be minimized (individual subjective norm), finding it less difficult to avoid soft drinks (perceived behavioral control), being convinced they could avoid soft drinks in different situations (self-efficacy), having family and friends who rarely consume soft drinks (modelling), and having stricter family rules about soft drink intake were less likely to consume soft drinks. Students showing stronger behavioral control, having stricter family rules about energy drink intake, and reporting lower energy drink availability were less likely to consume energy drinks. Gender and residency moderated several associations between psychosocial constructs and consumption. Future research should investigate whether interventions focusing on the above personal and environmental correlates can indeed improve university students' beverage choices.

Associations of sugar-sweetened and artificially sweetened soda with chronic kidney disease: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The risk of chronic kidney disease (CKD) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to evaluate the associations between consumption of sugar-sweetened and artificially sweetened soda and CKD.

METHODS

A literature search was performed using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from inception until 30 June 2014. Studies that reported odds ratios or hazard ratios comparing the risk of CKD in patients consuming significant amounts of either sugar-sweetened or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects, generic inverse variance method.

RESULTS

Five studies were included in our analysis of the association between consumption of sugar-sweetened soda and CKD. The pooled RR of CKD in patients consuming sugar-sweetened soda was 1.58 (95% CI 1.00-2.49). Four studies were selected to assess the association between consumption of artificially sweetened soda and CKD. The pooled RR of CKD in patients consuming artificially sweetened soda was 1.33 (95% CI 0.82-2.15).

CONCLUSIONS

Our study demonstrates statistically significant increased risks of CKD in patients consuming sugar-sweetened soda, but not in patients consuming artificially sweetened soda. This finding suggests that sugar-sweetened soda consumption is associated with CKD and may impact clinical management and primary prevention of CKD in high-risk patients.

Sugar and artificially sweetened soda consumption linked to hypertension: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The risk of hypertension (HTN) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to assess the associations between consumption of sugar and artificially sweetened soda and HTN.

METHODS

A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through January 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of HTN in patients consuming a significant amount of either sugar or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.

RESULTS

Eight studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and HTN. The pooled RR of HTN in patients consuming sugar-sweetened soda was 1.12 (95% CI, 1.03-1.23). Four studies were selected to assess the association between consumption of artificially sweetened soda and HTN. The pooled RR of HTN in patients consuming artificially sweetened soda was 1.15 (95% CI, 1.11-1.19).

CONCLUSIONS

Our study demonstrates statistically significant associations between both sugar and artificially sweetened soda consumption and HTN. This finding may impact clinical management and primary prevention of HTN.

Juice and water intake in infancy and later beverage intake and adiposity: could juice be a gateway drink?

OBJECTIVES

To examine the tracking and significance of beverage consumption in infancy and childhood.

METHODS

Among 1163 children in Project Viva, we examined associations of fruit juice and water intake at 1 year (0 oz, 1-7 oz [small], 8-15 oz [medium], and ≥16 oz [large]) with juice and sugar-sweetened beverage (SSB) intake and BMI z-score during early (median 3.1 years) and mid-childhood (median 7.7 years).

RESULTS

In covariate adjusted models, juice intake at 1 year was associated with greater juice and SSB intake during early and mid-childhood and also greater adiposity. Children who drank medium and large amounts of juice at 1 year had higher BMI z-scores during both early (medium: β = 0.16 [95% CI = 0.01-0.32]; large: β = 0.28 [95% CI = 0.01-0.56]) and mid-childhood (medium: β = 0.23 [95% CI = 0.07-0.39]; large: β = 0.36 [95% CI = 0.08-0.64]). After covariate adjustment, associations between water intake at 1 year and beverage intake and adiposity later in childhood were null.

CONCLUSIONS

Higher juice intake at 1 year was associated with higher juice intake, SSB intake, and BMI z-score during early and mid-childhood. Assessing juice intake during infancy could provide clinicians with important data regarding future unhealthy beverage habits and excess adiposity during childhood.

