ArticleLiterature Review

Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis

August 2013
American Journal of Clinical Nutrition 98(4)

DOI:10.3945/ajcn.113.058362

Source
PubMed

Authors:

An Pan

Huazhong University of Science and Technology

Walter C Willett

Harvard University

The relation between sugar-sweetened beverages (SSBs) and body weight remains controversial. We conducted a systematic review and meta-analysis to summarize the evidence in children and adults. We searched PubMed, EMBASE, and Cochrane databases through March 2013 for prospective cohort studies and randomized controlled trials (RCTs) that evaluated the SSB-weight relation. Separate meta-analyses were conducted in children and adults and for cohorts and RCTs by using random- and fixed-effects models. Thirty-two original articles were included in our meta-analyses: 20 in children (15 cohort studies, n = 25,745; 5 trials, n = 2772) and 12 in adults (7 cohort studies, n = 174,252; 5 trials, n = 292). In cohort studies, one daily serving increment of SSBs was associated with a 0.06 (95% CI: 0.02, 0.10) and 0.05 (95% CI: 0.03, 0.07)-unit increase in BMI in children and 0.22 kg (95% CI: 0.09, 0.34 kg) and 0.12 kg (95% CI: 0.10, 0.14 kg) weight gain in adults over 1 y in random- and fixed-effects models, respectively. RCTs in children showed reductions in BMI gain when SSBs were reduced [random- and fixed-effects: -0.17 (95% CI: -0.39, 0.05 kg) and -0.12 (95% CI: -0.22, -0.2 kg)], whereas RCTs in adults showed increases in body weight when SSBs were added (random- and fixed-effects: 0.85 kg; 95% CI: 0.50, 1.20 kg). Sensitivity analyses of RCTs in children showed more pronounced benefits in preventing weight gain in SSB substitution trials (compared with school-based educational programs) and among overweight children (compared with normal-weight children). Our systematic review and meta-analysis of prospective cohort studies and RCTs provides evidence that SSB consumption promotes weight gain in children and adults.

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

Article

Full-text available

Nov 2024

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.

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

Article

Full-text available

Oct 2024

Background: The Chinese beverage industry is experiencing rapid growth, particularly in the popularity of non-sugar sweetened beverages (NSSs) and ready-to-drink beverages (RSBs). This study aimed to assess current consumption patterns and determinants of various beverage types among retail visitors. Methods: A total of 44 observation points, including 22 supermarkets and 22 convenience stores, were randomly selected across Shanghai. At each location, at least 100 individuals were recruited to participate. Data were collected using an electronic self-administered questionnaire. Results: The consumption rates of total beverages, sugar-sweetened beverages, NSSs, and RSBs were 57.70%, 56.94%, 19.60%, and 29.50%, respectively; the median consumption amounts among the drinking population were 162.57 mL/day, 137.98 mL/day, 32.85 mL/day, and 32.85 mL/day, respectively. The consumption proportions of NSSs and RSBs ranked 2nd and 3rd. The multifactorial analyses showed that people aged 6–18 years consumed more beverages (p < 0.05). Males were more likely to consume sugar-sweetened beverages and NSSs, but females were more likely to consume RSBs (p < 0.05). Higher educated people and bachelors were more likely to consume beverages (p < 0.05). Conclusions: The emerging beverage categories, NSSs and RSBs, warrant attention due to their significant consumption rates. Tailored intervention strategies should be considered for demographic groups varying by age, gender, and educational attainment.

Sugar-Sweetened Beverages and Adverse Human Health Outcomes: An Umbrella Review of Meta-Analyses of Observational Studies

Article

Aug 2024

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.

Analysis of the Factors Influencing the Calories of Cereals

Article

Full-text available

Jan 2025

Zihui Gu

Cereals are a major global source, classified into whole and refined grains. Whole grain cereals provide a higher nutritional value due to the inclusion of the bran, germ, and endosperm, making them a rich source of dietary fiber, vitamins, and minerals. Conversely, refined grains undergo processing that eliminates the bran and germ components, resulting in a loss of valuable nutrients. In recent years, there has been a growing interest in exploring the health benefits of whole grain cereals. Research has established a connection between whole grains consumption and reduced risks of chronic diseases such as heart disease, diabetes, and certain cancers. Additionally, whole grains are recognized for their role in maintaining digestive health and promoting satiety which can aid in weight management. Therefore, this paper aims to investigate how various element present total calorie content using R-studio. The findings reveal that calories serves as the independent variable while protein content, type, sugars and carbohydrates act as independent variables influencing calorie levels accordingly. Cereal type plays a negative role by increasing calories whereas other factors contribute positively positively towards increased caloric intake levels

Sweetened beverage consumption and its association with overweight and obesity across population groups in the Philippines

Article

Dec 2024

Introduction: The increasing prevalence of overweight and obesity has been a major nutritional concern. Evidence shows that habitual or excessive sweetened beverage (SB) consumption is associated with weight gain and obesity. This study assessed the SB consumption across different age groups and determined its association with overweight and obesity. Methods: Data of 31,003 preschool children, school-age children, adolescents, and adults from 2018- 2019 Expanded National Nutrition Survey were utilised. Data on SB consumption, type, and quantity were obtained from 24-hour food recalls, and participants’ nutritional status was assessed. Multivariate logistic regression was conducted to evaluate association between SB consumption and obesity using STATA 16. Results: Mean SB intake per day increased with age. Nearly 48% of preschool children, 33% of schoolchildren, 24% of adolescents, and 21% of adults consumed SBs amounting to >10% of total energy intake. Males, urban dwellers, and those with higher socioeconomic status were more likely to consume SBs. After controlling for sex, age, wealth, and place of residence, children and adults with higher SB intake, and all age groups with higher sugar intake from SB per day were more likely to be overweight and obese. Conclusion: SB consumption was higher among older age groups, males, urban dwellers, and those with higher socioeconomic status. High consumption of SBs was associated with overweight and obesity. Revisiting current nutrition policies, particularly the food-based dietary guidelines and front-of-pack labelling, and necessary regulations are needed to reduce SB consumption and control obesity in the Philippines.

Effects of the MyBFF@school obesity intervention program with nutrition education intervention on nutrition knowledge and attitude of secondary schoolchildren: a cluster randomized controlled trial

Article

Full-text available

Jan 2025
BMC PUBLIC HEALTH

Background The increasing global and national prevalence of childhood obesity particularly among schoolchildren has warranted a more viable school-based obesity intervention. Apart from physical activity, nutrition is important in any obesity intervention package. This study examined the effects of the MyBFF@school program with nutrition education intervention (NEI) on nutrition knowledge and attitude of overweight and obese secondary schoolchildren. Methods This is a cluster randomized controlled trial which involved schoolchildren aged 13, 14 and 16 years old from 15 out of 415 government secondary schools in central Peninsular Malaysia which were randomly assigned into six intervention (N = 579 schoolchildren) and nine control (N = 462 schoolchildren). The intervention group was given NEI consisting of a nutrition education module carried out by trained personnel for 24 weeks on top of the existing curriculum while the control group only followed the existing school curriculum by the Ministry of Education. The primary outcomes were the nutrition knowledge and attitude score. The mixed effect model taking into consideration the cluster effect was used to assess the changes of nutrition knowledge and attitude scores from baseline until 6 months. Results Overall, there was no significant increase in the adjusted mean difference (AMD) of nutrition knowledge score (AMD = 0.33%, Confident Interval (95 CI): -4.35% to 5.01) between the intervention and control group after 6 months of intervention after controlling for nutrition knowledge score at baseline, gender, location and ethnicity. Similarly, after controlling for the nutrition attitude score at baseline, ethnicity, location and gender as well as taking into account the cluster effects, there was no significant increase on the AMD of nutrition attitude score in the overall (AMD = 0.194, (95 CI): -1.17 to 1.56) and also among girls, location (urban vs rural) and Malays. There was also no significant reduction of AMD in the nutrition attitude score among boys and non-Malays. Conclusion MyBFF@school with NEI resulted with no significant improvement for nutrition knowledge and attitude among older schoolchildren. Therefore, to effectively impart the nutrition knowledge and change their nutrition attitude requires an in-depth study and multi-pronged and customized approach. Trial registration Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13–439-16563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

The associations between the energy and timing of sugar-sweetened beverage intake and phenotypic age acceleration in U.S. adults: a cross-sectional survey of NHANES 2007–2010

Article

Full-text available

Jan 2025
BMC PUBLIC HEALTH

Objectives The relationship between sugar-sweetened beverage (SSB) intake and phenotypic age acceleration (PhenoAgeAccel) is unclear. The aim of this study was to explore the associations between the energy and timing of SSB intake and PhenoAgeAccel in adults. Methods A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010, which involved U.S. adults aged 20 to 79 years. The assessment and estimation of SSB intake were conducted through 24-hour dietary recall interviews, categorizing participants into three groups: non-intake, low moderate-intake, and moderate–high-intake. Furthermore, SSB consumers were divided into three time intervals based on intake timing: dawn-to-forenoon (5:00 a.m. to 11:59 a.m.), noon-to-afternoon (12:00 p.m. to 17:59 p.m.), and dusk-to-night (18:00 p.m. to 4:59 a.m.). Multivariable linear regression models were employed to evaluate the associations between SSB intake (energy and timing) and PhenoAgeAccel. Additionally, stratified analyses and interaction analyses were conducted. Furthermore, obesity was assessed via two distinct metrics: the body roundness index (BRI) and the body mass index (BMI). Mediation analysis was conducted to investigate the mediating effect of obesity on the relationship between the energy of SSB intake and PhenoAgeAccel. Results After controlling for covariates, SSB intake (per 100 kcal/day) was positively correlated with PhenoAgeAccel (β = 0.179, 95% confidence interval [CI]: 0.086–0.271). The moderate–high-intake group presented a significantly greater PhenoAgeAccel than the non-intake group (β = 1.023, 95% CI: 0.414–1.632). This relationship remained stable across stratified analyses. Compared with those who abstained from SSB, those who consumed SSB during the dusk-to-night period exhibited notably elevated PhenoAgeAccel (β = 0.915, 95% CI: 0.316–1.514). A significant interactive effect of smoking on the SSB intake timing–PhenoAgeAccel association was observed (P for interaction = 0.002). Mediation analysis revealed that both BRI and BMI significantly mediated the relationship between energy intake from SSB and PhenoAgeAccel, with mediation proportions of 16.29% and 16.21%, respectively. Conclusion Our study revealed a positive correlation between SSB energy intake and PhenoAgeAccel, which may be partially mediated by obesity. Moreover, consuming SSB during the dusk-to-night period may increase PhenoAgeAccel.

