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A qualitative study about college students' attitudes, knowledge and perceptions regarding sugar intake ☆
Abstract
Excessive sugar intake has been associated with multiple health conditions (e.g., higher risk for non-communicable diseases). Hence, health organizations have issued guidelines defining the maximum daily intake of free or added sugars. However, data from several countries suggests that these guidelines are rarely met, particularly by young adults. For example, almost half of Portuguese adolescents and young adults exceed the recommended sugar intake. In this work, we aim to further explore college students' attitudes, knowledge, and perceptions about sugar intake, as well as about sugar intake guidelines. A thematic analysis on data from five focus groups (N = 40) indicated that participants reported difficulty in the comprehension of added/free sugars definition and sugar intake recommendations. Overall, attitudes toward sugar were ambivalent. Sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful. Although aware of the potential negative health outcomes associated with excessive sugar intake, most participants did not perceive being at risk due to their youth, exercise habits, or type of diet. The few concerns expressed were mostly associated with the negative impact of high sugar intake on body image (e.g., weight gain). The main barriers to reducing sugar intake identified were environmental (e.g., time restrictions, food available at the university). Still, participants could identify several individual strategies to effectively regulate sugar intake. By identifying knowledge gaps and sources of bias related to sugar consumption, our findings are useful to inform future interventions aiming to address the problem of high sugar intake among university students.
... The desire for sweet foods varies according to individual knowledge, attitudes, and eating habits [1,2]. Given the multitude of sugar types and sources [3], coupled with limited consumer knowledge around dietary guidelines for sugar intake, it is not surprising that consumers have a difficult time making evidence-based decisions around sugars consumption [4,5]. Total sugars consumption was estimated to be approximately 18% of total energy intake in Canadian adults in 2015 [6]. ...
... Tierney et al. [4] reported that limiting sugars intake was considered an important factor in maintaining health. Another study in young adults found that providing sugars content on nutrition facts labels was identified as a strategy for reducing sugars intake [5]. Previous studies found that lower consumption of sugarsweetened beverages was associated with higher levels of education [16], as well as a higher degree of knowledge regarding the negative health impacts of sugars [17,18]. ...
... This is the first study in Canadian adults to evaluate consumer mindsets related to dietary sugars using RDE, although previous research has been carried out on related topics using different methods [4,5,14]. The present study identified the messages that generated interest from respondents and revealed three distinct mindsets. ...
Little is known about the attitudes and perceptions towards dietary sugars in Canadian adults. The objective of this study was to use rule-developing experimentation (RDE) to identify consumer mindsets related to dietary sugars in 18–50-year-old Canadians. Following an isomorphic permuted experimental design, participants (n = 269) each rated a unique set of 24 scenarios, each consisting of a distinct mixture of two to four messages about dietary sugars on a 5-point scale. A regression model was created for each respondent, identifying the value that each respondent attributed to each of the 16 messages. K-means clustering revealed three distinct mindset groups as follows: “Sugars Beliefs” (MS1), “Trend Analysts” (MS2), and “Health Seekers” (MS3). In conclusion, this study found that RDE is a useful methodological approach for evaluating how consumers think about dietary sugars and revealed mindset-specific messages that matter most to people who differ in their attitudes toward sugars.
... Although it is known that high consumption of added sugars is a worldwide problem and global recommendations for limiting added sugars have been in place since 2015, there is scarce scientific discussion on the topic. The few studies that have examined consumers' understanding and perceptions of added sugars demonstrated lack of understanding about sugar concepts, consumption, and recommendations (16)(17)(18)(19)(20)(21)(22). No studies conducted with Brazilian consumers were found. ...
... The perception that sugar can cause addiction was also emerged by some participants in our study. These results are similar to those found in a qualitative study with university students from Portugal, where sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful (18). Some evidence has shown that adults present withdrawal symptoms after cessation of prolonged sucrose consumption, with behaviors similar to those of depression and anxiety (37)(38)(39). ...
... The development of diabetes was the most cited example of harmful effects associated with high sugar consumption, followed by obesity and tooth decay. In contrast, university students from Portugal have demonstrated few concerns about harmful effects of excessive consumption of added sugars by young adults and were mostly concerned about the negative impact of high sugar intake on body image (18). ...
It is recommended to limit added sugars to below 10% of the daily energy intake, as excessive consumption has been associated with several chronic non-communicable diseases. This exploratory qualitative study used focus groups to investigate the knowledge and perception of Brazilian university students about added sugars concepts, consumption recommendations, and health effects. Focus groups were led by a moderator using a semi-structured discussion guide. The focus groups were recorded, transcribed verbatim, and subjected to thematic analysis. Five focus groups were conducted with a total of 32 participants (50% women, mean age 23 years). Participants could not distinguish added sugars from sugars naturally present in foods and were unaware of the health impacts associated with excessive added sugar consumption, except for the risk of diabetes. Although most participants reported limiting sugar consumption, they had no knowledge of official consumption recommendations. Given that current public policy agendas aim to reduce added sugar intake, there is a need to strengthen strategies for disseminating information on added sugar concepts, recommendations, health effects and how to identify them in the foods products.
... It is recommended that added or free sugar intake should be less than 10% of total energy intake. Nevertheless, data from several studies in different countries suggest that people rarely follow these guidelines, as the immediate enjoyment of sugar's taste is often valued more than its potential health risks [2]. ...
... As a result, several individual and contextual factors were identified as promoting sugar consumption. The most relevant individual factors were habit, enhanced flavor or pleasure, negative events, and emotions, whereas social influence, limited time to eat, and limited variety of available food were the most referred contextual factors [2]. ...
Background and Objectives: Added sugar usage has become an important public health issue nowadays. Therefore, the interest in studying the cognitive and emotional effects associated with sugar consumption has increased. The present study aimed to investigate how the intake of added sugar affects participants’ impulsivity and cognitive functions monitored during the performance of a computerized Go/NoGo task. Materials and Methods: This study included 20 subjects (10 men and 10 women). Quantitative data for this study were collected via self-report questionnaires, including demographics, the Dietary Fat and Free Sugar—Short Questionnaire (DFS), the Yale Food Addiction Scale (YFAS 2.0), and the Barratt impulsiveness scale-11 (BIS-11). Results: Event-related potentials (ERPs) were registered throughout this study. Comparing the results of psychophysiological and neuropsychological evaluations before and after the added sugar consumption reveals differences in ERPs. Specifically, the NoGo-P3 amplitude increased after the intake of added sugar. However, there were no behavioral differences between the two experimental sessions. Conclusions: Overall, the results of our study suggest that added sugar intake was associated with stronger neuronal firing in NoGo trials. One possible explanation for this could be the need for more cognitive endeavors for participants to successfully inhibit their response impulses after added sugar consumption.
... For example, excessive sugar intake can predispose individuals to increased adiposity and, ultimately, overweight and obesity [10,11], especially when this consumption co-occurs with low levels of physical activity. Obesity, in turn, is currently considered a global epidemic with severe individual In other cases, individuals acknowledge the negative health outcomes but downplay the likelihood of experiencing them in the near future [24,28]. ...
... To the best of our knowledge, studies that are focused on examining the perceived health consequences of excessive sugar intake are still scarce. Although the reviewed qualitative studies provide important cues in this regard, these findings cannot be generalized, because they are based on small and specific samples (e.g., see [24,25]). Still, a few studies about sugar-sweetened beverages (SSB) consumption tackled this issue. ...
Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants (N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.
... Our sample also largely underestimated the impact of reducing the consumption of soft drinks and fruit juice, despite the fact that sugary drinks are the third largest contribution to dietary GHG emissions (The Association of UK Dietitians, 2018). Overall, they underestimate the environmental impact of cutting sugary drinks out of their diet, which makes it a good example of a behaviour that could be targeted from a health perspective, given the known health impacts of too much sugar (Bleich & Vercammen, 2018;Prada et al. 2021). ...
We sought to gain a more holistic understanding of young adults’ knowledge and perceptions around sustainable diets using a mixed methods online survey of 500 young adults (18-25 yrs.). Variables measured included food choice motivators (6-point importance scale), knowledge (ranking of efficacy of sustainable dietary behaviors), and several open-ended questions (responses assessed using inductive coding). Results show that environmental and health dimensions of sustainability are most salient for young adults. Decreasing food waste and consuming local and seasonal produce were rated as the most important behaviours for promoting a sustainable diet, while reducing consumption of sugary drinks, and reducing dairy consumption were rated as the least important. Cost was cited as the most important barrier to engaging in a sustainable diet. Young adults’ knowledge around sustainable diets is mixed, but sustainability is an important motivator in their dietary choices. Results inform education and communication strategies that seek to mobilize young adults to make sustainable dietary decisions.
... Previous studies reported poor dietary habits among university students, with low consumption of fruits, vegetables, milk, and dairy products [2,[8][9][10]. Their diet was also found to be characterized by an increased intake of unhealthy foods such as sugar-sweetened beverages and fast foods [8,9,11,12]. This, in combination with other unhealthy habits, including skipping meals, physical inactivity, and smoking, places them at an increased risk for obesity and other chronic diseases such as type 2 diabetes and cardiovascular diseases later in life [10,13]. ...
... In the food field, the investigation using the FG technique in the last years has mainly focused on the study of increasing acceptance of meat substitutes among consumers [10,11,12], functional foods [13,14,15], dietary behaviors and healthy diets [16][17][18][19][20][21], plastic waste [22] and novel foods as craft chocolate [23], African wild meat [24] and eggs from insect-fed hens [25], among others. ...