Sugar-sweetened carbonated beverage consumption and childhood/adolescent obesity: a case-control study

OBJECTIVE

To assess the association between the consumption of sugar-sweetened carbonated beverages (SSCB) and obesity in children and adolescents from Navarra (Spain).

DESIGN

We used a matched case-control study design. The exposure, SSCB consumption (1 serving: 200 ml), was measured with a previously validated FFQ. Anthropometrical measures were taken using standardized protocols. The outcome, obesity, was defined as BMI above the age- and sex-specific 97th percentile according to the Spanish reference charts. In the analysis we used conditional logistic regression. Potential confounders were controlled using a multivariable model.

SETTING

Subjects were recruited in the paediatric departments of the Universidad de Navarra Clinic and the Navarra Hospital Complex, and in three primary health centres of Navarra. Controls were recruited when attending for a routine medical examination or vaccination.

SUBJECTS

One hundred and seventy-four obese children and 174 individually sex- and age-matched controls, 52·87% boys, with a mean age of 11·6 years. Exclusion criteria were dietary interventions, exposure to hormone treatment, development of secondary obesity due to endocrinopathy and serious intercurrent illness.

RESULTS

Independently of other factors, high consumption of SSCB (>4 servings/week) was significantly associated with obesity (OR = 3·46; 95% CI 1·24, 9·62; P = 0·01). Besides, each additional daily serving of SSCB was associated with a 69% relative increase in the risk of obesity (OR = 1·69; 95% CI 1·04, 2·73; P = 0·03).

CONCLUSIONS

We found a strong and significant association between SSCB consumption and obesity risk. Our results suggest a monotonic dose-response linear shape for this association in children and adolescents (P for trend = 0·02).

Adherence to a snacking dietary pattern and soda intake are related to the development of adiposity: a prospective study in school-age children

OBJECTIVE

Snacking has been related to increased prevalence of overweight among school-age children in cross-sectional studies. It is uncertain, however, whether snacking influences the development of adiposity over time.

DESIGN

We examined whether adherence to a snacking dietary pattern was associated with greater increases in children's BMI, subscapular:triceps skinfold thickness ratio and waist circumference over a median 2·5-year follow-up. Dietary patterns were identified through principal component analysis of an FFQ administered at recruitment in 2006. Anthropometric follow-up was conducted annually. Linear mixed-effects models were used to estimate rates of change in each indicator according to quartiles of adherence to the snacking pattern. We also examined change in BMI, subscapular:triceps skinfold thickness ratio and waist circumference in relation to intake of the food items in the snacking pattern.

SUBJECTS

Children (n 961) 5-12 years of age.

SETTING

Public schools in Bogotá, Colombia.

RESULTS

After adjustment for age, sex, total energy intake and socio-economic status, children in the highest quartile of adherence to the snacking pattern had a 0·09 kg/m2 per year higher BMI gain than children in the lowest quartile (P trend = 0·05). A similar association was observed for mean change in subscapular:triceps skinfold thickness ratio (highest v. lowest quartile difference = 0·012/year; P = 0·03). Of the food items in the snacking pattern, soda intake was positively and significantly associated with change in BMI (P trend = 0·01) and waist circumference (P trend = 0·04) in multivariable analysis.

CONCLUSIONS

Our results indicate that snacking and soda intake are associated with development of adiposity in school-age children.

Regular-soda intake independent of weight status is associated with asthma among US high school students