Exploring Alternative Sweeteners: Consumer Perspectives and Product Development for Healthier and Affordable Choices

Article

Full-text available

Dec 2024

Objective: This study aimed to evaluate the consumption, consumer experiences, and expectations of alternative sweeteners (AS) among adults. It also developed and assessed a prototype alternative sweetener product (ASP) in terms of acceptability and willingness-to-pay compared to sugar.Material and Methods: Two studies were conducted. In Study I, a cross-sectional survey assessed consumer experiences and expectations of AS. In Study II, a prototype ASP was developed using erythritol, stevia and sucralose via a geometric dilution method. The ASP was then compared to sugar in snacks and beverages through a single-blinded experiment.Results: The survey revealed that 63.6% disliked the taste of AS, expecting a sugar-like taste and affordable price. The single-blinded experiment showed no significant differences in overall liking between the ASP and sugar. The cost of the ASP prototype was 88% cheaper than the average marketed AS available in physical markets.Conclusion: These findings indicate consumer readiness to accept AS, although current market products do not fully meet consumer expectations. The ASP prototype, being more affordable and acceptable, has the potential to reduce barriers related to the affordability and acceptability of AS. The simplicity of the technique used to prepare the ASP prototype also facilitates the transfer of this technology to consumers for home use.

Characterization of healthy habits and physical activity in adolescent students from Chile

Article

Full-text available

Dec 2024

This study aimed to characterize the physical activity levels and their association with healthy and unhealthy behaviors in adolescent students in Chile. It was a non-experimental, cross-sectional, and descriptive study. The non-probabilistic sample consisted of 175 high school students from public schools (n=103 females, age: 14.4±1.48 years; n=72 males, age: 14.2±1.56 years) who completed the World Health Organization's Global School-based Student Health Survey during the second semester of the year 2023. The main findings revealed a 32.5% prevalence of overweight and obesity and an 8.6% compliance with the World Health Organization physical activity recommendation. Those who engage in at least 60 minutes of physical activity per day show higher consumption of fruits and vegetables and fewer absences from classes, while those who use active transportation also demonstrate higher consumption of fruits and vegetables. Adolescent students are mostly physically inactive, with a higher level of inactivity among females, and those who met the physical activity recommendations consumed more fruits and vegetables than those who did not. From a gender perspective, females exhibited higher drug and marijuana consumption, increased feelings of loneliness, worry, suicidal ideation, and higher rates of absenteeism compared to males. These results highlight the necessity of developing intervention strategies targeting the adolescent school population with a gender perspective, focusing on promoting physical activity, active transportation, as well as healthy habits in both physical and mental domains.

Caracterización de hábitos saludables y actividad física en estudiantes adolescentes de Chile

Article

Full-text available

Dec 2024

Introduction: Healthy lifestyle habits in school-aged children are crucial for their physical, emotional, and cognitive health and development. Objective: to characterize physical activity levels and their association with healthy and unhealthy behaviors in adolescent students in Chile. Methodology: It was a non-experimental, cross-sectional, and descriptive study. The non-probabilistic sample consisted of 175 high school students from public schools (n=103 females, age: 14.4±1.48 years; n=72 males, age: 14.2±1.56 years) who completed the World Health Organization's Global School-based Student Health Survey during the second semester of the year 2023. Results: The main findings revealed a 32.5% prevalence of overweight and obesity and an 8.6% compliance with the World Health Organization's physical activity recommendation. Those who engage in at least 60 minutes of physical activity per day show higher consumption of fruits and vegetables and fewer absences from classes, while those who use active transportation also demonstrate higher consumption of fruits and vegetables. Discussion: Adolescent students are mostly physically inactive, with a higher level of inactivity among females, and those who met the physical activity recommendations consumed more fruits and vegetables than those who did not. From a gender perspective, females exhibited higher drug and marijuana consumption, increased feelings of loneliness, worry, suicidal ideation, and higher rates of absenteeism compared to males. Conclusions: These results highlight the necessity of developing intervention strategies targeting the adolescent school population with a gender perspective, focusing on promoting physical activity, active transportation, as well as healthy habits in both physical and mental domains.

A review of sugar-sweetened beverages taxation in Saudi Arabia and United Arab Emirates

Article

Full-text available

Dec 2024

Background: The World Health Organization recommends taxes on sugar-sweetened beverages (SSBs) as part of costeffective interventions to prevent diet-related noncommunicable diseases. Aim: To analyse the adoption and implementation of SSBs taxation in Saudi Arabia and United Arab Emirates and its impact on obesity rates. Methods: Using a semi-structured questionnaire, we collected information on progress with implementation of SSBs taxes in Saudi Arabia and United Arab Emirates between January 2015 and December 2023. We searched literature published in Arabic and English on the subject and used the WHO acceleration scenario modelling tool to forecast the potential impact of SSBs on overweight and obesity in the 2 countries over the same period. Results: Both countries implemented SSBs taxation consistently between 2015 and 2023, generating additional revenue and reducing obesity rates. The acceleration scenario estimates showed that SBB taxation could reduce overweight prevalence among children and adolescents (aged 5–19 years) from 38.2% in 2020 to 34.4% in 2030 in Saudi Arabia and from 37.0% to 34.6% in United Arab Emirates, and could reduce obesity rate by approximately 12.7% in Saudi Arabia and 9.5% in United Arab Emirates in the same period. Conclusion: This review provides further evidence that SSBs taxes can be effective in reducing sugar consumption, thereby reducing overweight and obesity rates. However, to effectively combat obesity and overweight among children and adolescents, taxation policies must be implemented alongside other strategies, including public health campaigns to increase awareness about the health risks associated with excessive sugar consumption.

Advantages of Khalas Date Products (Phoenix dactylifera L.) as a Natural Substitute for Sugar and Sweeteners in Food Processing

Article

Full-text available

Nov 2024

Advances in food science have led to the development of high-value food products, enhancing nutritional value by incorporating nutrient-rich ingredients. Adding high-nutritional plant materials, like dates, supports this trend. Dates, one of the oldest fruit crops, hold cultural and economic significance in the Middle East, especially in Saudi Arabia, the world's second-largest producer with over 300 varieties and an annual yield of 1.6 million tons. Saudi Arabia has advanced date production, leading to top-ranking global exports since 2021, with food industries comprising 24% of the Kingdom's exports. Dates are rich in sugars, fibre, minerals, vitamins, and antioxidants, providing numerous health benefits, including protection against diseases. Date paste, containing natural sugars, fibre, phenolic compounds, and essential vitamins, enhances health by promoting digestive health, regulating blood sugar, and supporting heart health. Using date paste as a natural sweetener reduces refined sugar intake and offers a flavorful, nutritious alternative suitable for various recipes, enhancing both taste and health. Therefore, this study aims to support the using date paste as a natural sweetener and an alternative to sugar in different food products, to improve the nutritional value and sensory acceptability instead of those made of sugar and synthetic sweeteners.

Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study

Preprint

Full-text available

Nov 2024

Background The World Health Organization has established key indicators to monitor infant and young child feeding practices globally, particularly in low- and middle-income countries. In urban areas, the nutrition transition from traditional diets has increased the consumption of ultra-processed foods/beverages and added sugar, raising concerns about their impact on children's diets and health. This study aimed to investigate complementary feeding practices, added sugar use, and sources of nutrition information among caregivers of young children in Kampala, Uganda. Methods This secondary analysis was conducted in August 2024, using data from a cross-sectional study conducted in 2021 on commercial baby food consumption among 6–36 month olds in Kampala, Uganda. For this analysis, 286 children aged 6–23 months were selected through systematic sampling. Data collection focused on eight WHO complementary and two breastfeeding indicators, sources of nutrition information, and added sugar consumption. Descriptive statistics and modified Poisson regression assessed associations to examine the association between socio-demographic factors and dietary indicators. Results The study included 286 children aged 6–23 months with a median age of 14 months. Nearly all caregivers reported that the children had ever breastfed since the birth, with 67.1% still breastfeeding at the time of the study. Added sugar consumption was high, with 89.9% of children consuming added sugars. Only 37.1% met the minimum dietary diversity, and 33.9% met the minimum acceptable diet. Higher maternal education and socio-economic status were associated with better dietary diversity and acceptable diet. Family and the internet were the most common sources of nutrition information. Conclusion Complementary feeding practices in urban Kampala reveal high breastfeeding rates but significant added sugar consumption and low dietary diversity. There is a need for policies and guidelines emphasising the quality of both commercial and home-prepared foods and addressing the consumption of ultra-processed foods and beverages. Nutritional education should leverage internet access to deliver tailored infant and young child feeding messages effectively. Improving complementary feeding practices can enhance children's nutritional outcomes and overall health in urban Uganda. This study underscores the importance of targeted interventions and policy measures to promote optimal feeding practices and improve the nutritional status of young children.

Change in liking following reduction in sweetness level of carbonated beverages: a randomized controlled parallel trial

Article

Full-text available

Nov 2024

Despite recommendations to reduce sweet-tasting foods and beverage consumption, there is limited understanding of our ability to adapt to a less sweet diet and the optimal method for doing so. Thus, we conducted two parallel, double-blind, randomized controlled trials in the USA and Mexico to investigate whether different methods of reducing sweetness could change sweetness preferences. Over 6 months, habitual consumers of full-sugar sweetened (FSS-CSD) or low-calorie sweetened carbonated soft drinks (LCS-CSD) consumed a full sweetness CSD (Control), CSD with gradually decreasing sweetness levels (StepR), and a reduced sweetness test CSD (DirR). The StepR and DirR methods were similarly effective in helping the USA FSS-CSD cohort maintain their preference for reduced-sweetness CSD, without affecting sweetness intensity perception. However, neither method significantly impacted the sweetness intensity perception or preference of the USA LCS-CSD cohort, and the FSS-CSD and LCS-CSD cohorts in Mexico. Nevertheless, participants from both sweetness reduction groups in all cohorts were more willing to purchase reduced sweetness CSD compared to Control, underscoring the potential for consumer acceptance of less sweet beverages regardless of adaptation strategies. This trial was registered at www.clinicaltrials.gov as NCT04609657 and NCT05010408.

