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The global production and consumption of sugar-sweetened beverages (SSBs) has been on the rise in recent decades. The intake of SSBs has been increasing in China, and it is more prevalent among children and adolescents. As research continues to intensify, more and more studies have shown that, in addition to the increased risks of dental caries and obesity reported by the World Health Organization (WHO), SSBs intake can also increase risks of chronic diseases such as diabetes, cardiovascular disease, gout, and cancer, and early death, adding to the burden of disease. Due to the health risks associated with the overconsumption of SSBs, many countries around the world have taken measures to control the intake. The main measures currently in place are taxation of SSBs, restrictions on marketing and sales of SSBs, front-of-package labeling and reducing availability of SSBs in schools. In China, the main measures currently in place are to control the sales of beverages in schools, with Shenzhen taking the lead in implementing health warning labeling to alcoholic beverages and carbonated beverages, extending the measures to reduce SSBs intake beyond school grounds.
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Background Children and adolescents drink sugar-sweetened beverages (SSBs) frequently. Research has confirmed that SSBs associate with weight gain and overweight or obesity. However, it is unclear whether high SSBs intake associates with abnormal changes in physical growth and glucolipid metabolism before causing adverse health outcomes such as overweight and obesity. Early identification of associated health risks of overconsumption of SSBs have important public health implications. Objective To investigate the differences in physical growth and glucolipid metabolism between different SSBs intake frequency groups in normal weight children and adolescents aged 6-17 years, and to evaluate the early effects of SSBs intake on physical growth and glycolipid metabolism before causing overweight and obesity, aiming to provide a scientific basis for the prevention and control of childhood overweight and obesity and related chronic diseases, and for the formulation of policies on the control of SSBs consumption. Methods Data were from the Shanghai Diet and Health Survey (SDHS) among primary and secondary school students. The participants were normal weight children and adolescents aged 6-17 years. Propensity scores were calculated according to energy intake and physical activity factors, after stratifying by age and gender. Participants were 1:1 matched with the closest propensity scores in the high-frequency (≥1 time·d−1) and the low-frequency (≤1 time·week−1) SSBs intake groups. The outcome indicators were physical measurements such as height, weight, percent of body fat, and waist circumference, and metabolic indicators such as fasting blood glucose, total triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Body mass index (BMI) was calculated. Food frequency questionnaire was used to collect SSBs consumption in the past three months through face-to-face interview. A paired t-test was used to compare the differences in physical and glycolipid metabolic indicators between the high-frequency intake group and the low-frequency intake group of SSBs. Results A total of 431 pairs were obtained. For children and adolescents in grades 6-9, overall height (difference=2.92 cm, P=0.002), weight (difference=2.53 kg, P=0.003), and waist circumference (difference=1.34 cm, P=0.035) were higher in those who consumed SSBs ≥1 time·d−1 than in those who consumed ≤1 time·week−1. For children and adolescents in grades 10-12, overall weight (difference=2.27 kg, P=0.041) was higher in those who consumed SSBs ≥1 time·d−1 than in those who consumed ≤1 time·week−1. Over 95% of the study subjects reported blood glucose and lipid test results within the normal range; but girls in grades 1-5 who consumed SSBs ≥1 time·d−1 had a higher total cholesterol (difference=0.20 mmol·L−1, P=0.027) and low-density lipoprotein cholesterol (difference=0.19 mmol·L−1, P=0.010) than those who consumed ≤1 time·week−1; boys in grades 6-9 who consumed SSBs ≥1 time·d−1 had a lower high-density lipoprotein cholesterol (difference=-0.10 mmol·L−1, P=0.039) than those who consumed ≤1 time·week−1. Conclusion High-frequency intake of SSBs may be associated with higher total cholesterol and low-density lipoprotein cholesterol in normal weight children and adolescents in grades 1-5, and higher weight in normal weight children and adolescents in grades 6-12. There is an urgent need to educate children and adolescents about nutritional health, enhance their ability to make healthy food and beverage choices, and take early interventions to control the intake of SSBs in children.