For more than 30 years, the Focus Group methodology has been used for numerous types of research on the most varied topics. Until very recently, the Focus Groups were considered a mature methodology with just a few genuine innovations. But in the last decade, innovations have started to emerge, such as the Focus Group integration with other techniques such as projective mapping and projective and creative techniques to improve data generation and for co-creation of ideas and product development. Moreover, a key limitation of the Focus Groups is the need to identify, recruit and gather a group of people in only one place for discussion. Technology has reduced, if not completely eliminated, this limitation and has allowed a wider use of Focus Groups in a world available for the internet.
... On the other hand, it can also be inferred that the consumption of Sug is a frequent feed habit in these higher education students. As it was mentioned before, it was found that the intake of fruits and candies is a characteristic of S. It is common that Sug could be perceived as pleasurable and needed, but also as addictive and harmful [23]. Even if students could be aware of the negative health outcomes associated with Sug intake, it is well-known that most of the time young people did not perceive the risks they can face caused by this ingredient. ...
... It appears that both socio-economic and environmental factors, are associated with high sugar diets and sugary beverage consumption in university students [36][37][38]. Of interest, university students' perceptions regarding sugar intake were explored in a qualitative study and although students perceived that excessive sugar intake affected their body image because of weight-gain, the students, nonetheless thought that they were not at risk of negative health outcomes as they were young [39]. Our findings alluded that the strategies to reduce sugary beverage consumption so as to reduce obesity among ASEAN university students should be applied to all students regardless of their body weight status. ...
Background
This study investigated, through cluster analysis, the associations between behavioural characteristics, mental wellbeing, demographic characteristics, and health among university students in the Association of Southeast Asian Nations (ASEAN) University Network – Health Promotion Network (AUN-HPN) member universities.
Methods
Data were retrieved from a cross-sectional self-administered online survey among undergraduate students in seven ASEAN countries. A two-step cluster analysis was employed, with cluster labels based on the predominant characteristics identified within the clusters. The ‘healthy’ cluster was assigned as the reference group for comparisons using multinomial logistic regression analysis.
Results
The analytic sample size comprised 15,366 university students. Five clusters of student-types were identified: (i) ‘Healthy’ (n = 1957; 12.7%); (ii) ‘High sugary beverage consumption’ (n = 8482; 55.2%); (iii) ‘Poor mental wellbeing’ (n = 2009; 13.1%); (iv) ‘Smoker’ (n = 1364; 8.9%); and (v) ‘Alcohol drinker’ (n = 1554; 10.1%). Being female (OR 1.28, 95%CI 1.14, 1.45) and being physically inactive (OR 1.20, 95%CI 1.04, 1.39) increased the odds of belonging to the ‘High sugary beverage consumption’ cluster. Being female (OR 1.21, 95%CI 1.04, 1.41), non-membership in a sports club (OR 1.83, 95%CI 1.43, 2.34) were associated with ‘Poor mental wellbeing’. Obesity (OR 2.03, 95%CI 1.47, 2.80), inactively commuting to campus (OR 1.34, 95%CI 1.09, 1.66), and living in high-rise accommodation (OR 2.94, 95%CI 1.07, 8.07) were associated with membership in the ‘Smoker’ cluster. Students living in The Philippines, Singapore, Thailand, and Vietnam had a higher likelihood of being alcohol drinkers, compared with those who lived in Brunei.
Conclusions
ASEAN university students exhibited health-risk behaviours that typically clustered around a specific health behaviour and mental wellbeing. The results provided support for focusing interventions on one dominant health-risk behaviour, with associated health-risk behaviours within clusters being potential mediators for consideration.
... Research also indicates that consumers have their own developed ways of lowering/reducing the amount of sugar in their diets, e.g., research using focus group interviews indicates that participants revealed some strategies they found to work well for them (or for people they know) when trying to reduce their amount of sugar intake. These included: reducing the amount of consumed sugar gradually, while maintaining some flexibility (i.e., allowing themselves some occasions where they could eat some sweets); choosing and/or buying products with lower sugar content; trying to cook at home more frequently and adding less sugar to recipes; not adding sugar to coffee or tea; substituting sweet desserts with fruit; and establishing a weekly maximum intake of specific products [60]. However, it is still recommended to increase the level of nutrition knowledge among consumers in order to better understand the information on the label and consequently make better choices on the food market [15]. ...
The aim of this article is to explore the reasons for seeking selected information on a food label, with particular emphasis on certain information about sugar. In order to meet the aim, in 2020, a survey was conducted among consumers aged 18-45. Predictive models (Logistic Regression) were developed for noticing "light" products and reading food labels. The results of our study indicate that consumers are mainly discouraged from reading label information by a large amount of information, the lack of time, and a general reluctance to be interested in label information. When it comes to the factors that lead people to read label information, the naturalness of the product, its organic origin, and physical activity are important. Moreover, respondents who declared that they noticed products on the market defined as "light" were those who were interested in the naturalness of the product, but also consumers declaring that they have nutritional knowledge. The results of the study indicate the need to intensify information campaigns in order to emphasize how important it is for consumers to read the information on food labels. The amount and complexity of information currently appearing on the food label may unfortunately discourage consumers from reading it, so it is important to continuously improve this form of communication with the consumer.
... Thanks to a broader range of food services and a better economic situation in many countries, fast food (McDonald's, KFC, Burger King, Subway, and others) are gaining prominence. Excessive sugar intake has been associated with multiple health conditions (Prada et al., 2021). Lee and Allen (2020) conducted a research between 2,983 young adults. ...
According to the modified models of the marketing mix, countries and regions are also products. They can be attractive for life, study, business, employment and tourism. One of the benchmarks is creative potential. Creativity is difficult to measure and subjective feature. It does not exist only in the psychological context, but also in the business (innovation ability) and regional (concept of creative economy). Measuring the creative potential of countries and regions is based on the Florida 3T Index (Technology, Talent, Tolerance). This index has many modifications for European, national and regional conditions. The aim of the paper is to create a national (Slovak) creative index and modify the regional index (PSK) using competitive benchmarking. These indices are composed of 6 sub-indices (Openness and Diversity, Human Capital, Cultural Environment, Technologies, Institutional Environment, Creative Outputs), 36 indicators (SCI) and 38 indicators (PCI). The following methods are used in the paper: analysis, synthesis, induction, deduction, comparative method, desk research, mathematical-statistical methods. The contribution of the paper lies mainly in the new use of competitive benchmarking, which is traditionally used when comparing products, services, processes, in a spatial (regional) context. Benchmarking the creative potential of countries and regions has many advantages, e.g. municipalities and regional development organizations can see the structure of weaknesses and their quantitative expression, not just the final result. Then they can implement preventive and corrective activities.
... Thanks to a broader range of food services and a better economic situation in many countries, fast food (McDonald's, KFC, Burger King, Subway, and others) are gaining prominence. Excessive sugar intake has been associated with multiple health conditions (Prada et al., 2021). Lee and Allen (2020) conducted a research between 2,983 young adults. ...
Creative potential of region is very important for its attractivity – e.g. for living, study, business, employement and tourism. Prešov region (regional level NUTS3) is composed of 13 districts (regional level LAU1), which have different roles in creative regional development (preference of technological innovations and start-ups or focusing on art, culture and history). Aim of this work is to suggest integrated model of management of creative cluster in Prešov region. Integrated management is composed of basic managerial functions (planning, organization, leadership and control) on regional and company level. These levels are connected and in this model is used systematic and project approach. Authors use these methods: analysis, synthesis, induction, deduction, comparative, abstraction and mathematical- startitical methods – e. g. indices. Benefits of this work can use potential cluster stakeholders (e. g. creative companies, public administration, universities, art, environmental and tourism organizations, regional development organizations).
... Due to a protracted inability to perceive any taste or flavour, a number of participants (34 %) resorted to consuming higher than normal amounts of sugar, salt, fat and highly processed foods [defined in the report by the European Prospective Investigation into Cancer (EPIC) (49) to include foods that are industrially prepared or with such ingredients under specific categories]. The risks associated with such food consumption behavioural patterns given above, leading to type 2 diabetes, hypertension, obesity and cardiovascular disease, are well documented (53)(54)(55) . In addition, concern was expressed about the lack of adequate nutrient intake by 4/47 (8⋅51 %) in the cohort. ...
Objective : To explore food consumption and subsequent behavioural changes amongst PASC suffers associated with alterations in taste and smell. Design : A qualitative study involving five focus groups. Setting : Birmingham and Leicester, England, United Kingdom. Participants : Forty-seven Post-Acute Sequelae of COVID-19 sufferers. Results : Shifts in taste and odour were very common with disgusting or unpleasant notes being perceived in many foods, including animal products rich in protein. Food consumption patterns varied affecting nutrition status, individuals weight, types of foods consumed, cooking habits, coping mechanisms, anxieties, family and social interactions. Individuals expressed the need to taste something or experience normal tastes and flavour. Low pH foods, highly processed foods which may contain large amounts of refined sugars as well as cold processed food were the preferred items for consumption. Conclusion : Olfactory dysfunction was related to the consumption of nutrients that require moderation and to the quality of life. Intervention at an early stage is necessary in order to help avoid such complications and thus, this work informs medical practitioners and health workers of the variety of food choices that are more acceptable for people suffering from altered tastes and odour perception.
... Thanks to a broader range of food services and a better economic situation in many countries, fast food (McDonald's, KFC, Burger King, Subway, and others) are gaining prominence. Excessive sugar intake has been associated with multiple health conditions (Prada et al., 2021). Lee and Allen (2020) conducted a research between 2,983 young adults. ...