Associations of saccharin intake with all-cause, cardiovascular and cancer mortality risk in USA adults

Article

Nov 2024
BRIT J NUTR

Saccharin is a widely used sugar substitute, but little is known about the long-term health effects of saccharin intake. Our study aimed to examine the association between saccharin intake and mortality in diabetic and pre-diabetic population and overweight population from NHANES 1988–1994. Cox proportional hazard models were used to evaluate the association between saccharin intake and CVD, cancer and all-cause mortality. After multivariable adjustment, increased absolute saccharin intake was associated with the risk of all-cause mortality (hazard ratio (HR): 1·41, 95 % CI: 1·05, 1·90), CVD mortality (HR: 1·93, 95 % CI: 1·15, 3·25) and cancer mortality (HR: 2·26, 95 % CI: 1·10, 4·45) in diabetic and pre-diabetic population. Among overweight population, higher absolute saccharin intake was associated with the risk of cancer mortality (HR: 7·369, 95 % CI: 2·122, 25·592). Replacing absolute saccharin intake with total sugar significantly reduced all-cause mortality by 12·5 % and CVD mortality by 49·7 % in an equivalent substitution analysis in the diabetic and pre-diabetic population. Aspartame substitution reduced all-cause mortality by 29·2 % and cancer mortality by 30·2 %. Notably, the relative daily intake of saccharin also had similar effects as the absolute intake on all-cause, cardiovascular and cancer mortality in all analyses. This was despite the fact that the relative daily intake in our study was below the Food and Drug Administration limit of 15 mg/kg. In conclusion, our study showed a considerable risk of increased saccharin intake on the all-cause, CVD mortality and cancer mortality.

A Quantitative Study on Parental Influence and Lifestyle Factors in Child Obesity

Article

Full-text available

Oct 2024

Child obesity is a growing global health concern, significantly impacting both developed and developing countries. This study examines the influence of parental behaviors and lifestyle factors on child obesity in Keyouqianqi, Inner Mongolia, China. Employing a quantitative research design, data was collected from 50 parents of obese children through structured questionnaires. Statistical analyses revealed significant associations between parental promotion of healthy eating, physical activity encouragement, and lower obesity rates, whereas restrictive feeding practices were linked to higher obesity rates. Lifestyle factors such as high-calorie food consumption, sugary beverage intake, insufficient physical activity, and excessive screen time were also significantly associated with child obesity. The findings underscore the importance of comprehensive interventions addressing both parental behaviors and children's lifestyle choices to combat child obesity effectively.

The link between the risk of cardiovascular diseases and the intake of different types of dietary carbohydrates in Iranian adults

Article

Full-text available

Oct 2024

Background The risk of cardiovascular diseases (CVDs) may be influenced by dietary carbohydrates. The aim of this study was to investigate the link between CVDs and the intake of carbohydrates. Methods In this cross-sectional study, data was extracted from the Prospective Epidemiologic Research Studies in Iran (PERSIAN) cohort in Sabzevar, Iran. A total of 4241 adults, including 1535 patients with CVDs and 2706 people without CVDs, were included. A validated 237-item food frequency questionnaire was used to estimate the intake of different types of dietary carbohydrates. Results A positive association was found between stroke and dietary intake of starch (OR = 1.108; 95% CI, 1.005–1.220; P = 0.039). Additionally, a negative association was found between stroke and dietary intake of sucrose (OR = 0.97; 95%CI, 0.94–0.99; P = 0.037). No association was found between other types of CVDs and the intake of different types of carbohydrates. Conclusion This study provided some evidence for the association between CVDs and different types of dietary carbohydrates. Consumption of starch may increase the risk of stroke, while a higher intake of sucrose may decrease the risk of stroke. Further studies are warranted.

Monoterpenes in Your Beverage: A Flavoring Catalyst for Faster Aging?

Preprint

Full-text available

Sep 2024

Background Aging is characterized by the progressive deterioration of tissue structure and physiological functions. While the impact of sugar and artificial sweeteners in beverages on biological aging, mediated through increased body mass index (BMI) and obesity, has been well-documented, the potential effects of other food additives, particularly monoterpenes, have not been thoroughly explored. This study aimed to investigate the association between high exposure to monoterpenes in beverages and biological age acceleration. Methods Included in the current study were 1,217 adults from the National Health and Nutrition Examination Survey (NHANES) in 2013–2014. Beverage intake was assessed through the 24-hour dietary recall. Serum levels of three monoterpenes—limonene, α-pinene, and β-pinene were used to estimate monoterpene exposure. Biological age was assessed using phenotypic age (PA), with acceleration calculated as the difference from chronological age. Multiple statistical approaches, including linear regression, restricted cubic spline (RCS) models, quantile g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR), were employed to analyze associations between beverage intake, monoterpene exposure and biological aging. Furthermore, mediation analyses were conducted to explore the mediated effects of monoterpenes and BMI on the association of beverage intake with PA acceleration. Results High beverage intake (β = 0.94, 95% CI: 0.26, 1.62) and increased exposure to monoterpenes, particularly limonene (β = 1.65, 95% CI: 0.55, 2.76) and β-pinene (β = 1.35, 95% CI: 0.53, 2.18), were associated with accelerated PA. In the RCS analyses, the effects of limonene and β-pinene on PA acceleration exhibited both linear and nonlinear. In the Qgcomp model, the mixed exposure of three monoterpenes had a significant positive relationship with PA acceleration (β = 0.25, 95% CI: 0.12, 0.37). Moreover, we observed antagonistic effects between limonene and each of α-pinene and β-pinene concerning the acceleration of biological aging in the BKMR model. Additionally, limonene and BMI were identified as parallel mediators of the relationship between beverage intake and PA acceleration. Conclusion The study provides novel insights into the detrimental effects of high monoterpene exposures in beverages on biological aging. These findings highlight the importance of considering a broader range of food additives in public health guidelines, as their impact on long-term health outcomes may be significant.

The trajectories of free sugar intake during childhood, their main sources and its association with socio-economic factors: generation XXI birth cohort

Article

Sep 2024
BRIT J NUTR

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries ( n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children’s sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year ² until 13 years. At all ages, the main food source was sweets. Some item’s consumption declined (sweets 25–21 % and yoghurts 22–7 %) as children grew older. Inversely, soft drink intake increased (9–18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal–SES was associated with lower children’s FS intake: occupational status ( β = –3·5; 95 % CI: –4·97, –1·94), years of education ( β = –3·7; 95 % CI: –4·93, –2·40) and household income ( β = –4·9; 95 % CI: –6·50, –3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term β = –1·04; CI 95 % (–1·50, –0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children’s FS intake was always higher when their mothers had a lower SES.

BMI, Dental Caries, and Risk Factors among Elementary School Children: A Cross-Sectional Study

Article

Full-text available

Sep 2024

Deema Farsi

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and weight, their body mass indices (BMIs) were calculated. Oral examination was performed to record the decayed, missed, and filled scores (dmft/DMFT). A thorough questionnaire was compiled and validated to gather information on diet and physical activity (PA). The KIDMED score was calculated from a 16-item questionnaire to assess diet. Junk food and PA scores were also calculated based on relevant questions. Nonparametric tests were used to assess the associations between the scores and health outcomes (dmft/DMFT and BMI). Results: Fifty-eight of the children had poor diets, which was associated with higher dmft/DMFT (p = 0.012). PA levels were very low, and the average PA score was 2.12 0.61. No association was found between BMI percentiles and PA level, nor between BMI percentiles and diet quality. Older children had lower BMI percentiles compared with younger children (coefficient = −9.35, 95% CI: −17.05, −1.65), and a borderline significant negative association was observed between dmft/DMFT and BMI percentile. Conclusions: Poor diets and chips consumption were related to dental caries. Obesity was not related to diet quality nor PA level.

Chronic Use of Artificial Sweeteners: Pros and Cons

Article

Full-text available

Sep 2024

Over the past few decades, the scientific community has been highly concerned about the obesity epidemic. Artificial sweeteners are compounds that mimic the sweet taste of sugar but have no calories or carbohydrates; hence, they are very popular among patients suffering from diabetes or obesity, aiming to achieve glycemic and/or weight control. There are four different types of sweeteners: artificial, natural, rare sugars, and polyols. Artificial and natural sweeteners are characterized as non-nutritional sweeteners (NNSs) since they do not contain calories. The extended use of sweeteners has been reported to have a favorable impact on body weight and glycemic control in patients with type 2 diabetes (T2DM) and on tooth decay prevention. However, there is concern regarding their side effects. Several studies have associated artificial sweeteners’ consumption with the development of insulin resistance, nonalcoholic fatty liver disease (NAFLD), gastrointestinal symptoms, and certain types of cancer. The present review focuses on the description of different types of sweeteners and the benefits and possible deleterious effects of the chronic consumption of NNSs on children’s health. Additionally, possible underlying mechanisms of the unfavorable effects of NNSs on human health are described.

Effectiveness of a nutrition education intervention using simulation videos and encouragement of parental involvement for elementary school students

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Full-text available

Sep 2024

This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants’ knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants’ healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.

Effects of Nonnutritive Sweeteners on the BMI of Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies

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Full-text available

Sep 2024

The effect of nonnutritive sweeteners (NNSs) on the body mass index [BMI (in kg/m 2)] of children and adolescents remains unclear despite rising consumption. Detailed systematic evaluations are warranted. We aimed to summarize evidence on NNS consumption and BMI sex-and age-specific absolute changes (kg/m 2) in pediatric populations, by NNS type, study design, duration, analysis type, conflicts of interest (COI), geographical region, age, sex, and baseline BMI. We searched randomized controlled trials (RCTs) and prospective cohort studies in children (2-9 y), adolescents (10-24 y), and young adults (20-24 y). Pooled estimates derived from random-effects meta-analysis for BMI changes, and the evidence quality was evaluated overall and by subgroup. From 2789 results, we included 4 RCTs [n ¼ 1372; mean follow-up ¼ 42.6 wk (standard deviation ¼ 18.4); 2 (50%) with COI], and 8 prospective cohort studies [n ¼ 35,340; median follow-up 2.5 y (interquartile range ¼ 1.7-6.3), 2 (25%) with COI]. No identified studies evaluated NNS in food, NNS beverages compared with water, or participants aged 20-24 y. Random allocation to NNS beverages (25-2400 mg/d, from beverages) showed less BMI gain [mean difference ¼ À0.114 kg/m 2 (95% confidence interval [CI]: À0.207, À0.021); I 2 ¼ 87.02%] compared with sugar-sweetened beverages (SSBs). Stratified estimates resulted in less BMI gain in adolescents, participants with baseline obesity, consumers of mixed NNS, longer trials, and trials without COI. Pooled estimates from prospective cohorts showed a nonsignificant association between NNS beverages and BMI gain [0.05 kg/m 2 (95% CI: À0.03, 0.13); I 2 ¼ 75.06%; per daily 355 mL serving]. Stratified estimates remained consistent. Removing studies with COI attenuated estimates. Evidence had low to moderate quality. In summary, pooled results from RCTs comparing NNS beverages compared with SSBs showed less BMI gain in adolescents with obesity. Meta-analyses of long-term cohort studies did not display a significant association between NNS beverages and BMI changes. This trial was registered at PROSPERO as CRD42022352284. Statement of Significance This study's significance lies in its comprehensive consideration of age and sex as crucial determinants of growth in pediatric populations, particularly when examining the association between nonnutritive sweeteners and BMI changes. Furthermore, we provide novel insights into the potential impact of diverse study designs, analytical methodologies, and commercial conflicts of interest within original studies, offering valuable perspectives for interpreting findings in this field.