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Background Long-term excessive consuming sugar-sweetened beverages have a negative impact on health. In order to decrease the consumption of sugar-sweetened beverages and create a healthy food environment, the Health Commission of Shenzhen Municipality pioneered to enforce health warning labels presented in commercial locations vending sugar-sweetened beverages based on relevant provisions of the Health Regulations of Shenzhen Special Economic Zone，but its effect has not yet been evaluated. Objective To evaluate the impact of presenting health warning labels in commercial locations vending sugar-sweetened beverages in Shenzhen. Methods A multi-stage stratified sampling method was used to randomly select one street in each of the 10 districts (excluding the Shenzhen Shantou Special Cooperation Zone) of Shenzhen followed by a convenience sampling to select sampling sites to conduct an undercover investigation on the presentation of health warning labels for sugar-sweetened beverages in six different types of venues (n=232) such as shopping malls, ordinary supermarkets/convenience stores, self-service vending machines, catering service places, medical institutions, and venues serving minors' education and activities. At the same time, 238 site managers, 1002 adult consumers, and 7396 child and adolescent consumers were interviewed. Results Among 213 commercial locations vending sugar-sweetened beverages, the rate of health warning label installation was 26.3%, with the highest installation rate in shopping malls (55.0%). Among site managers, 47.8% were aware that commercial locations were required to install health warning labels, and 50.0% were aware of the standards for setting up health warning labels. The higher the awareness of relevant regulations, the higher the rate of installation of health warning labels. More than half of site managers (55.3%) believed that after installing health warning labels, the sales of sugar-sweetened beverages and sugar-sweetened beverages in large-volume packages had decreased compared to the same period in previous years. Most of the interviewed consumers indicated that if they saw the health warning labels for sugar-sweetened beverages, they would buy less, give up purchasing, or choose low-sugar or sugar-free beverages, and also discourage their family members or friends from drinking such beverages. Compared with participants without awareness of the health warning labels, both adult and child and adolescent consumers with awareness of the health warning labels believed that the installation is beneficial to their good eating habits and reported a higher proportion of discouraging family members or friends from drinking such beverages, with a lower frequency of consuming sugar-sweetened beverages. Conclusion Health warning labels for sugar-sweetened beverages have a significant effect on promoting behavior changes, and both site managers and citizens have a high level of support for them. However, in view of the low voluntary compliance rate of commercial locations and the installation rate of health warning labels, the publicity and enforcement of the Health Regulations of Shenzhen Special Economic Zone should be enhanced.
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Recently, limiting the excessive intake of added sugar has gradually become an important topic in the field of nutrition. Sugar, sweetened dairy products, and sugar sweetened beverages (SSBs) are the three most important contributions of added sugar in China. For children, adolescents, and young adults, the issue of excessive intake of SSBs is not optimistic for now. Although the daily per capita intake of SSBs in China is currently at a low level on a global scale, the overall trend of SSBs production and consumption are rapidly increasing. Excessive intake of added sugar adversely affects glycolipid metabolism and multiple metabolic diseases, which is widely concerned and discussed. For the purpose of limiting added sugar, the gradually popularized use of sugar substitutes poses entirely new challenges. Multiple sugar-restriction strategies have been implemented and validated abroad. Given the rapid growth of consumption of added sugar and increasing evidence of related health hazards in China, there is a great need to improve the awareness of eating less added sugar for Chinese residents by multilevel strategies, and finally reduce the consumption of SSBs. In this article, the definition, history, and development of added sugar, main dietary sources, recommended limits, and both domestic and international consumption trends of added sugar were narrated. Then, the main health risks of added sugar and the global sugar-restriction strategies were briefly described. The article calls for raising awareness among Chinese residents of the health hazards of added sugar and limiting its excessive intake.
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Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d−1 increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1 were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week−1 group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week−1 group compared to the <1 serving·week−1 SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (Pinteraction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L−1 and 0.18 mmol·L−1, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.
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Introduction: Excessive consumption of sugar-sweetened beverages (SSBs) in adolescents has become a global issue. As its link to obesity and noncommunicable diseases is clear, it is imperative to understand SSB consumption behaviors in the future health-care professionals. The objective of this study is to document the prevalence, patterns, and clinico-social and behavioral factors predicting high intake of SSBs among medical students. Material and Methods: This cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital between October and November 2019 were included in this study. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioral patterns, and money spent in connection with SSB consumption. Data were analyzed using IBM SPSS version 24. Results: The mean age of participants was 19.3 ± 1.6 years, 71.7% being males. The current prevalence of SSB consumption was 90.5%. Furthermore, 49.9% and 29.1% of participants preferred soft drinks and sweetened fruit juice, respectively. Multivariate analysis showed that male gender (adjusted odds ratio [aOR]: 1.83, (1.03–3.25), current alcohol consumption (aOR: 4.09, 1.25–13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs [aOR: 7.36, (3.41–15.87)] whereas, preference of energy/sports category of drinks predicted low intake of SSBs [aOR 0.10, (0.02–0.47)]. Conclusion: The consumption of SSBs among medical students was high. Targeted health education and behavior change interventions should be provided to males, alcohol users, and frequent consumers
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@#Introduction: Childhood obesity is a public health problem in Malaysia. Intake of sugar-sweetened beverages (SSB) is associated with obesity in children. There is a lack of studies on factors associated with SSB consumption in Malaysia. This study aimed to determine the sociodemographic factors associated with SSB consumption among Malaysian adolescents. Methods: Data of 2,021 students, aged 10-17 years on sociodemographic, SSB intake and anthropometrics were drawn from the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster sampling was used to obtain a nationally representative sample of primary and secondary school students. Body mass index (BMI)-for-age status was determined based on calculated z-score using the World Health Organization 2007 reference. SSB consumption was obtained from a food frequency questionnaire. Results: The prevalence of overweight and obesity among Malaysian adolescents were 16.6% and 14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day. Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3 cups) children, while males (1.5 cups) had a significantly higher intake than females (1.3 cups). There were no significant differences in SSB consumption between thin, normal, overweight and obese adolescents. Conclusion: Almost all Malaysian adolescents consumed SSB during one month prior to the survey and the average amount consumed was 1.4 cups per day. Rural locality and male were associated with higher SSB consumption. There were differences in SSB consumption between Chinese and Malays, between Chinese and Indians, and between Chinese and Bumiputra Sarawak. There were no differences in consumption between the different BMI-for-age categories.