... Despite reporting that they buy some food products specifically for children (e.g., breakfast cereals, cookies, juices), in general, parents perceived food products marketed to children as having high sugar content. The products more associated with sugar included sodas, cookies, and breakfast cereals, while fruitbased products were the only examples of lower sugar options (e.g., Prada et al., 2021). It is noteworthy that the products parents identified as having higher sugar content overlap with the most frequently consumed by Portuguese children (e.g., cookies, breakfast cereals, Lopes et al., 2017). ...
Excessive sugar intake is one of the factors contributing to the alarming rates of childhood obesity and overweight in Portugal. Children's preferences and food consumption patterns are largely determined by the foods that are more familiar to them. Parents and caregivers are responsible for shaping children's eating habits since they are the ones who choose the food available in the household. The present study explores parental perceptions about sugar and sugar intake and its consequences on children's health. Moreover, we also examined the practices that parents use to regulate their children's diet, namely, to promote the consumption of desired foods (e.g., vegetables) and limit the intake of undesired food (e.g., sweets), and the perceived barriers and facilitators of sugar intake regulation. To this end, 42 interviews were conducted with parents of school-aged children (ages 6–10 years). A thematic analysis revealed that parents perceive sugar as highly negative (e.g., “evil”, “poison”, “addiction”) and its consumption as harmful (e.g., hyperactivity; overweight). Nonetheless, the view that sugary food consumption is not necessarily problematic was also common. Indeed, most parents considered that sugar intake should be regulated but not forbidden. To control the intake of sugary foods (e.g., sodas, cookies), they reported using strategies such as restriction, explanation, or negotiation. Several barriers to sugar intake regulation were identified (e.g., birthday parties, parents' lack of knowledge), but also a few facilitators (e.g., bringing food from home to school). Our findings may inform the development of interventions or policies to promote healthier eating habits in school-age children.
... This is not surprising, as over 150 types of free sugars have been identified in ingredient lists [49], and consumers often have difficulties in recognizing these types of ingredients as sugar sources (e.g., [50]). Research also showed that individuals often report negative attitudes toward sugar (e.g., [51]), which may explain why breakfast cereals with "fruit sugar" are perceived as more healthful than the same products with "sugar" [52]. Therefore, future studies could investigate whether different terms used to describe sugars influence consumers' food perception and decision-making, particularly for high-sugar products such as breakfast cereals. ...
Excessive free-sugar intake has become highly prevalent in numerous countries, and Portugal is not the exception. One product category that contributes to the daily intake of free sugars is breakfast cereals. In the current work, we identified 289 exemplars from two major retailers in Portugal and collected information on their nutritional profile (e.g., sugar, salt, fiber per 100 g), price, packaging features, type of food claims present (e.g., statements about the composition, sensory features, the origin of the product), and ingredients list. Overall, the sugar content of breakfast cereals was high (Mean = 19.9 g), and less than 10% of the products complied with the current national guidelines (i.e., 5 g of sugar per 100 g of product). Sugar (or other sugar sources) was listed in the top three ingredients for over 85% of the products. On average, each product included about four claims (Mean = 3.9), and sugar content was lower when the claims were related to the product composition. Critically, the sugar content was particularly high for children-oriented products (Mean = 26.4 g). Correlation analysis showed that breakfast cereals with higher sugar content also were cheaper and had lower quantities of fiber, proteins, and salt. Our findings suggest the need to implement strategies to reduce sugar in this product category (e.g., incentivize manufacturers to reformulate products). Also, our results may inform strategies aimed at promoting consumers’ awareness about the sugar content in breakfast cereals and other processed foods, facilitating healthier decision-making.
World Health Organization recommends a reduction in calorie intake by an individual. The antioxidant activity and low calorie profile of stevia leaves assists the people to move towards a state of finest health. The foremost antioxidants are known to get impacted by the method of drying. Drying significantly affects the thermal stability and volatile contents of stevia leaves. This prompted us for the development of a lyophilization method which may yield the stevia leaves extract having profound antioxidant activity. Stevia rebaudiana leaves were subjected to aqueous extraction by percolation method to yield to dark brown extract. The extract was divided into two fractions and subjected to drying via lyophilization and evaporation respectively. The dried extracts were analysed for chemical constituents and in-vitro antioxidant activity. Total phenolics content in the lyophilized fraction exhibited phenolics content (mg gallic acid equivalent per gram weight of dry extract) 10.09 as compared to that obtained by conventional evaporation (06.26). Total flavonoids content in the lyophilized fraction and conventionally dried fraction were 11.59 and 08.26 respectively as mg quercetin per gram weight of dry extract. The 2,2-diphenyl-1-picrylhydrazyl inhibition assays (IC50, µg/mL) were executed using ascorbic acid (15.48) as reference. Lyophilized and conventional extracts exhibited IC50 of 26.48 and 36.21 respectively. Thus lyophilization of the aqueous Stevia rebaudiana leaves results in higher phenolic and flavonoid contents and superior DPPH inhibition. Consequently, utilization of lyophilized extract may be valuablefor development of nutraceuticals.
Introduction
Overweight and obesity pose significant health risks, affecting social and economic well-being and potentially hindering mental health and learning outcomes. This study investigated the knowledge, attitudes, and prevalence of overweight and obesity among undergraduate students at Universiti Kuala Lumpur Royal College of Medicine (UniKL RCMP), Malaysia.
Methods
A total of 351 UniKL RCMP undergraduate students participated in this study. Descriptive analysis was used to evaluate the sociodemographic and educational profiles of respondents. The chi-square test was conducted to identify the relationship between the sociodemographic and educational profiles and the level of knowledge and attitudes towards overweight and obesity.
Results
The prevalence of overweight and obesity was 25.4%. The majority of the respondents possessed a good level of knowledge regarding overweight and obesity (n=316, 90%). The respondents’ programme was significantly associated with their level of knowledge (P=0.001).
Conclusion
This study provides important information to university authorities, students, lecturers, parents and other stakeholders in education and health sectors about the impacts of overweight and obesity on the physical, social and academic welfare of university students.
OBJECTIVE: To assess the knowledge, attitudes and practices toward added sugar intake among Cypriot university students. METHODS: This cross- sectional study was conducted among 200 students enrolled in public and private universities in Cyprus. Knowledge, attitudes and practices toward added sugar consumption was evaluated using self-administered questionnaire. RESULTS: Only 8.5% of the students were able to accurately report the recommended values of sugar consumption. Most of the participants (76% ) were aware of the health consequences of excessive sugar consumption, whereas 63.5% were aware of the existence of hidden sources of sugar and 88% of students stated that they read the nutrition declaration of the products that they are considering consuming. About 67% of students stated that they are actively trying to reduce their sugar consumption and the majority consume sugary beverages less than 1 day per week. CONCLUSIONS: Results support that although students read the nutrition facts label there is a limited awareness of sugar intake recommendations. Tailored-made strategies targeting students in order to improve sugar-related knowledge could be warranted.
In sugar industry, the sugar processing done in different sections, but to increase total crushing per day (TCD) capacity, the milling section takes a vital role in the sugar industry. The sugar industry aims to extract the maximum amount of juice from sugarcane. In the milling section, the processed sugarcane is fed in between the three-roller shaft from the different arrangements, there are different loads applied on each part roller shafts. When load between all rollers varies then there is a chance of bending it is analyzed to check the roller shaft condition. The modeling is done on roller shaft with the help of CATIA V5. After modeling, we analyze the condition of the rollers, when different stress or forces are applied to different sections of the roller shaft it analyzed with the help of Finite element method using ANSYS WORKBENCH software. We were selecting titanium alloy materials for the roller shaft to analyze the variation in results. When comparing the calculated and software-based results using Maximum Shear stress and Total deformation for top, feed, and discharge rollers said the roller shafts are safe to use in the sugar industry and titanium alloy is the best material for these roller shafts.
The reduction of free sugars has been identified as a priority issue internationally. A range of public health initiatives have been recommended, including the provision of information and support for sugar reduction. To inform these approaches, it is important to know what people actually do in real world settings to reduce their consumption. This study documents and defines the range of consumer-based behaviour change strategies for sugar reduction. A total of 1145 strategies were extracted from 47 internet sources (i.e., consumer, popular and professional). Using a pragmatic content analysis, hundreds of strategies were organized into 25 discrete categories of strategies. Categories were grouped into the Rubicon Model of Action Phases and classified as pre-decisional (i.e., decisional balance, feedback, realisation, seek knowledge and information), post-decisional (i.e., action planning, coping planning, set goal intention, sugar guidelines) and actional phase. Actional strategies were the most prolific and included avoidance, consumption control, consumption planning, environmental restructuring, healthy eating focus, maintain readiness, professional support, refocusing, self-monitoring, social support, substance substitution, tapering, address underlying issues, urge management, well-being and withdrawal management. There was one post-actional strategy which was associated with self-evaluation (i.e., reviewing a change attempt in order to plan for the future). Four categories of strategies differed according to the source. Substance substitution was substantially less frequently discussed by consumers than professionals and few professional sites acknowledged or advised strategies to manage the struggle of maintaining readiness following a change attempt. Hundreds of individual strategies are discussed or promoted in online settings, and more information is needed on the effectiveness of these self-initiated approaches.
Background:
Relative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition.
Objectives:
This study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes.
Methods:
We converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15-49 y old and children 12-23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence.
Results:
Most noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points.
Conclusions:
Relative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.