Limited research shows an inconclusive association between soda intake and asthma, potentially attributable to certain preservatives in sodas. This cross-sectional study examined the association between regular (nondiet)-soda intake and current asthma among a nationally representative sample of high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 15,960 students (grades 9 through 12) with data for both regular-soda intake and current asthma status. The outcome measure was current asthma (ie, told by doctor/nurse that they had asthma and still have asthma). The main exposure variable was regular-soda intake (ie, drank a can/bottle/glass of soda during the 7 days before the survey). Multivariable logistic regression was used to estimate the adjusted odds ratios for regular-soda intake with current asthma after controlling for age, sex, race/ethnicity, weight status, and current cigarette use. Overall, 10.8% of students had current asthma. In addition, 9.7% of students who did not drink regular soda had current asthma, and 14.7% of students who drank regular soda three or more times per day had current asthma. Compared with those who did not drink regular soda, odds of having current asthma were higher among students who drank regular soda two times per day (adjusted odds ratio=1.28; 95% CI 1.02 to 1.62) and three or more times per day (adjusted odds ratio=1.64; 95% CI 1.25 to 2.16). The association between high regular-soda intake and current asthma suggests efforts to reduce regular-soda intake among youth might have benefits beyond improving diet quality. However, this association needs additional research, such as a longitudinal examination.

Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments

Nutritively sweetened beverages (NSBs) may play a role in the obesity epidemic. We abstracted data from randomized controlled trials (RCTs) and evidence-based reviews through January 2009 concerning effects of consumption of NSBs on changes in body weight and adiposity. Studies included were those (i) conducted in humans; (ii) lasting at least 3 weeks; (iii) incorporating random assignment of subjects to conditions that differed only in the consumption of NSBs and (iv) including an adiposity indicator as an outcome. Twelve studies met the inclusion criteria. Meta-analysis of six studies that added NSBs to persons' diets showed dose-dependent increases in weight. Contrarily, meta-analysis of studies that attempted to reduce NSB consumption consistently showed no effect on body mass index (BMI) when all subjects were considered. Meta-analysis of studies providing access to results separately for subjects overweight at baseline showed a significant effect of a roughly 0.35 standard deviations lesser BMI change (i.e. more weight loss or less weight gain) relative to controls. The current evidence does not demonstrate conclusively that NSB consumption has uniquely contributed to obesity or that reducing NSB consumption will reduce BMI levels in general. We recommend an adequately powered RCT with overweight persons, for whom there is suggestive evidence of an effect.

Fructose-rich beverages and risk of gout in women

CONTEXT

Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and, thus, the risk of gout, but prospective data on the relationship are limited.

OBJECTIVE

To examine the relationship between intake of fructose-rich beverages and fructose and the risk of incident gout among women.

DESIGN, SETTING, AND PARTICIPANTS

In the Nurses' Health Study, a US prospective cohort study spanning 22 years (1984-2006), we analyzed data from 78,906 women with no history of gout at baseline who provided information on intake of beverages and fructose through validated food frequency questionnaires.

MAIN OUTCOME MEASURE

Incident cases that met the American College of Rheumatology survey criteria for gout.

RESULTS

During 22 years of follow-up, we documented 778 confirmed incident cases of gout. Increasing intake of sugar-sweetened soda was independently associated with increasing risk of gout. Compared with consumption of less than 1 serving per month of sugar-sweetened soda, the multivariate relative risk of gout for 1 serving per day was 1.74 (95% confidence interval [CI], 1.19-2.55) and for 2 or more servings per day was 2.39 (95% CI, 1.34-4.26) (P<.001 for trend). The corresponding relative risks for orange juice were 1.41 (95% CI, 1.03-1.93) and 2.42 (95% CI, 1.27-4.63) (P = .02 for trend). The absolute risk differences corresponding to these relative risks were 36 and 68 cases per 100,000 person-years for sugar-sweetened soda and 14 and 47 cases per 100,000 person-years for orange juice, respectively. Diet soft drinks were not associated with the risk of gout (P = .27 for trend). Compared with the lowest quintile of fructose intake, the multivariate relative risk of gout in the top quintile was 1.62 (95% CI, 1.20-2.19; P = .004 for trend) (risk difference of 28 cases per 100,000 person-years).

CONCLUSION

Among this cohort of women, consumption of fructose-rich beverages is associated with an increased risk of incident gout, although the contribution of these beverages to the risk of gout in the population is likely modest given the low incidence rate among women.

Intake of sugar-sweetened beverages and weight gain: a systematic review

Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages' high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.