A Holistic Approach to Human Health: The Journal of Ethiopian Church Studies

Article

May 2024

የኢትዮጵያ ኦርቶዶክስ ተዋሕዶ ቤተ ክርስቲያን የተከታዮቿን እምነትና ተግባር በመምራት ረገድ ከፍተኛ ሚና አላት። የትምህርቶቹ ዋና ዋና ተግባራት እንደ ጾም፣ ጸሎት፣ ይቅርታ እና የማኅበረሰብ ተሳትፎን የመሳሰሉ መንፈሳዊ እና አካላዊ ደኅንነትን የሚያበረታቱ መርሖዎች ናቸው። ነገር ግን በጤና ላይ በተለይም ተላላፊ ያልሆኑ በሽታዎችን በመከላከል ረገድ ያላቸው ሚና እና ልዩ ተፅዕኖ ገና በበቂ መጠን አልተመረመረም። ይህ ጥናት በኢ/ኦ/ተ/ቤ/ክ ክርስቲያናዊ ልምምዶች እና በሰው ልጅ ጤና እና ደኅንነት መካከል ያለውን የተወሳሰበ ግንኙነት ለመመርመር ያለመ ነው። በዚህ ጥናት የኢ/ኦ/ተ/ቤ/ክን ትምህርት፣ ቀኖና እና ትውፊት በጥልቀት በመመርመር እንደ ጾም፣ ጸሎት፣ ይቅርታ እና የኅብረተሰብ ተሳትፎ ተግባራት አካላዊ፣ አእምሯዊ እና ማኅበራዊ ደኅንነትን በማስተዋወቅ ረገድ ያለውን ሚና በጥልቀት ። በተጨማሪም የቤተ ክርስቲያን ልዩ ልዩ ሰነዶች እና ጽሑፎች መርምረናል ። ከሃይማኖት አባቶች እና ከሕክምና ባለሙያዎች ጋር የአንድ ለአንድ ውይይት እና ምክክር አድርገናል። የጥናታችን ግኝቶች እንደሚያሳዩት የኢ/ኦ/ተ/ቤ/ክ የክርስትና ሕይወት ዘይቤን መከተል ከልዩ ልዩ አዎንታዊ የጤና ውጤቶች ጋር በጥብቅ የተቆራኘ መሆኑን አሳይተዋል። በተለይም እንደ ጾም ያሉ ልምምዶች ክብደትን ከመቆጣጠር፣ ጤናን በማሻሻል (improved metabolic health) እና እንደ ስኳር በሽታ እና የልብና የደም ሥር (cardiovascular) ያሉ ተላላፊ ያልሆኑ በሽታዎች ተጋላጭነትን በከፍተኛ ሁኔታ ሊቀንሱት እንደሚችሉ ተረድተናል። ጸሎት እና ይቅርታ ደግሞ በአእምሮ ጤና ላይ ጠቃሚ ተጽዕኖዎች እንዳሉት፤ ስሜታዊ ጥንካሬን እና ለአጠቃላይ ጤና ደኅንነት ወሳኝ የሆኑትን ማኅበራዊ ግንኙነቶችን እና ማኅበራዊ መረቦችን በከፍተኛ ሁኔታ ሊጨምሩ እንደሚችሉ ተረድተናል። በተጨማሪም በኢ/ኦ/ተ/ቤ/ክ ማኅበረሰብ ውስጥ ንቁ ተሳትፎ ማድረግ ለአጠቃላይ ጤና እና ደኅንነት ወሳኝ የሆኑ ማኅበራዊ ግንኙነቶችን ማሻሻል እንደሚችሉ አረጋግጠናል። ጥናቱ የኢ/ኦ/ተ/ቤ/ክ የክርስትና ሕይወት ዘይቤን መከተል የሰው ልጅ ሁለንተናዊ ጤናን በማሳደግ እና በሽታን በመከላከል ረገድ ያለውን ሚና አጉልቶ አሳይቷል። በተለይም የኢ/ኦ/ተ/ቤ/ክ ተከታዮች የሕይወት ዘይቤ ተላላፊ ያልሆኑ በሽታዎች ተጋላጭነትን በመንፈሳዊ እና በአካላዊ ልምምዶች ከማሻሻል በተጨማሪ የአእምሮ እና ማኅበራዊ ጤናን እንዲሁም አጠቃላይ የሰው ልጅ ደኅንነትን እንደሚያሳድግ ታምኖበታል። ስለዚህ የሕዝብ ጤናን ለማሻሻል የሃይማኖትና የጤና ተቋማት በጋራ እንዲሠሩ እንመክራለን። በሌላ መልኩ ግን የኢ/ኦ/ተ/ቤ/ክ አስተምህሮ በሰው ልጅ ሁለንተናዊ ጤና ላይ የሚያመጣውን ተጽዕኖ የበለጠ ለማወቅና የተሟላ ግንዛቤ ለማግኘት፤ ከሕዝብ ጤና ፖሊሲዎች ጋር ለማዋሐድ ተጨማሪ ጥናቶች እንዲካሄዱ እንጠቁማለን ።

A Holistic Approach to Human Health: Exploring the Role of the Ethiopian Orthodox Tewahedo Church

Article

May 2024

RELATIONSHIP OF HALAL AWARENESS, SELECTION OF MENU VARIATION AND NUTRITION KNOWLEDGE WITH PURCHASE DECISIONS: A STUDY ON CHATIME CONSUMERS IN SURABAYA

Article

Full-text available

Oct 2022

Boba drinks attracts people's attention to consume it. Surabaya is one of the big cities visited by a boba franchise company, namely the Chatime brand. The purpose of this study to analyzed the relationship between halal awareness, selection of menu variations and nutrition knowledge with purchasing decisions on Chatime brand boba drinks. This research method used analytic observational with a cross-sectional type of research. The sample in this study amounted to 162 respondents who were partly students in the city of Surabaya with the accidental sampling method. Collecting data using a questionnaire. The data analysis performed was univariate and bivariate analysis using the Spearman rank test. The results showed that halal awareness was good (61,7%), selection of menu variation was good (35.8%), nutrition knowledge was good (61.1%) and purchasing decisions was enough (47.5%). The results show there was a significant relationship between halal awareness and the purchasing decision of Chatime boba drinks (p-value = 0.002), there was a significant relationship between the selection of menu variations and the purchasing decision of Chatime boba drinks (p-value = 0.000), there was no relationship between nutrition knowledge and purchasing decisions of Chatime boba drink (p-value = 0.489). The conclusion in this study is that there was a relationship between halal awareness and purchasing decisions. There was a relationship between the selection of menu variations with purchasing decisions. There was no relationship between nutrition knowledge and purchasing decisions. Keywords: boba drink, halal awareness, purchasing decisions.

Personal goal setting eHealth component associated with improved weight loss at 6 months: A mixed methods secondary analysis

Article

Full-text available

Aug 2024

Objective Goal setting is a behavior change technique associated with improved change in outcomes. Digital (eHealth, mHealth) behavior change interventions often prescribe all goals with no opportunity for participants to create and track their own; thus, little is known about the types of goals participants create for themselves and their impacts on behavioral outcomes. This analysis describes the goals created by participants using an optional personal goal-setting component and evaluates the association between participant goal creation and weight loss in an eHealth adult weight loss intervention. Methods This represents a mixed methods QUANT-qual design to understand the types of goals users create for themselves and their impacts on behavior change outcomes. Qualitative codes were applied for the topic, behavior/outcome focus, adherence to SMART criteria, and repetition with count summaries. Quantitative analyses applied regression modeling to determine if the number of goals set was associated with the 6-month weight change, controlling for covariates. Results Participants (n = 363) set an average of 23.4 goals (SD = 22.7) over 6 months. Those who reached at least 5% weight loss set significantly more goals than those who lost between 1% and 4.99% or who lost <1% or gained weight (p's < 0.0001). Setting more personal goals was associated with significant weight loss reduction at 6 months, controlling for covariates (p's < 0.05). Conclusions Greater use of a personal goal-setting feature was associated with improved weight loss outcomes among active users. This can be a low-investment addition to digital behavior change interventions to contribute to improved outcomes.

Investigating the Impact of Nutrition, Physical Activity, and Mental Health Interventions on Childhood Obesity

Article

Full-text available

Jul 2024

Childhood obesity is a multifaceted public health issue influenced by various factors, including nutrition, physical activity, and mental health. This study employs a qualitative approach to investigate the impact of interventions targeting these factors on childhood obesity. Through in-depth interviews, focus group discussions, and document analysis, the study examines the effectiveness of nutrition education programs, physical activity promotion initiatives, and mental health support services in addressing childhood obesity. The research explores how these interventions are implemented in diverse settings, such as schools, communities, and healthcare facilities, and assesses their outcomes in terms of changes in dietary behaviors, physical activity levels, and psychological well-being among children. Additionally, the study investigates the barriers and facilitators encountered during the implementation of these interventions, including socio-cultural factors, policy environments, and resource availability. The findings highlight the complex interplay between nutrition, physical activity, and mental health in shaping childhood obesity outcomes. Effective interventions often involve a comprehensive, multi-sectoral approach that addresses the underlying determinants of unhealthy behaviors and promotes holistic well-being. Key themes identified include the importance of community engagement, the need for culturally sensitive programming, and the integration of mental health support into obesity prevention efforts. By elucidating the impact of nutrition, physical activity, and mental health interventions on childhood obesity, this study contributes to the evidence base for designing and implementing effective strategies to combat this growing public health challenge.