Background: Sugar is widely consumed in Malaysia, and the excessive intake of sugar has been associated with cognitive functions. However, the association between sugar intake and cognitive impairment among Malaysian older adults is yet to be determined.
Purpose: The objective of this study was to evaluate the associations between types and sources of sugar intake and cognitive functions and to identify their risk in predicting cognitive impairment (MMSE score <24).
Subjects and methods: A total of 1,209 subjects aged ≥60 years were recruited through multi-stage random sampling from selected states in Malaysia. Dietary intake was derived using a 7-day dietary history questionnaire and supplemented with a quantitative food frequency questionnaire for added sugar intake.
Results: The prevalence of cognitive impairment as defined by Mini-Mental State Examination (MMSE) less than 24 was 31.9%, while the prevalence of mild cognitive impairment was 13.1%. The median (IQR) for total sugar intake was 44.60 g/day (26.21–68.81) or 8 tsp, and free sugar intake was 33.08 g/day (17.48–57.26) or 6 tsp. The higher intake of total sugars, free sugars, sucrose, lactose, sugar-sweetened beverages, sugar-sweetened cakes, and dessert was found to be significantly associated with a lower MMSE score, after adjusting for covariates. On the other hand, the consumption of cooked dishes and fruits was significantly associated with a better MMSE score. The adjusted OR for risk of cognitive impairment (MMSE score <24) was 3.30 (95% CI 2.15–5.08) for total sugars and 3.58 (95% CI 2.32–5.52) for free sugars, comparing the highest with the lowest intake percentiles.
Conclusion: Excessive sugar consumption among older adults showed a notable association with poor cognitive functions, but longitudinal studies and clinical trials are further needed to clarify the direction of causality and to investigate the underlying mechanism.
The World Health Organization (WHO) recommends reducing free sugars to less than 10% of total energy intake (TEI) due to their potential implications in weight gain and dental caries. Our objectives were to (1) estimate the intake of total, added, and free sugars, (2) define the main sugar sources, and (3) evaluate the adherence to sugar guidelines. The first national nutrition survey 2014–2015 included non-institutional adults aged 18–75 years. Diet was assessed with two non-consecutive 24-hour dietary recalls in 2057 participants. Added and free sugar content was systematically estimated by two dietitians using available information from the manufacturer and/or standard recipe/composition. Usual daily intake distributions were modeled and weighted for sampling design, non-response, weekdays, and seasons. Total, added, and free sugar intake was respectively 107 g (±44), 53 g (±36), and 65 g (±40), representing 19%, 9%, and 11% of TEI. Sugar consumption was higher among younger adults and lower among people living in the Italian-speaking region. The three main food sources of free sugars were: (1) sweet products (47% of total free sugars), in particular sweet spreads (15%) and cakes/cookies (11%); (2) beverages (29%), mainly fruit and vegetable juices (13%), and sugar-sweetened beverages (12%, but 20% in younger adults); and (3) dairy products (9%), with yogurt accounting for 6%. Respectively, 44% of women and 45% of men had free sugar intake below 10% of TEI. Of people aged between 18–29, 30–64, and 65–75 years, 36%, 45%, and 53% had free sugar intake below 10% of TEI, respectively. The prevalence of Swiss people with free sugar intake that was <5% of the TEI was 8%. Adherence to the WHO recommendations guidelines was generally low in Switzerland, particularly among young adults, and in line with other high-income countries.
Poor eating habits are common during young adulthood and influence chronic disease morbidity. This systematic review evaluates the effectiveness of interventions aiming to improve dietary intake among young adults and, identifies which behaviour change techniques (BCTs) are most effective. Six electronic databases were searched for RCTs published until October 2018, and evaluating behavioural interventions assessing change in dietary intake in young adults (17–35 years). Of the 18,779 articles identified, 54 were included. Forty studies focused on fruit and/or vegetable intake, of which 63% showed a significant between-group difference in favour of the intervention group. Meta-analysis (n = 17) demonstrated a significant increase in fruit and vegetable intake of +68.6 g/day after three months of intervention and +65.8 g/day for interventions >3 months when compared to control. A meta-analysis (n = 5) on total energy intake found no significant differences between groups. The BCTs with the highest effectiveness ratio were habit formation (100%), salience of consequences (83%) and adding objects to the environment (70%). The review highlights the potential of behavioural interventions to improve young adults’ fruit and vegetable intake but was less convincing for other dietary outcomes. Due to the lack of studies including each BCT, the BCTs imperative to success could not be identified.
Sugar consumption in the UK consistently exceeds recommendations, despite the association it has with poor health outcomes. Low socioeconomic groups are most likely to over-consume sugar, which could exacerbate existing health disparities. Various interventions attempt to reduce the amount of sugar consumed, but their effectiveness is still unclear. This study qualitatively explored the sugar consumption behaviours of individuals experiencing food poverty, and examined how an information-based sugar reduction intervention might influence these behaviours. Eight clients and six volunteers from a food bank in Bristol (UK) completed semi-structured, one-to-one interviews that were thematically analysed. Food bank clients appeared to heavily consume sugar, with little understanding of the associated health effects and limited awareness of the intervention. Consumption behaviours were particularly influenced by personal and psychological factors, such as mental health; in addition to social factors, like familial behaviours and food access issues. It emerged that food bank clients’ often-challenging personal circumstances were likely to promote their sugar consumption. Making intervention materials visually appealing and easily comprehendible were found to be important for improving an intervention’s reception. Recommendations were developed to improve the efficacy of similar information-based sugar reduction interventions among socioeconomically deprived groups.
Taste is frequently cited as an important factor in food choice, and while a number of studies have attempted to identify relationships between taste function and dietary intake, a systematic review of these studies has been lacking. This review identified studies that examined associations between taste function or taste perception and dietary intake. The purpose was to determine which taste measure was most closely associated with dietary intake in healthy adults. Studies that measured some component of dietary intake, either acutely or longer-term, were eligible for inclusion. Studies were grouped into three categories: those that measured sensitivity (thresholds), intensity, or hedonic responses to sweet stimuli. Sensitivity and intensity studies demonstrated little association with dietary intake measures. Hedonic measurements were more likely to be associated with dietary intake, especially if sweet likers were analyzed separately from sweet dislikers, but the degree of heterogeneity among stimulus concentrations and dietary measures as well as small sample sizes likely obscured more consistent relationships between hedonic evaluation and dietary intake. Due to the potential for within-day and between-day variability in both taste function and dietary intake, future work should explore obtaining more than one taste measurement before comparing results to longer-term dietary assessments and attempts to standardize methods.
Objective: Research on self-licensing, i.e. employing justifications to give into temptation, largely consists of studies examining dichotomous food choices (healthy vs. unhealthy), while evidence for its effects on how much (unhealthy) food is consumed remains scarce. The present studies aimed to demonstrate self-licensing effects on caloric consumption in both lab (Study 1 & 2) and field setting (Study 3).
Design: In all studies, female student samples were recruited. They either received a justification cue (license condition) or not (control condition), after which they could eat freely from unhealthy snacks (Study 1, N = 85 and Study 2, N = 95) or choose a snack for direct consumption at a take-out lunch place (Study 3, N = 110).
Main outcome measures: Caloric value of consumed snacks (Study 1 and 2) and chosen snack (Study 3).
Results: In all studies, caloric consumption was higher in the license condition compared to the control condition: Participants ate more of the provided unhealthy snacks (Study 1 and 2) and chose a snack of higher caloric value (Study 3).
Conclusions: The present research corroborates self-licensing as an important factor in the consumption of unhealthy foods by employing more ecologically valid outcomes.
Objective:
The current study investigated how adolescents perceive their own health risks and compare their own likelihood of health risks with that of others of the same age. Moreover, the study identified the differences in health risk perceptions between males and females.
Methods:
A total of 625 adolescents (314 males and 311 females) from the Nowon district, geographically located in northern Seoul, voluntarily participated. In order to measure health risk perceptions a Korean version of self-other risk judgments profile was used.
Results:
The findings indicated that study participants, regardless of gender and age, tend to underestimate their vulnerability to majority of health risk events. Furthermore, there were significant gender and age differences in health risk perception and perception bias in all health risk domains.
Conclusion:
The present study suggests that further research is needed to identify realistic and unrealistic perception mechanism for a large number of people from different demographic and socioeconomic backgrounds.
Background:
Unhealthy environments and food advertisements are major determinants of childhood obesity. Recent regulation has banned unhealthy foods from schools in Mexico. However, currently there is no regulation limiting exposure to food marketing around schools. Thus, our objective was to analyze the characteristics of food advertising practices around 60 elementary schools in two cities and to evaluate compliance with the Pan American Health Organization (PAHO) recommendations and the local food industry self-regulatory marketing code.
Methods:
Data were collected during the period of October 2012 to March 2013. A random sample of elementary schools was selected from two Mexican cities. Using geographic information systems, we drew a 100-m-diameter buffer around each school. Trained personnel obtained photographs to assess the locations and types of food advertisements. Our results were stratified by school type and by indicators of compliance with the PAHO and industry recommendations. We developed a multivariate negative binomial regression model to determine factors predicting the number of advertisements around schools.
Results:
The number of advertisements was significantly higher around public schools than around private schools (6.5 ± 5.6 vs. 2.4 ± 3.5, p < 0.05). Printed posters were the most common type of marketing medium (97%), showing mostly sugar-sweetened beverages, sweet breads, candies, and bottled water. Promotions, such as special prices or gifts, were included on 30% of printed posters. Food advertising practices were often in compliance with industry recommendations (83%) but not with those from the PAHO (32%) (p < 0.001).