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BACKGROUND/OBJECTIVES: Association between the consumption of sugar-sweetened beverages (SSBs) and obesity is universally a controversial issue. This study was undertaken to examine the beverage consumption pattern of Korean adolescents. SUBJECTS/METHODS: Data was collected from the 2016 Korea Youth Risk Behavior Survey involving 65,528 adolescent respondents. A list of the most frequently consumed beverages was analyzed, and the consumption frequency of carbonated beverages, SSBs, and energy drinks during the past seven-days was assessed. The main reasons for the adolescents to consume the beverages were also determined. RESULTS: The beverage preference of adolescents were carbonated beverages (31.0%), ‘fruit and vegetable beverages (17.7%)’, ‘milk (13.6%)’, and ‘coffee (12.7%)’. Carbonated beverages and SSBs were consumed more than three times a week by 27.1% and 41.1% of the respondents, respectively. About 86.2% of adolescents did not take of any energy drinks during the last seven-days. Taste was the most common reason that adolescents considered when choosing a drink. Carbonated beverages consumed more frequently by boys than girls, and high school students drank coffee more frequently than middle school students. CONCLUSIONS: Boys had a higher preference for unhealthy beverages than girls, whereas consumption of high-caffeine drinks was greater amongst high-school students than middle school students.
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Adolescent , Female , Humans , Beverages , Carbonated Beverages , Coffee , Energy Drinks , Korea , Obesity , Risk-Taking , Surveys and Questionnaires , VegetablesABSTRACT
PURPOSE: The purpose of this study was to investigate the consumption behaviors of sugar-sweetened beverages and blood lipid profiles according to food-related lifestyles of adults in Incheon. METHODS: Subjects were recruited from 19 to 64 year old adults residing in Incheon who visited for the purpose of a health examination at D hospital. A total of 110 subjects consented to participate in this study and to allow their health examination records to be used at D hospital. Data were collected using self-administered questionnaires and anthropometric data, and blood lipid profiles were collected from health examination records. Statistical analysis was performed using the SPSS 20.0 program. RESULTS: In the factor analysis, food-related lifestyles were categorized into four factors: planned purchase seeking, taste seeking, well-being seeking, and convenience seeking. Using the K-average clustering method, food-related lifestyles of subjects were categorized into two groups: health and rationality-oriented group (HRG) and convenience purchase-oriented group (CPG). Average total scores of sugar-related nutrition knowledge in the HRG were significantly higher compared to the CPG, and average scores of consumption habits regarding sugar-containing foods in the HRG were significantly lower compared to the HRG. When subjects chose sugar-sweetened beverages, the CPG showed a significantly higher frequency of checking food labeling and considering nutrition compared to the CPG. Drinking frequency of carbonated beverages in the CPG was significantly higher compared to the HRG. CONCLUSION: There were significant differences in sugar-related nutrition knowledge and consumption habits of sugar-sweetened beverages between the two food-related lifestyle groups. These results could be useful for establishing guidelines for reducing consumption of sugar-sweetened beverages. In addition, it is necessary to continue sugar-related nutrition education by considering the food-related lifestyles of adults.
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Adult , Humans , Beverages , Carbonated Beverages , Drinking , Education , Food Labeling , Life Style , MethodsABSTRACT
Inadequate vitamin D status is highly prevalent in the Korean population, especially among young adults. Nonetheless, correlates of suboptimal vitamin D levels in young adults are not well defined. This study aimed to investigate potentially modifiable determinants of vitamin D levels in young adults in Korea. This cross-sectional study was based on health check-up data from 3,450 healthy male and female university students aged 18-29 yr in Seoul between April and May 2013. Serum 25-hydroxyvitamin D [25(OH)D] levels were determined using chemiluminescent immunoassay. Anthropometric data were measured, and lifestyle, dietary, and sociodemographic factors were obtained through self-administered questionnaires. General linear regression was used to assess correlates of serum 25(OH)D levels. The mean serum 25(OH)D level was 11.1 ng/mL, and the prevalence of 25(OH)D levels less than 10 ng/mL was 44.7% (39.5% in men, 50.2% in women). In a final multivariable model, significant positive correlates of serum 25(OH)D were older age, male sex, increased physical activity, sunlight exposure > or = 30 min/day, eating breakfast regularly, consumption of dairy and fatty fish, and use of vitamin D-containing supplements. In contrast, significant inverse correlates were obesity (body mass index, BMI > or = 25 kg/m2) or underweight (BMI < 18.5 kg/m2), abdominal obesity, increased sedentary time, and frequent consumption of instant noodles and sugar-sweetened beverages. In conclusion, many modifiable lifestyle and dietary factors were associated with low serum 25(OH)D levels in Korean young adults. Further studies on potential mechanisms of the correlates and optimal strategies to improve vitamin D status in this vulnerable subpopulation are warranted.