Global trends and hotspots of type 2 diabetes in children and adolescents: A bibliometric study and visualization analysis

Article

Jan 2025

BACKGROUND Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus (T2DM) among children and adolescents worldwide. Due to rapid disease progression, severe long-term cardiorenal complications, a lack of effective treatment strategies, and substantial socioeconomic burdens, it has become an urgent public health issue that requires management and resolution. Adolescent T2DM differs from adult T2DM. Despite a significant increase in our understanding of youth-onset T2DM over the past two decades, the related review and evidence-based content remain limited. AIM To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes. METHODS This study utilized the terms “children”, “adolescents”, and “type 2 diabetes”, retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection (SCI, SSCI, ESCI). Utilizing CiteSpace and VoSviewer software, we analyze and visually represent the annual output of literature, countries involved, and participating institutions. This allows us to predict trends in this research field. Our analysis encompasses co-cited authors, journal overlays, citation overlays, time-zone views, keyword analysis, and reference analysis, etc. RESULTS A total of 9210 articles were included, and the annual publication volume in this field showed a steady growth trend. The United States had the highest number of publications and the highest H-index. The United States also had the most research institutions and the strongest research capacity. The global hot journals were primarily diabetes professional journals but also included journals related to nutrition, endocrinology, and metabolism. Keyword analysis showed that research related to endothelial dysfunction, exposure risk, cardiac metabolic risk, changes in gut microbiota, the impact on comorbidities and outcomes, etc., were emerging keywords. They have maintained their popularity in this field, suggesting that these areas have garnered significant research interest in recent years. CONCLUSION Pediatric and adolescent T2DM is increasingly drawing global attention, with genes, behaviors, environmental factors, and multisystemic interventions potentially emerging as future research hot spots.

The Open Public Health Journal Development and Psychometric Properties of a Tool Related to the Adoption of Desirable Behaviors in the Consumption of Sugar-sweetened Beverages in Children Based on the Social Cognitive Theory

Article

Full-text available

Jan 2025

Background: Consumption of sugar-sweetened beverages is associated with chronic diseases such as diabetes and cardiovascular disorders and other severe negative health consequences and is one of the challenging issues in the field of nutrition in today's societies. This study was conducted with the aim of designing a psychometric questionnaire in relation to the consumption behavior of sugar-sweetened drinks in children. Methods: In this cross-sectional research, 607 students were selected and included in the study by multi-stage cluster sampling from the first-year secondary schools covered by the Urmia Department of Education. Waltz's method was used to design the questionnaire, and based on a targeted review of the literature and questionnaires related to nutrition behavior, an initial questionnaire with 51 items was designed. After confirming the face and content validity of the questionnaire by 15 members of the expert panel, construct validity steps were performed using exploratory factor analysis. Finally, the internal reliability of the questionnaire was determined by calculating Cronbach's alpha. Results: The first version of the questionnaire was designed with 51 items and all the items were retained in the psychometric process during content validity. The content validity index and ratio were calculated to be higher than 0.79 and 0.6, respectively. Based on the exploratory factor analysis, the number of items in the questionnaire remained at 51, and the dimensions of the questionnaire were categorized into 6 factors: perceived barriers, self-efficacy, self-regulation, social support, preventive behaviors, and reinforcing behaviors, with a predictive power of 56,261 and in repeating the exploratory factor analysis for items with a different nature from other factors, 3 separate factors were identified: the physical health dimension of outcome expectations, negative outcome expectations, and positive outcome expectations with a predictive power of 54.667. The internal reliability of the questionnaire items was accepted and confirmed with Cronbach's alpha coefficient above 0.70. Conclusion: The final questionnaire with 51 items has the ability to be used by various researchers due to the strength of the factorial structure and suitable psychometric properties.

Taxing for Change: An Umbrella Review of Impacts of Sugar-Sweetened Beverages (SSBs) Taxation in Low and Middle-Income Countries

Article

Dec 2024

Context: The increasing prevalence of non-communicable diseases in low- and middle-income countries (LMICs) has prompted governments to consider levying taxes on sugar-sweetened beverages (SSBs) to reduce consumption and improve public health. Objectives: This review aims to provide evidence-based insights to policymakers on implementing SSBs taxes to enhance health outcomes. Methods: A comprehensive analysis of data from seven databases was conducted to evaluate the effects of SSBs taxes on pricing, consumption, substitution patterns, health outcomes, unintended consequences, and tax revenue. The review included systematic reviews and meta-analyses, following the Joanna Briggs Institute (JBI) format for data extraction and synthesizing existing research findings relevant to these outcomes. Results: Of the 938 studies reviewed, five met the inclusion criteria, providing detailed explanations for most quality benchmarks, though certain challenges were noted. The findings indicated that SSBs taxes often result in reduced consumption of sugary beverages, increased consumption of substitutions, and are associated with decreases in diabetes, strokes, heart attacks, and overall mortality. However, there was limited evidence regarding unintended consequences of SSB taxation in LMICs. Additionally, studies highlighted increased revenue generation through sin taxes. Conclusions: Taxing SSBs can effectively reduce consumption, improve health outcomes, and generate revenue. However, the impact on healthcare funding depends on factors such as the type of tax, consumer behavior, income levels, and political agreement on public expenditure priorities. To maximize benefits, revenue from SSBs taxes could be allocated to health programs targeting low-income communities. Policymakers are encouraged to design tax mechanisms thoughtfully, monitor and evaluate their policies regularly, and address the financial impact on low-income households. This approach could help mitigate health disparities and enhance the overall effectiveness of SSBs taxation.

(Traditional risk factors and chronic diseases associated with an increased risk of coronary artery disease. Risk stratification and intervention from childhood)

Article

Full-text available

Jun 2024

“Can we add a little sugar?” the contradictory discourses around sweet foods in Swedish home economics

Article

Apr 2023
Pedagog Cult Soc

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence

Article

Dec 2024
OBES REV

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher‐quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub‐domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in ‘healthcare environments’, behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in ‘School environments’. This review extends on previous reviews by consolidating evidence from high‐quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

Towards healthier low-sugar and low-fat beverages: Design, production, and characterization

Article

Nov 2024
FOOD RES INT

Digital behavioral dietary interventions to promote a healthy diet among children and adolescents: a scoping review of technologies, design, behavioral theory, and assessed outcomes

Article

Full-text available

Nov 2024

Background Childhood overweight and obesity prevalence steeply increased during recent decades, prompting the development of many digital behavioral dietary interventions (DBDIs). However, a coherent overview is lacking, which is crucial for delineating research in this field. Objective This scoping review outlines the landscape of DBDIs for improving dietary behaviors in children and adolescents, including delivery modes, design and development approaches, behavioral theory, and outcomes assessed. Secondary objectives involved examining the integration of behavior change techniques (BCTs) and identifying outcomes favoring DBDIs. Methods Following PRISMA guidelines, PsycInfo, PubMed, and Scopus were systematically searched for evaluated DBDIs. Two reviewers independently screened titles and abstracts; one performed full-text screening. Studies included had a digital component, targeted dietary behavior, focused on children or adolescents, and evaluated effects on behavior change, health, or process evaluation outcomes. One reviewer extracted data, including general information, theoretical underpinning, and outcomes assessed, while BCTs were coded independently by two reviewers. DBDIs were deemed favorable if significant improvements were observed in all outcomes (p ≤ .05). Results From 51 included studies, 41 DBDIs were identified, including app-based (37%), web-based (29%), computer-based (27%), text-message-based (5%), and combined technology tools (2%). Stakeholders were involved in the design of 59% of DBDIs, with 5% using co-design methodologies. Studies evaluated behavior change outcomes (86%), process evaluation outcomes (59%), and health outcomes (20%). DBDIs included an average of 6.2 BCTs, primarily ‘Feedback on behavior’ (56%) and ‘Non-specific reward’ (46%). Among experimental studies, 15% yielded favorable results, 58% mixed results, and 28% no favorable results. Discussion This review outlines the diverse landscape of DBDIs, highlighting various technological delivery modes and outcomes assessed. Methodological variations and limitations challenge consistent effectiveness assessment. Future research should prioritize rigorous study designs to understand efficacy and identify effective BCTs among diverse pediatric populations. Leveraging co-design methods may enhance engagement and effectiveness.

Economic effect of consumption of sugar-containing beverages in Kazakhstan and regulatory initia tives to reduce their consumption

Article

Sep 2024

Object: The purpose of the study is to assess the potential economic damage from the consumption of sugar containing beverages based on the DALY coefficient, as well as to study regulatory strategies adopted in various coun tries of the world aimed at reducing the consumption of sugar-containing beverages, for the possibility of their applica tion in Kazakhstan. Methods: Methods of systematic, comparative, functional, economic and statistical analysis and synthesis, math ematical methods were used as the methodological basis of the study. Findings: The addition of unnecessary sugars to food is an important global problem, leading to numerous short- and long-term health problems and increasing health-related costs for both individuals and governments. Excessive sug ar consumption leads to adverse health consequences, including obesity, type 2 diabetes, poor oral health, cancer risks, etc. The global burden of increasing morbidity from the consumption of sugar-containing beverages has serious conse quences not only for health care, but also for the economy as a whole. Thus, the amount of lost profit in the develop ment of diseases and continued consumption of energy drinks will amount to 3.2 trillion tenge. Conclusions: This review summarizes the international experience in the field of taxation of sugar-containing beverages and its effectiveness. Internationally, public health experts recommend taxing sugary drinks as a key part of a comprehensive strategy to fight obesity and diet-related chronic diseases.