Conclusion:
Our results support the importance of monitoring the obesogenic environment and identifying policy tools to protect children from food marketing not only inside schools but also around them, particularly in lower income communities.
The National Food, Nutrition and Physical Activity Survey of the Portuguese general population aimed to collect nationwide and regional data on dietary intake and physical activity, and their relation with health determinants, namely socioeconomic factors. Results from this project were obtained from a representative sample of the Portuguese population, aged between three months to 84 years of age, selected from the National Heath Registry, by multistage sampling (a sample size of 5068 individuals was estimated and 5811 participants with two dietary assessments were achieved). To accomplish the EFSA requirements, a minimum, of 260 individuals in each age group (130 by sex) was planned. Two face-to-face interviews were conducted at a health care centre or participant’s home. Dietary intake was obtained by two non-consecutive days of food diaries for children (<10 years old) and two non-consecutive 24-hours recalls for the older age groups, with a time interval between 8 and 15 days, complemented with a Food Propensity Questionnaire. An electronic platform based on a client-server architecture was used to manage the field work and to assist the data collection. The Electronic Assessment Tool for 24-hours recall (eAT24) allowed the collection of dietary data by an Automated Multiple-Pass Method for 24-hours. This interview-based dietary assessment instrument allowed obtaining a very detailed description and quantification of foods, recipes, and food supplements consumed in the course of the preceding day, and it had several adaptations, described in detail in this report. The survey outcomes support solid evidence-based information covering all age groups of the population, using harmonized methodologies at the European level, and will contribute to develop a national infrastructure for monitoring progress of specific targets supporting national and European policies and future interventions on diet, physical activity and food safety.
In animal studies, sugar has been found to produce more symptoms than is required to be considered an addictive substance. Animal data has shown significant overlap between the consumption of added sugars and drug-like effects, including bingeing, craving, tolerance, withdrawal, cross-sensitisation, cross-tolerance, cross-dependence, reward and opioid effects. Sugar addiction seems to be dependence to the natural endogenous opioids that get released upon sugar intake. In both animals and humans, the evidence in the literature shows substantial parallels and overlap between drugs of abuse and sugar, from the standpoint of brain neurochemistry as well as behaviour.
Added sugar intake during adolescence has been associated with weight gain and cardiometabolic risk factors. Moreover, dietary habits may persist into adulthood, increasing chronic disease risk in later life. This systematic review investigated changes in intake of added sugars between the ages of 13 and 30 years.
Literature databases were searched for longitudinal studies of diet during adolescence or early adulthood. Retrieved articles were screened for studies including multiple measures of intake of sugars or sugary foods from cohort participants between the ages of 13 and 30. Data were analysed using random‐effects meta‐analysis, by the three main nutrient and food group categories identified (PROSPERO: CRD42015030126).
Twenty‐four papers reported longitudinal data on intake of added sugar or sucrose (n = 6), sugar‐sweetened beverages (SSBs) (n = 20) and/or confectionery (n = 9). Meta‐analysis showed a non‐significant per year of age decrease in added sugar or sucrose intake (−0.15% total energy intake (95%CI −0.41; 0.12)), a decrease in confectionery consumption (−0.20 servings/week (95%CI −0.41; −0.001)) and a non‐significant decrease in SSB consumption (−0.15 servings/week (95%CI −0.32; 0.02)). Taken together, the overall decrease in added sugar intake observed from adolescence to early adulthood may suggest opportunities for intervention to further improve dietary choices within this age range.
Excess consumption of added dietary sugars is related to multiple metabolic problems and adverse health conditions. Identifying the modifiable social cognitive and motivational constructs that predict sugar consumption is important to inform behavioral interventions aimed at reducing sugar intake. We tested the efficacy of an integrated dual-process, dual-phase model derived from multiple theories to predict sugar consumption. Using a prospective design, university students (N = 90) completed initial measures of the reflective (autonomous and controlled motivation, intentions, attitudes, subjective norm, perceived behavioral control), impulsive (implicit attitudes), volitional (action and coping planning), and behavioral (past sugar consumption) components of the proposed model. Self-reported sugar consumption was measured two weeks later. A structural equation model revealed that intentions, implicit attitudes, and, indirectly, autonomous motivation to reduce sugar consumption had small, significant effects on sugar consumption. Attitudes, subjective norm, and, indirectly, autonomous motivation to reduce sugar consumption predicted intentions. There were no effects of the planning constructs. Model effects were independent of the effects of past sugar consumption. The model identified the relative contribution of reflective and impulsive components in predicting sugar consumption. Given the prominent role of the impulsive component, interventions that assist individuals in managing cues-to-action and behavioral monitoring are likely to be effective in regulating sugar consumption.
The consumption of total and individual sugars is controversial and little is known about consumption and dietary sources in Spain. The purpose was to examine free and intrinsic sugar intake and food and beverage sources. The ANIBES Study (Anthropometry, Intake and Energy Balance in Spain), a cross-sectional study of a representative sample of the Spanish population (9–75 years old; n = 2009) carried out in 2013, was used. Food and beverage records were obtained by a three-day dietary record by using a tablet device. The median total sugar intake was 71.5 g/day (17% Total Energy, TE), the intrinsic sugar intake was 38.3 g/day (9.6% TE), and the free sugar was 28.8 g/day (7.3% TE). Total sugar intake (free and intrinsic) was higher in men than in women for all age groups, although in terms of the contribution to total energy intake, the opposite was observed. Differences were observed for free sugar consumption dependent on age and marked differences (up to two-fold) were observed when considering the percent TE, which was much higher in children and adolescents. For the intrinsic sugar, however, a higher contribution to TE was observed in the elderly. The major sources of intrinsic sugars were fruits (31.8%), milks (19.6%), juices and nectars (11.1%), vegetables (9.89%), yogurt and fermented milk (7.18%), low-alcohol-content beverages (4,94%), bread (2.91%), and sugar soft drinks (2.24%), greater than 90% from diet contribution. As for free sugars, sources were sugar soft drinks (25.5%), sugar (17.8%), bakery and pastry items (15.2%), chocolates (11.4%), yogurt and fermented milk (6.44%), other dairy products (5.99%), jams (3.58%), juices and nectars (2.91%), and breakfast cereals and cereal bars (2.78%), summing up to 90% of the contribution. The present study demonstrates that only a moderate percentage of the Spanish population adhered to the present recommendations for total sugar intake, and urgent efforts are needed to improve diet quality in the youngest populations.
Dietary changes needed to achieve nutritional adequacy for 33 nutrients were determined for 1719 adults from a representative French national dietary survey. For each individual, an iso-energy nutritionally adequate diet was generated using diet modeling, staying as close as possible to the observed diet. The French food composition table was completed with free sugar (FS) content. Results were analyzed separately for individuals with FS intakes in their observed diets ≤10% or >10% of their energy intake (named below FS-ACCEPTABLE and FS-EXCESS, respectively). The FS-EXCESS group represented 41% of the total population (average energy intake of 14.2% from FS). Compared with FS-ACCEPTABLE individuals, FS-EXCESS individuals had diets of lower nutritional quality and consumed more energy (2192 vs. 2123 kcal/day), particularly during snacking occasions (258 vs. 131 kcal/day) (all p-values < 0.01). In order to meet nutritional targets, for both FS-ACCEPTABLE and FS-EXCESS individuals, the main dietary changes in optimized diets were significant increases in fresh fruits, starchy foods, water, hot beverages and plain yogurts; and significant decreases in mixed dishes/sandwiches, meat/eggs/fish and cheese. For FS-EXCESS individuals only, the optimization process significantly increased vegetables and significantly decreased sugar-sweetened beverages, sweet products and fruit juices. The diets of French adults with excessive intakes of FS are of lower nutritional quality, but can be optimized via specific dietary changes.
Evidence of an association between added sugars (AS) and the risk of obesity has triggered public health bodies to develop strategies enabling consumers to manage their AS intake. The World Health Organisation (WHO) has strongly recommended a reduction of free sugars to 10% of total dietary energy (TE) and conditionally recommended a reduction to 5% TE to achieve health benefits. Despite food labelling being a policy tool of choice in many countries, there is no consensus on the mandatory addition of AS to the nutrition panel of food labels. An online survey was conducted to explore consumer ability to identify AS on food labels and to investigate consumer awareness of the WHO guidelines in relation to sugar intakes. The questionnaire was tested for participant comprehension using face-to-face interviews prior to conducting the online study. The online survey was conducted in Northern Ireland during May 2015 and was completed by a convenient sample of 445 subjects. Results showed that just 4% of respondents correctly classified 10 or more ingredients from a presented list of 13 items, while 65% of participants were unaware of the WHO guidelines for sugar intake. It may be timely to reopen dialogue on inclusion of AS on food product nutrition panels.
A number of recommendations for policy and program interventions to limit excess free sugar consumption have emerged, however there are a lack of data describing the amounts and types of sugar in foods. This study presents an assessment of sugar in Canadian prepackaged foods including: (a) the first systematic calculation of free sugar contents; (b) a comprehensive assessment of total sugar and free sugar levels; and (c) sweetener and free sugar ingredient use, using the University of Toronto’s Food Label Information Program (FLIP) database 2013 (n = 15,342). Food groups with the highest proportion of foods containing free sugar ingredients also had the highest median total sugar and free sugar contents (per 100 g/mL): desserts (94%, 15 g, and 12 g), sugars and sweets (91%, 50 g, and 50 g), and bakery products (83%, 16 g, and 14 g, proportion with free sugar ingredients, median total sugar and free sugar content in Canadian foods, respectively). Free sugar accounted for 64% of total sugar content. Eight of 17 food groups had ≥75% of the total sugar derived from free sugar. Free sugar contributed 20% of calories overall in prepackaged foods and beverages, with the highest at 70% in beverages. These data can be used to inform interventions aimed at limiting free sugar consumption.