Impact of non-sugar sweeteners on metabolism beyond sweet taste perception

Article

Nov 2024
TRENDS ENDOCRIN MET

School food policy in secondary schools in England and its impact on adolescents’ diets and dental health: the FUEL multiple-methods study

Article

Nov 2024

Background School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. Objectives To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. Methods An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11–15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Results Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = –2.78 g, 95% confidence interval –4.66 to –0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. Limitations There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. Conclusions In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. Future research We need to develop healthy secondary-school food provision models that meet pupils’ preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration This trial is registered as ISRCTN68757496. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research ; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Associations of Food Group Intakes with Serum Carbon Isotope Ratio Values in Youth: Results from 2 Prospective Pediatric Cohort Studies

Article

Nov 2024
J NUTR

Adherence to a Healthful Plant-Based Diet and Risk of Chronic Kidney Disease Among Individuals with Diabetes

Article

Oct 2024

Objective: Chronic kidney disease (CKD) is highly prevalent among people with diabetes. While identifying modifiable risk factors to prevent a decline in kidney function among those living with diabetes is pivotal, there is limited evidence on dietary risk factors for CKD. In this study, we examined the associations between healthy and less healthy plant-based diets (PBDs) and the risk of CKD among those with diabetes, and to identify potential underlying mechanisms. Methods: We conducted a prospective analysis among 7,747 UK Biobank participants with prevalent diabetes. Multivariable Cox proportional hazard regression models were used to examine the associations between healthful and unhealthful PBDs and the risk of CKD. Causal mediation analyses were further employed to explore the underlying mechanisms of the observed associations. Results: Among 7,747 study participants with diabetes, 1,030 developed incident CKD over 10.2 years of follow-up. Higher adherence to a healthy PBD was associated with a 24% lower CKD risk (HRQ4 versus Q1: 0.76 [95%CI: 0.63-0.92], ptrend = 0.002), while higher adherence to an unhealthy PBD was associated with a 35% higher risk (HRQ4 versus Q1: 1.35 [95%CI: 1.11-1.65], ptrend = 0.006). The observed associations were predominantly mediated by markers of body fatness (proportion mediated: 11-25%) and kidney function (23-89%). Conclusions: In this prospective cohort study of middle-aged adults with diabetes, adherence to a healthy PBD was associated with lower CKD risk, whereas adherence to an unhealthy PBD was associated with a higher CKD risk. Associations were primarily mediated by markers of lower body fatness and improved kidney function.

Alimentación y cáncer

Article

Oct 2024

Carlos A. González Svatetz

Indigenous Knowledge and Sugar Sweetened Beverages: Qualitative adaptations towards chronic disease prevention and intervention

Article

Oct 2024

Safety of Food Additives: Sweeteners

Chapter

Jan 2024

Ahmet Dundar

The consumption of harmful substances, including environmental pollutants, endocrine disruptors, and certain food additives, has the potential to compromise food safety and the consumption of safe food, which are fundamental dynamics for society. Furthermore, it can pose a risk to health. This book, entitled Food Safety, aims to assist consumers in developing an awareness of healthy and safe food consumption, beginning with an understanding of the fundamental concepts of food safety, providing e_ective information for the prevention of foodborne diseases, and elucidating the possible e_ects on health. Furthermore, the book addresses contemporary concerns such as food terrorism, packaging safety, and the use of preservatives. Emphasizing food safety from a health perspective, this book is a vital reference for industry professionals, academics, and health professionals. By integrating current research _ndings and real-world examples, the book furnishes readers with a robust foundation of knowledge while raising awareness of food safety. Covering a wide range of food safety issues, this book is a comprehensive resource for anyone working in food toxicology.

Economic effect of consumption of sugar-containing beverages in Kazakhstan and regulatory initia tives to reduce their consumption

Article

Sep 2024

Adherence to a healthful plant-based diet and risk of mortality among individuals with chronic kidney disease: A prospective cohort study

Article

Sep 2024
CLIN NUTR

Obesity, Metabolic Syndrome, and Sugar-Sweetened Beverages (SSBs) in America: A Novel Bioethical Argument for a Radical Public Health Proposal

Article

Sep 2024
J BIOETHIC INQ

Michael Gentzel

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer’s disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the “consistency argument”). This argument’s radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer’s disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.

The effectiveness of sugar-sweetened beverage warning labels: An examination of consumer reactance and cost of compliance

Article

Sep 2024
J BUS RES

Ultraprocessed food intake and body mass index change among youths: a prospective cohort study

Article

Aug 2024
AM J CLIN NUTR

The Role of Eating Frequency and Snacking on Energy Intake and BMI

Chapter

May 2020

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Article

Full-text available

Jan 2014

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

Research methods and reporting. preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Article

Full-text available

Jul 2009
PLOS MED

Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.

Changes in water and beverage intake and long-term weight changes: Results from three prospective cohort studies

Article

Full-text available

Jan 2013
INT J OBESITY

Objective: To examine the long-term relationship between changes in water and beverage intake and weight change. Subjects: Prospective cohort studies of 50013 women aged 40-64 years in the Nurses' Health Study (NHS, 1986-2006), 52987 women aged 27-44 years in the NHS II (1991-2007) and 21988 men aged 40-64 years in the Health Professionals Follow-up Study (1986-2006) without obesity and chronic diseases at baseline. Measures: We assessed the association of weight change within each 4-year interval, with changes in beverage intakes and other lifestyle behaviors during the same period. Multivariate linear regression with robust variance and accounting for within-person repeated measures were used to evaluate the association. Results across the three cohorts were pooled by an inverse-variance-weighted meta-analysis. Results: Participants gained an average of 1.45 kg (5th to 95th percentile: -1.87 to 5.46) within each 4-year period. After controlling for age, baseline body mass index and changes in other lifestyle behaviors (diet, smoking habits, exercise, alcohol, sleep duration, TV watching), each 1 cup per day increment of water intake was inversely associated with weight gain within each 4-year period (-0.13 kg; 95% confidence interval (CI): -0.17 to -0.08). The associations for other beverages were: sugar-sweetened beverages (SSBs) (0.36 kg; 95% CI: 0.24-0.48), fruit juice (0.22 kg; 95% CI: 0.15-0.28), coffee (-0.14 kg; 95% CI: -0.19 to -0.09), tea (-0.03 kg; 95% CI: -0.05 to -0.01), diet beverages (-0.10 kg; 95% CI: -0.14 to -0.06), low-fat milk (0.02 kg; 95% CI: -0.04 to 0.09) and whole milk (0.02 kg; 95% CI: -0.06 to 0.10). We estimated that replacement of 1 serving per day of SSBs by 1 cup per day of water was associated with 0.49 kg (95% CI: 0.32-0.65) less weight gain over each 4-year period, and the replacement estimate of fruit juices by water was 0.35 kg (95% CI: 0.23-0.46). Substitution of SSBs or fruit juices by other beverages (coffee, tea, diet beverages, low-fat and whole milk) were all significantly and inversely associated with weight gain. Conclusion: Our results suggest that increasing water intake in place of SSBs or fruit juices is associated with lower long-term weight gain.

A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

Article

Full-text available

Sep 2012

Background: The consumption of beverages that contain sugar is associated with overweight, possibly because liquid sugars do not lead to a sense of satiety, so the consumption of other foods is not reduced. However, data are lacking to show that the replacement of sugar-containing beverages with noncaloric beverages diminishes weight gain. Methods: We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools. At 18 months, 26% of the children had stopped consuming the beverages; the data from children who did not complete the study were imputed. Results: The z score for the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) increased on average by 0.02 SD units in the sugar-free group and by 0.15 SD units in the sugar group; the 95% confidence interval (CI) of the difference was -0.21 to -0.05. Weight increased by 6.35 kg in the sugar-free group as compared with 7.37 kg in the sugar group (95% CI for the difference, -1.54 to -0.48). The skinfold-thickness measurements, waist-to-height ratio, and fat mass also increased significantly less in the sugar-free group. Adverse events were minor. When we combined measurements at 18 months in 136 children who had discontinued the study with those in 477 children who completed the study, the BMI z score increased by 0.06 SD units in the sugar-free group and by 0.12 SD units in the sugar group (P=0.06). Conclusions: Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children. (Funded by the Netherlands Organization for Health Research and Development and others; DRINK ClinicalTrials.gov number, NCT00893529.).

Intake of Liquid and Solid Sucrose in Relation to Changes in Body Fatness over 6 Years among 8- to 10-Year-Old Children: The European Youth Heart Study

Article

Full-text available

Jul 2012
OBESITY FACTS

Objective: To examine if intake of soft drinks is more closely associated with weight gain than other energy sources and if these associations are mediated through differences in energy intake or insulin level. Methods: Data derived from the Danish part of the European Youth Heart Study (n = 359). Height, weight, and waist circumference (WC) were measured in 1997-1998 and again in 2003-2004. Results: Intake of liquid sucrose was associated with changes in waist circumference (ΔWC) (β = 0.226, p = 0.07, R(2) = 0.17) as well as BMI z-scores (ΔBMI(z)) (β = 0.031, p = 0.05, R(2) = 0.30). Associations attenuated slightly after adjusting for energy intake, but were substantially reduced when adjusting for insulin. Adjustment for both insulin and energy intake attenuated the effect of soft drinks intake on ΔBMI(z), but not on ΔWC. Conclusion: Liquid sucrose seemed more clearly associated with ΔWC and ΔBMI(z) than other energy sources. For ΔWC, the association seemed to be based on decreases in insulin sensitivity rather than increases in energy intake, whereas for ΔBMI(z) the association seemed to be based on both increases in energy intake and decreases in insulin sensitivity.

Making soft drinks the dietary version of the cigarette

Article

Full-text available

Aug 2012
PUBLIC HEALTH NUTR

Article

Full-text available

Apr 2012

This observational study examined cross-sectional and 24-month longitudinal associations of physical activity and dietary behaviors with change in BMI and percent body fat among children aged 6–9 years old. Data were from the control group (n = 271; 48% Latino) of a community-based childhood obesity prevention program. Assessments were conducted at baseline and at 24 months and included height and weight, bioelectrical impedance–derived percent body fat, and 10 physical activity and dietary behaviors measured via parent report of their child. Cross-sectional analysis of variances (ANOVA) (normal weight, overweight, obese) and longitudinal mixed-effects linear regression models were used to investigate the relation of each physical activity and dietary behavior with BMI and percent body fat. At baseline, obese children engaged in less physical activity and more sedentary behavior than normal-weight children (p < 0.05). Increased physical activity (p < 0.01) and number of breakfasts eaten with family (p < 0.05) were associated with decreased BMI z-score and percent body fat. Decreased sedentary behavior and sugar-sweetened beverage consumption were associated with decreased percent body fat (p < 0.05) but not BMI. In this cohort of 271 children, increased physical activity and eating breakfast with family and reduced screen-based sedentary behaviors and sugar-sweetened beverage consumption were associated with more favorable trends in adiposity. Therefore, attention to these behaviors may be of particular importance. Results also suggest that future studies should include percent body fat as an outcome for a more precise assessment of the association of behavior with adiposity.