Purpose:
As obesity rates continue to climb, the notion that overconsumption reflects an underlying 'food addiction' (FA) has become increasingly influential. An increasingly popular theory is that sugar acts as an addictive agent, eliciting neurobiological changes similar to those seen in drug addiction. In this paper, we review the evidence in support of sugar addiction.
Methods:
We reviewed the literature on food and sugar addiction and considered the evidence suggesting the addictiveness of highly processed foods, particularly those with high sugar content. We then examined the addictive potential of sugar by contrasting evidence from the animal and human neuroscience literature on drug and sugar addiction.
Results:
We find little evidence to support sugar addiction in humans, and findings from the animal literature suggest that addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar. These behaviours likely arise from intermittent access to sweet tasting or highly palatable foods, not the neurochemical effects of sugar.
Conclusion:
Given the lack of evidence supporting it, we argue against a premature incorporation of sugar addiction into the scientific literature and public policy recommendations.
A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7-69 years) from the Dutch National Food Consumption Survey 2007-2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake <10 %TE was 5% in boys and girls (7-18 years), 29% in women, and 33% in men. Overall diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of <5 %TE and <10 %TE was generally low in the Netherlands, particularly in children. Adherence to the added and free sugar guidelines was not strongly associated with higher diet quality in adults.
Dental caries affects ≤80% of the world's population with almost a quarter of US adults having untreated caries. Dental caries is costly to health care and negatively affects well-being. Dietary free sugars are the most important risk factor for dental caries. The WHO has issued guidelines that recommend intake of free sugars should provide ≤10% of energy intake and suggest further reductions to <5% of energy to protect dental health throughout life. These recommendations were informed by a systematic review of the evidence pertaining to amount of sugars and dental caries risk, which showed evidence of moderate quality from cohort studies that limiting free sugars to ≤10% of energy reduced, but did not eliminate, dental caries. Even low levels of dental caries in children are of concern because caries is a lifelong progressive and cumulative disease. The systematic review therefore explored if there were further benefits to dental health if the intake of free sugars was limited to <5% of energy. Available data were from ecologic studies and, although classified as being of low quality, showed lower dental caries when free sugar intake was <5% of energy compared with when it was >5% but ≤10% of energy. The WHO recommendations are intended for use by policy makers as a benchmark when assessing intake of sugars by populations and as a driving force for policy change. Multiple strategies encompassing both upstream and downstream preventive approaches are now required to translate the recommendations into policy and practice.
Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is “saturation.” Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose the concept “information power” to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning and during data collection of a qualitative study is discussed.
The prevalence of overweight and obesity among children and adolescents has increased worldwide and has reached alarming proportions. Currently, sugar-sweetened beverages (SSBs) are the primary source of added sugar in the diet of children and adolescents. Contradictive findings from studies and reviews have fueled an endless debate on the role of SSBs in the development of childhood obesity.
The primary aim of the present review of reviews was to assess how review- and study-level methodological factors explain conflicting results across reviews and meta-analyses by providing an up-to-date synthesis of recent evidence regarding the association between SSB consumption and weight gain, overweight, and obesity in a population of 6-month-old to 19-year-old children and adolescents. The secondary aim was to assess the quality of included reviews using the Assessment of Multiple SysTemAtic Reviews (AMSTAR) measurement tool.
Systematic literature reviews and meta-analyses were included. The literature search was performed through the platforms Pubmed/Medline, Cinahl, and Web of Knowledge.
Thirteen reviews and meta-analyses were included. Nine reviews concluded that there was a direct association between SSBs and obesity in children and adolescents and four others did not. The quality of the included reviews was low to moderate, and the two reviews with the highest quality scores showed discrepant results.
The majority of reviews concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents. However, recent evidence from well-conducted meta-analyses shows discrepant results regarding the association between SSB and weight gain, overweight, and obesity among children and adolescents. Improving methodological quality of studies and reviews as well as ensuring responsible conduct of research and scientific integrity is essential for the provision of objective results.
Background:
We determined body weight increase in first year Dutch college students. We had the objective to determine whether the awareness of the unhealthy lifestyle raised concerns and willingness to change habits.
Methods:
Body weight, heartbeat, BMI, body fat percentages, and blood pressure values were collected from 1095 students. Comprehensive statistical analysis was performed on the data.
Results:
The students had a mean weight gain of 1.1 kg and an average BMI gain of 0.35. Members of a student corps gained significantly more weight (1.6 ± 3.1 kg) than non-members (1.0 ± 2.5 kg), while students who are living independently gained an average of 0.5 kg more than students living with their parents (p < 0.05). Approximately 40% of the students changed their eating patterns and 30.7% of the students consumed more alcohol.
Conclusions:
Students experienced hindrance in physical exercise and mental well-being. Students with a high BMI without irregular eating habits were willing to change their lifestyle. However, students who had irregular lifestyles exhibited the lowest willingness to change their eating behaviors and to lose weight. Our study provides insight into means by which adolescents at high risk for weight gain can be approached to improve experienced quality of life.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
To summarise evidence on the association between intake of dietary sugars and body weight in adults and children.
Systematic review and meta-analysis of randomised controlled trials and prospective cohort studies.
OVID Medline, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science (up to December 2011).
Eligible studies reported the intake of total sugars, intake of a component of total sugars, or intake of sugar containing foods or beverages; and at least one measure of body fatness. Minimum duration was two weeks for trials and one year for cohort studies. Trials of weight loss or confounded by additional medical or lifestyle interventions were excluded. Study selection, assessment, validity, data extraction, and analysis were undertaken as specified by the Cochrane Collaboration and the GRADE working group. For trials, we pooled data for weight change using inverse variance models with random effects. We pooled cohort study data where possible to estimate effect sizes, expressed as odds ratios for risk of obesity or β coefficients for change in adiposity per unit of intake.
30 of 7895 trials and 38 of 9445 cohort studies were eligible. In trials of adults with ad libitum diets (that is, with no strict control of food intake), reduced intake of dietary sugars was associated with a decrease in body weight (0.80 kg, 95% confidence interval 0.39 to 1.21; P<0.001); increased sugars intake was associated with a comparable weight increase (0.75 kg, 0.30 to 1.19; P=0.001). Isoenergetic exchange of dietary sugars with other carbohydrates showed no change in body weight (0.04 kg, -0.04 to 0.13). Trials in children, which involved recommendations to reduce intake of sugar sweetened foods and beverages, had low participant compliance to dietary advice; these trials showed no overall change in body weight. However, in relation to intakes of sugar sweetened beverages after one year follow-up in prospective studies, the odds ratio for being overweight or obese increased was 1.55 (1.32 to 1.82) among groups with the highest intake compared with those with the lowest intake. Despite significant heterogeneity in one meta-analysis and potential bias in some trials, sensitivity analyses showed that the trends were consistent and associations remained after these studies were excluded.
Among free living people involving ad libitum diets, intake of free sugars or sugar sweetened beverages is a determinant of body weight. The change in body fatness that occurs with modifying intakes seems to be mediated via changes in energy intakes, since isoenergetic exchange of sugars with other carbohydrates was not associated with weight change.
Objective:
Governments worldwide have been implementing interventions aimed at improving citizens' dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population.
Design:
Online survey to assess which interventions are the most salient and receive greater public support.
Setting:
Portugal.
Participants:
1010 (76·7 % female, MAge 36·33, sd 13·22).
Results:
Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex).
Conclusion:
By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.
Sugar-containing beverages are the leading source of added sugar consumption among young adults. The aim of this study was to explore how young adults conceptualise what influences the healthfulness of sugar-containing beverages.
Seven focus groups stratified by gender and educational institute were conducted with South Australians aged 18–25 years (n = 32). Focus groups were semi-structured and included a ranking activity where participants individually ranked eight beverages from least to most healthy. Focus groups were recorded, transcribed verbatim and thematically analysed.
Participants commonly selected soda (soft drink) and energy drink as the least healthy beverage and water as the healthiest, but those between varied in rankings. Four themes were identified relating to how participants conceptualise beverage healthfulness in our thematic analysis: ingredients harmful to health, properties beneficial to health, functionality, and packaging. While participants were aware that beverages can contain high amounts of sugar, and that this can be harmful to health, many other factors influence the perceptions of beverage healthfulness and these can outweigh the perceived harms of consumption.
Public health interventions and policies are needed to address misperceptions about the healthfulness of sugar-containing beverages to better put the harms of high sugar consumption in perspective for consumers.
Issue addressed
Sugar‐sweetened beverages (SSB) are the leading source of free sugars in Australian children's and adults’ diets. This study explores drivers of consumption among parents and young adults to inform interventions.
Methods
Eight focus groups (n=59) stratified by gender, age/life stage and SES; analysed thematically.
Results
Daily SSB consumption was normalised. Participants drank SSBs to avoid perceived energy/sugar deficits, to treat themselves and as a function of familial influence. Frequent consumption was considered acceptable if ‘in moderation’ and/or ‘balanced’ with exercise/diet; however, there was a large disconnect between this language of moderation and actual consumption practices. Participants acknowledged that social norms had changed over time. There was little evidence of accurate knowledge of sugar content for any beverage type. Participants relied heavily on packaging and labelling, much of which conveyed a health‐halo effect. While participants could list health effects of excess consumption, they were considered long‐term or of low personal relevance. Awareness of health recommendations was low.
Conclusions
Consumers’ adoption and use of concepts such as ‘treat’, ‘moderation’ and ‘balance’ reflect both food and beverage industry marketing and public health messaging. However, the disconnect between this language and knowledge and consumption practices is problematic.
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Objective
Cross-sectional observation of a university food environment and a survey of food purchasing preferences, behaviors, and opinions of students and staff to formulate strategies for interventions.
Design
A modified food environment-quality index was used to assess food outlets. A cross-sectional survey with closed (n = 42) and open-ended (n = 2) questions assessing students and staff purchasing, choice determinants, and opinions about the food environment.
Setting
Six campuses of 1 large urban university.
Participants
Food outlets (eg, convenience stores, restaurant and café, takeout, vending machines) (n = 57). University students and staff (n = 1,954).
Analysis
The researchers calculated descriptive statistics and Pearson chi-square tests to compare the percentages of healthy and/or unhealthy products in high- vs low-scoring outlets. Kruskal–Wallis H test was used to determine differences in healthiness between outlet types. Pearson chi-square tests were used to examine the influence of gender, and student and staff differences in survey responses.
Results
Median food environment-quality index was 79 out of 199 (interquartile range = 7). Six food outlets were categorized as healthy and 2 as unhealthy; the rest were intermediate. Overall, healthy items were less available, accessible, and promoted and cost more than unhealthy items. The majority of respondents in the survey (79%) purchased food and beverages on campus; males consuming them more frequently than did females (P = .001) and students consumed them more frequently than did staff (P = .001). Value for money, healthfulness, and taste determined the choice. Respondents suggested increasing value for money and healthy options.
Conclusions and Implications
Interventions that improve food availability, accessibility, prices, and promotions through policies are warranted and would be well-received among both university students and staff.
This research examines how the discrete negative emotions of guilt and sadness impact individual preference for carbohydrates, specifically in the form of sugar. Using Cognitive Appraisal Theory and research in biological psychology, we identify how these two discrete emotions influence the release of cortisol, which impacts sugar preferences. The results of four studies indicate that consumers select and prepare foods with higher amounts of sugar when experiencing sadness relative to when they feel guilt. Implications for public policy as well as marketing practitioners are discussed.
Issue addressed
University students generally make independent decisions regarding food choices. Current research about knowledge of Australian Dietary Guidelines (ADG), sources of nutrition information and influences on food choices for this group is scarce.
Methods
Qualitative data was collected from gender separated focus groups comprising four female (n=31) and four male (n=18) to identify: knowledge of ADG, sources of nutrition information; factors that influence food choices; perceived relevant nutrition messages and how best to deliver them.
Results
Gaps in knowledge were identified particularly regarding number of serves and serving size for food groups. Social media was the most commonly reported source of knowledge. Social media was also a major influence on food choice due to its impact on body ideals.
Conclusion
Current health promotion nutrition messages were perceived irrelevant given the focus on long‐term health risks. Health and adhering to the ADG were not identified as important. The desire to look a particular way was the major influence on food choices.
So What?
While there is an awareness of ADG, our participants made a deliberate decision not to follow them. This provides a challenge for developing relevant preventive health messages for this target audience.
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Efforts to reduce sugar intake levels have been primarily limited to increasing knowledge and changing attitudes. We conducted a systematic review to (1) identify factors influencing adults' knowledge and attitudes about sugar, and (2) determine if there is an association between knowledge and attitudes about sugar and sugar intake. We searched 15 electronic databases from inception to December 2016 for English language publications including adults with relevant exposure and outcome measures. Findings were summarised meta-narratively. Of 3287 studies, 22 studies (14 for objective one and 8 for objective two) were included. Individual (liking of sugary food), interpersonal (attitudes of peers) and environmental factors (media, health professionals and food labelling) influenced adults' knowledge and attitudes about sugar, at least to some extent. Overall, quality of the studies included in our review was weak, and evidence for the application of the Knowledge-Attitude-Behavior model for understanding sugar intake is limited. Protocol registered in the PROSPERO International prospective register of systematic reviews (registration number CRD42015027540).
In recent years there has been increasing interest in studying cognitive effects associated with sugar consumption. Neuro-cognitive research has confirmed that glucose, as a main energy substrate for the brain, can momentarily benefit cognitive performances, particularly for memory functioning. However, there is still limited understanding of relative effects of other common sugars (e.g., fructose and sucrose) on cognitive performance. The present study tested in 49 people the effects of three common dietary sugars against a placebo sweetener (i.e., sucralose), on performance of three well-studied cognitive tasks - simple response time, arithmetic, and Stroop interference, all of which are suggested to rely on the prefrontal lobe. A double-blind, placebo-controlled, cross-over experimental design was used. Results revealed that ingestion of glucose and sucrose led to poorer performances on the assessed tasks as opposed to fructose and the placebo (p<0.05); these effects were particularly pronounced under the fasting condition in comparison to the non-fasting condition (p<0.001). Overall, these results indicate that cognitive effects of sugar are unlikely to be mediated by the perception of sweetness. Rather, the effects are mediated by glucose. Further research should systematically assess effects of dietary sugars on other cognitive domains, such as memory, to give further insights on effects of sugar consumption.
Compensatory Health Beliefs (CHBs), defined as beliefs that an unhealthy behavior can be compensated for by engaging in another healthy behavior, are assumed to hinder health behavior change. The aim of the present study was to investigate the role of CHBs for two distinct eating behaviors (increased fruit and vegetable consumption and eating fewer unhealthy snacks) with a mixed method approach. Participants (N = 232, mean age = 27.3 years, 76.3% women) were randomly assigned to a fruit and vegetable or an unhealthy snack condition. For the quantitative approach, path models were fitted to analyze the role of CHBs within a social-cognitive theory of health behavior change, the Health Action Process Approach (HAPA). With a content analysis, the qualitative approach investigated the occurrence of CHBs in smartphone chat groups when pursuing an eating goal. Both analyses were conducted for each eating behavior separately. Path models showed that CHBs added predictive value for intention, but not behavior over and above HAPA variables only in the unhealthy snack condition. CHBs were significantly negatively associated with intention and action planning. Content analysis revealed that people generated only a few CHB messages. However, CHBs were more likely to be present and were also more diverse in the unhealthy snack condition compared to the fruit and vegetable condition. Based on a mixed method approach, this study suggests that CHBs play a more important role for eating unhealthy snacks than for fruit and vegetable consumption.
Snacking has become more prevalent in developed countries. While poor food choices pose health risks, nutritious choices contribute important nutrients to overall dietary intakes. Young adults consumer snacks frequently and nutritious choices should be promoted among this group. However, how young adults define the term 'nutritious' currently and how they evaluate the nutritiousness of various snack foods required further investigation. The current study used a mixed methods design with 115 young adults invited to sort 32 commonly available snack foods into a line ranging from 'not nutritious' to 'very nutritious'. The sorting data was analysed by hierarchical cluster analysis and multi-dimensional scaling (MDS) analysis. Participants were also asked to define the word 'nutritious', with definitions then categorized and number of counts per category analysed. Predictors of perceived snack nutritiousness were sugar (β = -0.45, P < 0.005), fat (β = -0.43, P < 0.05), nut (β = 0.45, P < 0.05) and fruit/vegetable (β = 0.33, P < 0.05) content. Level of food processing was significantly related to perceived nutritiousness (β = 0.79, P=<.05). The terms given within the definitions most frequently were: 'vitamins' (40%), 'good for body/body needs' (40%), 'minerals' (39%), 'low in sugars' (36%), 'protein' (32%), 'healthy' (28%) and 'long lasting source of energy' (27%). Results of the current study provide first insight into how young adults interpret the term 'nutritious'. This could help in the design of more effective nutrition education materials and food product labels to guide healthy choices in this age group.
Objective:
Emerging adulthood (18-24 y) where >50% of young adults attend tertiary education, is a transitional period that may provide an opportunity to influence future eating behaviors. The aim of this study was to identify possible strategies for encouraging healthy eating in university food environments.
Method:
Over 4 wk, students from a large university completed an anonymous researcher-designed survey with both closed (n = 41) and open-ended (n = 3) questions assessing food purchasing, food choice behaviors, and opinions of the campus food environment. Results were reported as proportions (%) or mean ± SD. Chi-square analysis was used to determine differences between sex and campuses. The study took place at an Australian urban university with seven campuses. We recruited 653 currently enrolled students by convenience sampling.
Results:
Respondents were mostly women (77%), aged <25 y (83%), and enrolled full time (96%). Almost all participants purchased food or beverages on campus (93%), with the most frequently purchased items being hot beverages and sandwiches. The greatest determinants of food choice were taste, value, convenience, and cost. Female students placed more importance on health-related factors and followed more special dietary behaviors than male students. The most common improvements suggested were lowering the cost and increasing the variety of food.
Conclusion:
As most students purchase food on campus, there are opportunities to intervene to improve diet quality. Our results indicate demand for healthy food and that price manipulation is an important lever for change. This information will be used for changing the local university food environment but may be useful for planning interventions at other universities.