Investigation into longitudinal dietary behaviours and household socio-economic indicators and their association with BMI Z-score and fat mass in South African adolescents: the Birth to Twenty (Bt20) cohort

Article

Full-text available

Jul 2012
PUBLIC HEALTH NUTR

Objective: The present study aimed to assess the relationship between dietary habits, change in socio-economic status and BMI Z-score and fat mass in a cohort of South African adolescents. Design: In the longitudinal study, data were collected at ages 13, 15 and 17 years on a birth cohort who have been followed since 1990. Black participants with complete dietary habits data (breakfast consumption during the week and at weekends, snacking while watching television, eating main meal with family, lunchbox use, number of tuck shop purchases, fast-food consumption, confectionery consumption and sweetened beverage consumption) at all three ages and body composition data at age 17 years were included in the analyses. Generalized estimating equations were used to test the associations between individual longitudinal dietary habits and obesity (denoted by BMI Z-score and fat mass) with adjustments for change in socio-economic status between birth and age 12 years. Setting: Birth to Twenty (Bt20) study, Soweto-Johannesburg, South Africa. Subjects: Adolescents (n 1298; 49·7 % male). Results: In males, the multivariable analyses showed that soft drink consumption was positively associated with both BMI Z-score and fat mass (P < 0·05). Furthermore, these relationships remained the same after adjustment for socio-economic indicators (P < 0·05). No associations were found in females. Conclusions: Longitudinal soft drink consumption was associated with increased BMI Z-score and fat mass in males only. Fridge ownership at birth (a proxy for greater household disposable income in this cohort) was shown to be associated with both BMI Z-score and fat mass.

Water and sugar-sweetened beverage consumption and changes in BMI among Brazilian fourth graders after 1-year follow-up

Article

Full-text available

May 2012
PUBLIC HEALTH NUTR

Objective: We examined whether drinking water per se is associated with drinking less of other beverages and whether changes in BMI are associated with the intake of water and other beverages. Design: Secondary analysis of a randomized trial of fourth graders followed over 1 year. Setting: Public schools in the metropolitan area of Rio de Janeiro, Brazil. Subjects: Participants were 1134 students aged 10-11 years. Results: At baseline, a higher frequency of water consumption was associated with a greater daily intake of fruit juice (P = 0.02) and a higher daily frequency of milk (P = 0.005). In the intervention group, the baseline frequency of water consumption was negatively associated with weight change over 1 year but without statistical significance (coefficient = -0.08 kg/m2; 95 % CI -0.37, 0.24 kg/m2), whereas fruit juice intake frequency was positively associated with weight change: each increase in fruit juice intake of 1 glass/d was associated with a BMI increase of 0.16 (95 % CI 0.02, 0.30) kg/m2. Conclusions: Our findings do not support a protective effect of water consumption on BMI, but confirm consumption of juice drinks as a risk factor for BMI gain. Students who reported high water consumption also reported high intake of other beverages; therefore, the promotion of water consumption per se would not prevent excessive weight gain.

Replacing caloric beverages with water or diet beverages for weight loss in adults: Main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial

Article

Full-text available

Mar 2012
AM J CLIN NUTR

Replacement of caloric beverages with noncaloric beverages may be a simple strategy for promoting modest weight reduction; however, the effectiveness of this strategy is not known. We compared the replacement of caloric beverages with water or diet beverages (DBs) as a method of weight loss over 6 mo in adults and attention controls (ACs). Overweight and obese adults [n = 318; BMI (in kg/m(2)): 36.3 ± 5.9; 84% female; age (mean ± SD): 42 ± 10.7 y; 54% black] substituted noncaloric beverages (water or DBs) for caloric beverages (≥200 kcal/d) or made dietary changes of their choosing (AC) for 6 mo. In an intent-to-treat analysis, a significant reduction in weight and waist circumference and an improvement in systolic blood pressure were observed from 0 to 6 mo. Mean (±SEM) weight losses at 6 mo were -2.5 ± 0.45% in the DB group, -2.03 ± 0.40% in the Water group, and -1.76 ± 0.35% in the AC group; there were no significant differences between groups. The chance of achieving a 5% weight loss at 6 mo was greater in the DB group than in the AC group (OR: 2.29; 95% CI: 1.05, 5.01; P = 0.04). A significant reduction in fasting glucose at 6 mo (P = 0.019) and improved hydration at 3 (P = 0.0017) and 6 (P = 0.049) mo was observed in the Water group relative to the AC group. In a combined analysis, participants assigned to beverage replacement were 2 times as likely to have achieved a 5% weight loss (OR: 2.07; 95% CI: 1.02, 4.22; P = 0.04) than were the AC participants. Replacement of caloric beverages with noncaloric beverages as a weight-loss strategy resulted in average weight losses of 2% to 2.5%. This strategy could have public health significance and is a simple, straightforward message. This trial was registered at clinicaltrials.gov as NCT01017783.

Bias in Meta-Analysis Detected by a Simple, Graphical Test

Article

Full-text available

Sep 1997

Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30

Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: A 6-mo randomized intervention study

Article

Full-text available

Dec 2011
AM J CLIN NUTR

The consumption of sucrose-sweetened soft drinks (SSSDs) has been associated with obesity, the metabolic syndrome, and cardiovascular disorders in observational and short-term intervention studies. Too few long-term intervention studies in humans have examined the effects of soft drinks. We compared the effects of SSSDs with those of isocaloric milk and a noncaloric soft drink on changes in total fat mass and ectopic fat deposition (in liver and muscle tissue). Overweight subjects (n = 47) were randomly assigned to 4 different test drinks (1 L/d for 6 mo): SSSD (regular cola), isocaloric semiskim milk, aspartame-sweetened diet cola, and water. The amount of intrahepatic fat and intramyocellular fat was measured with (1)H-magnetic resonance spectroscopy. Other endpoints were fat mass, fat distribution (dual-energy X-ray absorptiometry and magnetic resonance imaging), and metabolic risk factors. The relative changes between baseline and the end of 6-mo intervention were significantly higher in the regular cola group than in the 3 other groups for liver fat (132-143%, sex-adjusted mean; P < 0.01), skeletal muscle fat (117-221%; P < 0.05), visceral fat (24-31%; P < 0.05), blood triglycerides (32%; P < 0.01), and total cholesterol (11%; P < 0.01). Total fat mass was not significantly different between the 4 beverage groups. Milk and diet cola reduced systolic blood pressure by 10-15% compared with regular cola (P < 0.05). Otherwise, diet cola had effects similar to those of water. Daily intake of SSSDs for 6 mo increases ectopic fat accumulation and lipids compared with milk, diet cola, and water. Thus, daily intake of SSSDs is likely to enhance the risk of cardiovascular and metabolic diseases. This trial is registered at clinicaltrials.gov as NCT00777647.

Consumption of added sugars is decreasing in the United States

Article

Full-text available

Sep 2011
AM J CLIN NUTR

The consumption of added sugars (caloric sweeteners) has been linked to obesity, diabetes, and heart disease. Little is known about recent consumption trends in the United States or how intakes compare with current guidelines. We examined trends in intakes of added sugars in the United States over the past decade. A cross-sectional study of US residents ≥2 y of age (n = 42,316) was conducted by using dietary data from NHANES 1999-2008 (five 2-y cycles) and data for added-sugar contents from the MyPyramid Equivalents Database. Mean intakes of added sugars (grams and percentage of total energy intake) were weighted to obtain national estimates over time across age, sex, and race-ethnic groups. Linear trends were tested by using Wald's F tests. Between 1999-2000 and 2007-2008, the absolute intake of added sugars decreased from a mean (95% CI) of 100.1 g/d (92.8, 107.3 g/d) to 76.7 g/d (71.6, 81.9 g/d); two-thirds of this decrease, from 37.4 g/d (32.6, 42.1 g/d) to 22.8 g/d (18.4, 27.3 g/d), resulted from decreased soda consumption (P-linear trend <0.001 for both). Energy drinks were the only source of added sugars to increase over the study period (P-linear trend = 0.003), although the peak consumption reached only 0.15 g/d (0.08, 0.22 g/d). The percentage of total energy from added sugars also decreased from 18.1% (16.9%, 19.3%) to 14.6% (13.7%, 15.5%) (P-linear trend <0.001). Although the consumption of added sugars in the United States decreased between 1999-2000 and 2007-2008, primarily because of a reduction in soda consumption, mean intakes continue to exceed recommended limits.

Predictors of weight gain in a Mediterranean cohort: The Seguimiento Universidad de Navarra Study

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Full-text available

Feb 2006

High consumption of sugar-sweetened drinks has been associated with weight gain and obesity in the United States. This trend may also be affecting populations with different eating patterns who increasingly are adopting typical US dietary patterns. We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population. This was a prospective cohort analysis of 7194 men and women with a mean age of 41 y who were followed-up for a median of 28.5 mo with mailed questionnaires. Dietary exposure was assessed with a previously validated semiquantitative food-frequency questionnaire. During follow-up, we observed that 49.5% of the participants increased their weight (x weight gain: 0.64 kg; 95% CI: 0.55, 0.73 kg). In the participants who had gained > or =3 kg in the 5 y before baseline, the adjusted odds ratio of subsequent weight gain for the fifth quintile compared with the first quintile of sugar-sweetened soft drink consumption was 1.6 (95% CI: 1.2, 2.1; P for trend = 0.02). This association was absent in the participants who had not gained weight in the 5-y period before baseline. The consumption of hamburgers, pizza, and sausages (as a proxy for fast-food consumption) was also independently associated with weight gain (adjusted odds ratio for the fifth compared with the first quintile = 1.2; 95% CI: 1.0, 1.4; P for trend = 0.05). We also found a significant, but weaker, association between weight gain and both red meat and sweetened fruit juice consumption. In a Mediterranean cohort, particularly in the participants who had already gained weight, an increased consumption of sugar-sweetened soft drinks and of hamburgers, pizza, and sausages was associated with a higher risk of additional subsequent weight gain.

Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: A randomized controlled trial

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Full-text available

Jun 2011
AM J CLIN NUTR

Background: Sugar-sweetened beverages (SSBs) have unfavorable effects on glucose and lipid metabolism if consumed in high quantities by obese subjects, but the effect of lower doses in normal-weight subjects is less clear. Objective: The aim was to investigate the effects of SSBs consumed in small to moderate quantities for 3 wk on LDL particle distribution and on other parameters of glucose and lipid metabolism as well as on inflammatory markers in healthy young men. Design: Twenty-nine subjects were studied in a prospective, randomized, controlled crossover trial. Six 3-wk interventions were assigned in random order as follows: 600 mL SSBs containing 1)40 g fructose/d [medium fructose (MF)], 2) 80 g fructose/d [high fructose (HF)], 3) 40 g glucose/d [medium glucose (MG)], 4) 80 g glucose/d [high glucose (HG)], 5) 80 g sucrose/d [high sucrose (HS)], or 6) dietary advice to consume low amounts of fructose. Outcome parameters were measured at baseline and after each intervention. Results: LDL particle size was reduced after HF by -0.51 nm (95% CI: -0.19, -0.82 nm) and after HS by -0.43 nm (95% CI: -0.12, -0.74; P < 0.05 for both). Similarly, a more atherogenic LDL subclass distribution was seen when fructose-containing SSBs were consumed (MF, HF, and HS: P < 0.05). Fasting glucose and high-sensitivity C-reactive protein (hs-CRP) increased significantly after all interventions (by 4-9% and 60-109%, respectively; P < 0.05); leptin increased during interventions with SSBs containing glucose only (MG and HG: P < 0.05). Conclusion: The present data show potentially harmful effects of low to moderate consumption of SSBs on markers of cardiovascular risk such as LDL particles, fasting glucose, and hs-CRP within just 3 wk in healthy young men, which is of particular significance for young consumers. This trial was registered at clinicaltrials.gov as NCT01021969.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group PPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6: e1000097

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Jul 2009

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

Diet, Screen Time, Physical Activity, and Childhood Overweight in the General Population and in High Risk Subgroups: Prospective Analyses in the PIAMA Birth Cohort

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Full-text available

Jan 2010
J Obes

Objective. To prospectively identify behavioral risk factors for childhood overweight and to assess their relevance in high risk sub groups (children of mothers with overweight or low education). Methods. In the PIAMA birth cohort (n = 3963), questionnaire data were obtained at ages 5 and 7 on “screen time”, walking or cycling to school, playing outside, sports club membership, fast food consumption, snack consumption and soft drink consumption. Weight and height were measured at age 8 years. Results. Screen time, but none of the other hypothesized behavioral factors, was associated with overweight (aOR 1.4 (CI: 1.2–1.6)). The adjusted population attributable risk fraction for screen time > 1 hr/day was 10% in the high risk and 17% in the low risk sub groups. Conclusion. Reduction of screen time to < 1 hr/day could result in a reduction of overweight prevalence in the order of 2 percentage points in both high and low risks sub groups.

Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

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Feb 2010
Int J Surg

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol 171, 701-708

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Full-text available

Feb 2010

Soft drinks and other sweetened beverages may contribute to risk of type 2 diabetes and obesity. However, research has not addressed higher risk and Asian populations. The authors examined the association between soft drinks and juice and the risk of type 2 diabetes among Chinese Singaporeans enrolled in a prospective cohort study of 43,580 participants aged 45-74 years and free of diabetes and other chronic diseases at baseline. The incidence of physician-diagnosed type 2 diabetes was assessed by interview and validated; 2,273 participants developed diabetes during follow-up. After adjustment for potential lifestyle and dietary confounders, participants consuming > or =2 soft drinks per week had a relative risk of type 2 diabetes of 1.42 (95% confidence interval (CI): 1.25, 1.62) compared with those who rarely consumed soft drinks. Similarly, consumption of > or =2 juice beverages per week was associated with an increased risk (relative risk (RR) = 1.29, 95% CI: 1.05, 1.58). The association was modified by 5-year weight gain for > or =2 soft drinks per week among those who gained > or =3 kg (RR = 1.70, 95% CI: 1.34, 2.16) compared with those who gained less weight (RR = 1.20, 95% CI: 1.03, 1.41). Relatively frequent intake of soft drinks and juice is associated with an increased risk for development of type 2 diabetes in Chinese men and women.

Adolescent beverage habits and changes in weight over time: Findings from Project EAT

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Full-text available

Oct 2009
AM J CLIN NUTR

Obesity in adolescence has been increasing in the past several decades. Beverage habits among adolescents include increased consumption of sugar-sweetened beverages and decreased consumption of milk. This study aimed to examine the association between beverage consumption and 5-y body weight change in 2294 adolescents. Project EAT (Eating Among Teens) is a 5-y longitudinal study of eating patterns among adolescents. Surveys were completed in 1998-1999 (time 1) and in 2003-2004 (time 2). Multivariable linear regression was used to examine the association between beverage consumption at time 2 and change in body mass index from time 1 to time 2, with adjustments for age, socioeconomic status, race, cohort, physical activity, sedentary behavior, coffee, tea, time 1 body mass index, and beverage variables. In prospective analyses, consumption of beverages was not associated with weight gain, except for consumption of low-calorie soft drinks (positive association, P = 0.002) and white milk (inverse association, P = 0.03), but these associations did not appear to be a monotonic linear dose-response relation. The positive association with low-calorie soft drinks was no longer present after adjustment for dieting and parental weight-related concerns, which suggests that the use of low-calorie soft drinks is a marker for more general dietary behaviors and weight concerns. We showed no association between sugar-sweetened beverage consumption, juice consumption, and adolescent weight gain over a 5-y period. A direct association between diet beverages and weight gain appeared to be explained by dieting practices. Adolescents who consumed little or no white milk gained significantly more weight than their peers who consumed white milk. Future research that examines beverage habits and weight among adolescents should address portion sizes, adolescent maturation, and dieting behaviors.

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

Article

Aug 2006

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.

Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis

Article

Jun 2008

Background: Rates of overweight and obesity have increased. Consumption of sugar-sweetened beverages (SBs) may play a role. Objective: The purpose of this meta-analysis was to determine whether the results of original research with the use of longitudinal and randomized controlled trials (RCTs) support the hypothesis that SB consumption is associated with weight gain among children and adolescents. Design: The MEDLINE database was used to retrieve all original studies of SBs and weight gain involving children and adolescents. Twelve (10 longitudinal and 2 RCT) studies were reviewed. Eight of the longitudinal studies and both RCT studies were incorporated into a quantitative meta-analysis. Forest plots and overall estimates and CIs for the association of the difference (Δ) in SB consumption with Δbody mass index (BMI; in kg/m²) were produced. Funnel plots were examined as a diagnostic test for publication bias. Databases of unpublished scientific studies were searched. Sensitivity tests were conducted to examine the robustness of the meta-analysis results. Results: The overall estimate of the association was a 0.004 (95% CI: −0.006, 0.014) change in BMI during the time period defined by the study for each serving per day change in SB consumption with the fixed-effects model and 0.017 (95% CI: −0.009, 0.044) with the random-effects model. The funnel plot is consistent with publication bias against studies that do not report statistically significant findings. The sensitivity tests suggest that the results are robust to alternative assumptions and new studies. Conclusion: The quantitative meta-analysis and qualitative review found that the association between SB consumption and BMI was near zero, based on the current body of scientific evidence.

Measuring inconsistency in meta-analysis

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Jan 2003

Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration

Article

Jan 2011

J.P.T. Higgins

Endocrine and Metabolic Effects of Consuming Fructose- and Glucose-Sweetened Beverages with Meals in Obese Men and Women: Influence of Insulin Resistance on Plasma Triglyceride Responses

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Apr 2009

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement

Article

Jul 2009
PLOS MED

Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study

Article

Jan 2006

... Accessed January 12, 2005. 10. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar - sweetened drinks and childhood obesity : a prospective, observational analysis. Lancet. 2001;357:505–508[CrossRef][Web of Science][Medline]. 11. ...

Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women

Article

Nov 2004

... 8. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar - sweetened drinks and childhood obesity : a prospective, observational analysis. Lancet. 2001;357:505-508.pmid:11229668. ...

The Newcastle-Ottawa Scale (NOS) for Assessing The Quality of Nonrandomised Studies in Meta-analyses

Article

Jan 2014

Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community (Circulation (2007) 116, (480-488))

Article

Dec 2007

Dhingra

In the article, “Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the Community” by Dhingra et al, which appeared in the July 31, 2007, issue (Circulation. 2007;116:480–488), the following corrections are needed: • In the Results section of the Abstract, the sentence “On follow-up (mean 4 years), new-onset MetSyn developed in 765 of 4095 participants (18.7%) consuming <1 drink/day, and in 474 of 2059 persons (22.6%) consuming ≥1 soft drink/day” should read, “On follow-up (mean 4 years), new-onset MetSyn developed in 717 of 4033 participants (17.8%) consuming <1 drink/day, and in 433 of 2006 persons (21.6%) consuming ≥1 soft drink/day.” • In the title and first entry in the stub column of Table 3, the total value of “n=6154” should read “n=6039.” The current online version of the article has been corrected.

Obesity Epidemiology

Article

Sep 2009

Hu FB

During the past twenty years there has been a dramatic increase in obesity in the United States. An estimated 30% of adults in the US are obese; in 1980, only 15% were. The issue is gaining greater attention with the CDC and with the public health world in general. This book offers practical information about the methodology of epidemiologic studies of obesity. The book is structured in four main sections. The first section considers issues surrounding the definition of obesity, measurement techniques, and the designs of epidemiologic studies. The second section addresses the consequences of obesity, looking at epidemiologic studies that focus on cardio-vascular disease, diabetes, and cancer. The third section looks at determinants obesity, reviewing a wide range of risk factors for obesity including diet, physical activity and sedentary behaviors, sleep disorders, psychosocial factors, physical environment, biochemical and genetic predictors, and intrauterine exposures. The final section addresses the analytical issues and challenges for epidemiologic studies of obesity.

Quantifying heterogeneity in a metaanalysis

Article

Jan 2002

A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

Article

Oct 2012

Background: Consumption of sugar-sweetened beverages may cause excessive weight gain. We aimed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents. Methods: We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention. We hypothesized that the experimental group would gain weight at a slower rate than the control group. Results: Retention rates were 97% at 1 year and 93% at 2 years. Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups (1.7 servings per day), declined to nearly 0 in the experimental group at 1 year, and remained lower in the experimental group than in the control group at 2 years. The primary outcome, the change in mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) at 2 years, did not differ significantly between the two groups (change in experimental group minus change in control group, -0.3; P=0.46). At 1 year, however, there were significant between-group differences for changes in BMI (-0.57, P=0.045) and weight (-1.9 kg, P=0.04). We found evidence of effect modification according to ethnic group at 1 year (P=0.04) and 2 years (P=0.01). In a prespecified analysis according to ethnic group, among Hispanic participants (27 in the experimental group and 19 in the control group), there was a significant between-group difference in the change in BMI at 1 year (-1.79, P=0.007) and 2 years (-2.35, P=0.01), but not among non-Hispanic participants (P>0.35 at years 1 and 2). The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years (-0.5%, P=0.40). There were no adverse events related to study participation. Conclusions: Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up (the prespecified primary outcome). (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00381160.).

The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis

Article

Jan 2000

Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis

Abstract

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