Organic claims can influence how a product is perceived in dimensions that are unrelated with the food production method (e.g., organic food is perceived as more healthful and less caloric than conventional food). Such claims can also bias how the consumers of organic food are perceived and how other people judge their behavior. Schuldt and Schwarz (2010) have shown that individuals evaluating a target with a weight-loss goal are more lenient in judging the target forgoing exercise when the target had an organic (vs. conventional) dessert. This impact of organic claims on leniency judgments has been interpreted either as a halo or a licensing effect. In the current research we aim to replicate and extend Schuldt and Schwarz's (2010) results by examining the mechanisms that are more likely to explain the observed leniency judgments. In Experiment 1, we observed that leniency towards a target that has consumed an organic meal is only observed when the target intentionally chooses such organic meal (vs. choice determined by the situation). These findings suggest that the impact of organic claims on leniency judgments is not merely based on a halo effect. Instead, a licensing account emerges as the most probable mechanism. In Experiment 2, we further found that stronger (vs. weaker) motives for forgoing exercise influenced leniency judgments to the same extent as having had an organic meal. Understanding the mechanisms that shape consumers’ decisions may have important implications to prevent bias in their judgments about food and exercise.
The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peer-reviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now.
Objective:
To examine knowledge of sugar recommendations and test the efficacy of formats for labeling total and added sugar on pre-packaged foods.
Methods:
Online surveys were conducted among 2008 Canadians aged 16-24. Participants were asked to identify recommended limits for total and added sugar consumption. In Experiment 1, participants were randomized to one of six labeling conditions with varying information for total sugar for a high- or low-sugar product and were asked to identify the relative amount of total sugar in the product. In Experiment 2, participants were randomized to one of three labels with different added sugar formats and were asked if the product contained added sugar and the relative amount of added sugar.
Results:
Few young people correctly identified recommendations for total sugar (5%) or added sugar (7%). In Experiment 1, those who were shown percent daily value information were more likely to correctly identify the relative amount of total sugar (P < 0.05). In Experiment 2, those shown added sugar information were more likely to correctly identify that the product contained added sugar and the relative amount of added sugar in the product (P < 0.05).
Conclusions:
Improved labeling may improve consumer understanding of the amount of sugars in food products.
Internationally, vending machines are scrutinized for selling energy-dense nutrient-poor foods and beverages, and the contribution to overconsumption and subsequent risk of obesity. The aim of this review is to determine the efficacy of nutrition interventions in vending machine in eliciting behaviour change to improve diet quality or weight status of consumers. Electronic databases Cochrane, EMBASE, CINAHL, Science Direct and PubMed were searched from inception. Inclusion criteria: (i) populations that have access to vending machines; (ii) nutrition interventions; (iii) measured outcomes of behaviour change (e.g. sales data, dietary intake or weight change); and (iv) experimental trials where controls were not exposed to the intervention. Risk of bias was assessed independently by two researchers, and higher quality research formed the basis of this qualitative review. Twelve articles from 136 searched were included for synthesis. Intervention settings included schools, universities and workplaces. Reducing price or increasing the availability increased sales of healthier choices. The results of point-of-purchase nutrition information interventions were heterogeneous and when measured changes to purchases were small. This review offers evidence that pricing and availability strategies are effective at improving the nutritional quality foods and beverages purchased from vending machines. Evidence on how these interventions alter consumer's overall diet or body mass index is needed.
Applying theory on justification and self-control, this research examines the impact of physical activity on dieters' and nondieters' food consumption patterns. The results from two studies demonstrate that dieters, but not nondieters, consume more food after exercising as compared to situations in which no exercise is involved. In addition, dieters consume more food when they anticipate engaging in physical activity as compared to when they have completed their exercising. When physical activity is framed as fun (vs work), dieters decrease the amount of food they consume after exercising. Estimation of calories burned through exercise underlies this result.
© The Author(s) 2015.
Introduction: Cooking is recommended as a healthy diet behavior. This research examines national patterns in cooking frequency and diet quality among adults in the USA, overall and by weight loss intention.
Methods: Analysis of cross-sectional 24-hour dietary recall data (adults aged ≥20 years old) from the 2007-2010 National Health and Nutrition Examination Survey (N=9,569). Diet quality measures included total calories/day, grams of fat, sugar and carbohydrates/day, fast food meals/week, and frozen and ready to eat meals consumed in the past 30 days. Multivariable regression analysis was used to test for associations between frequency of cooking dinner/week (low (0-1), medium (2-5) and high (6-7)) and these dietary outcomes.
Results: In 2007-2010, 8% of adults cooked dinner 0-1 times/week and consumed, on an average day, 2301 total calories, 84 grams of fat, 135 grams of sugar. Overall, compared to low cookers (0-1 times/week), a high frequency of cooking dinner (6-7 times/week) was associated with lower consumption of daily calories, (2164 kcal vs. 2301 kcal, p=0.002), carbohydrates 262 grams vs. 284 grams, p<0.001), fat (81 grams vs. 86 grams, p=0.016), and sugar (119 grams vs. 135 grams, p<0.001). Individuals trying to lose weight consumed fewer calories than those not trying to lose weight, regardless of cooking frequency (2111 kcal vs. 2281 kcal, p<0.006).
Discussion: Adults who frequently cook dinner at home consume a healthier diet regardless of weight loss intention. Strategies are needed to encourage more cooking among the general population and help infrequent cookers better navigate the food environment outside the home.
•The relationships between changes in flexible vs. rigid restraints of eating and psychological well-being during weight management are studied.•The data includes information on 49 overweight persons, mainly middle-aged females, who participated in a weight loss and maintenance (WLM) intervention and a follow-up assessment after 8–9 months.•An increase in flexible cognitive restraint of eating during the WLM intervention was related to better weight loss maintenance and well-being.•Reduction of rigid restraint of eating after a WLM intervention was related to a better maintenance of improved psychological well-being.•Increasing flexible control while reducing rigid control of eating after an active weight loss phase is associated with improvements in success in weight management and the psychological well-being of weight losers.
A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to < 10% and < 5% energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption. Data sources included MEDLINE, EMBASE, Cochrane Database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences, China National Knowledge Infrastructure, Wanfang, and South African Department of Health. Eligible studies reported the absolute amount of sugars and dental caries, measured as prevalence, incidence, or severity. The review was conducted and reported in accordance with the PRISMA statement, and the evidence was assessed according to GRADE Working Group guidelines. From 5,990 papers identified, 55 studies were eligible - 3 intervention, 8 cohort, 20 population, and 24 cross-sectional. Data variability limited meta-analysis. Of the studies, 42 out of 50 of those in children and 5 out of 5 in adults reported at least one positive association between sugars and caries. There is evidence of moderate quality showing that caries is lower when free-sugars intake is < 10% E. With the < 5% E cut-off, a significant relationship was observed, but the evidence was judged to be of very low quality. The findings are relevant to minimizing caries risk throughout the life course.
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.
Little research has been conducted examining the food choice behaviors of young adults. The few studies reported have been limited to college students and used survey questionnaire techniques. This study sought to describe a broader sample of young adults and to gather information about reasons for food choice behavior using a qualitative method. Fifty‐seven focus group interviews were conducted across seven states with 270 young adult participants. The interviews were focussed on discussions of food‐related behaviors. Across all states consistent responses were given regarding time constraints, financial barriers and health concerns impacting food choice. Varying responses between states seemed related to racial and ethnic differences among participants. These results suggest that the effectiveness of efforts to promote positive food behavior change among young adults may be improved by incorporating means to overcome common barriers.
Purpose:
This study examined how college students choose beverages and whether behavioral interventions might reduce their heavy consumption of sugar-sweetened beverages.
Methods:
From April to June 2010, 90 students participated in 12 focus groups at 6 colleges in Massachusetts and Louisiana. The study team undertook a group content analysis of the verbatim focus group transcripts using the immersion-crystallization method.
Results:
The mean age of participants was 19 years. Fifty percent were white, and 47% were black. Several themes emerged in focus groups: taste is paramount; price is important but secondary; health and nutritional content of beverages are of limited interest; juice has a "health halo"; and water is consumed primarily for hydration. Students were often highly fixated on favorite sugar-sweetened beverages. Price was uniquely important for good-tasting beverages costing less than one dollar. Some students reported calorie content as important for food choices, but most had no awareness of beverage calorie content. Students' negative perceptions of sugar-sweetened beverages focused largely on the "dangers" of sugar and chemicals in sodas. They expressed particular concern about soda's corrosive chemical properties or diet soda causing cancer. The health halo for juice persisted even with some recognition of high sugar content. Students thought shocking educational messages would be necessary to get them to reduce consumption of sugar-sweetened beverages.
Conclusions:
Among college students, taste and price were the most important factors in choosing beverages. Interventions using shocking visual images or providing low-cost or free water may conquer taste and brand preference to reduce sugar-sweetened beverage intake.
Objective:
The purpose of this study was to objectively assess changes in weight, BMI, body composition and waist circumference during the first semester at university in Belgian students, as well as to identify correlates of change in BMI and fat%.
Methods:
Weight, height, body composition and waist circumference were measured at baseline (October/November 2011) and follow-up (February/March 2012) in 101 first year university students. Additionally, a health behaviour questionnaire was completed at follow-up.
Results:
After one semester at university, students gained on average 1.0 kg (range=-4.1 kg, +7.7 kg) of body weight consisting of 0.8 kg of fat mass. In contrast, fat free mass and waist circumference did not change. Regression models showed that being male, higher amount of TV/DVD watching and higher frequency of eating at a friends' place were contributors of BMI increase, whereas living in a student residence and lower frequency of reading and studying was related with higher increases in fat%.
Conclusions:
This is the first European study demonstrating that the first semester at university is a critical period for weight and fat gain. Future intervention studies should have special attention for male students and students living in student residences, and focus on promoting healthier food choices when eating out-of-home.