Consumption of sugar-sweetened and artificially sweetened beverages and prevalence of hypertension in adults: a population- based study

Systemic Arterial Hypertension is a multifactorial clinical condition associated with severe outcomes such as stroke and death. One of the main modifiable risk factor for hypertension is an unhealthy diet, often characterized by the consumption of ultraprocessed foods such as sweetened beverages. We aimed to investigate the relationship between the consumption of sweetened beverages, both sugar-sweetened and artificially sweetened, and the prevalence of hypertension in adults. A cross-sectional, household, population-based study with 1,162 adults from two Brazilian cities were carried out. The consumption of food groups and sweetened beverages was obtained by food frequency questionnaire and other data were self-reported. Weight, height, and waist circumference were measured. The association between sweetened beverages consumption and hypertension was analyzed using Poisson regression models, expressed as Prevalence Ratio. The prevalence of hypertension was 16.7%, with no significant difference between genders. The prevalence of consumption of sweetened beverages was 70.3% in men and 54.6% in women, being significantly higher in men. Women who consumed sugar-sweetened and artificially sweetened beverages 6 to 7 days per week had 92% higher prevalence of hypertension compared to those who did not consume or consumed at a lower frequency. Furthermore, women who consumed artificially sweetened beverages at least 1 time per week had 3.36 times higher prevalence of hypertension. The habitual consumption of sweetened beverages may be an important risk factor for hypertension, especially the consumption of diet beverages, which are often marketed as healthier than sugar-sweetened beverages.

La Hipertensión Arterial Sistémica es una condición clínica multifactorial asociada a resultados graves como el ictus y la muerte. Uno de los principales factores de riesgo modificables de la hipertensión es una dieta poco saludable, a menudo caracterizada por el consumo de alimentos ultraprocesados como las bebidas endulzadas. Nuestro objetivo fue investigar la relación entre el consumo de bebidas endulzadas, tanto azucaradas como edulcoradas artificialmente, y la prevalencia de hipertensión en adultos. Se realizó un estudio transversal, domiciliario y poblacional con 1,162 adultos de dos ciudades brasileñas. El consumo de grupos de alimentos y bebidas endulzadas se obtuvo mediante cuestionario de frecuencia de alimentos y los demás datos fueron autoinformados. Se midieron el peso, la talla y el perímetro de la cintura. La asociación entre el consumo de bebidas endulzadas y la hipertensión se analizó mediante modelos de regresión de Poisson, expresados como Ratio de Prevalencia. La prevalencia de hipertensión fue del 16,7%, sin diferencias significativas entre géneros. La prevalencia de consumo de bebidas endulzadas fue del 70,3% en los hombres y del 54,6% en las mujeres, siendo significativamente mayor en los hombres. Las mujeres que consumían bebidas azucaradas y edulcoradas artificialmente entre 6 y 7 días a la semana tenían 92% mayor prevalencia de hipertensión que las que no consumían o consumían con una frecuencia menor. Además, las mujeres que consumían bebidas edulcoradas al menos 1 vez por semana tenían una prevalencia de hipertensión 3,36 veces mayor. Así pues, el consumo habitual de bebidas endulzadas puede ser un importante factor de riesgo de hipertensión, especialmente el consumo de bebidas dietéticas, que a menudo se comercializan como más saludables que las bebidas azucaradas.

Main results and public health implications of the National School Health Survey (ENSE), Colombia 2017

Introduction: The school population represents a fundamental group for health promotion actions, given that the foundations of healthy behaviors in adult life are established in children and adolescents, who can be greatly influenced by the school. Objective: To describe the health-related behavioral factors of schoolchildren between 13 and 17 years of age in secondary and middle school in Colombia. Methods: A national cross-sectional study was conducted (i.e., School Health Survey -ENSE-) that recorded information on dietary practices, physical activity, alcohol and drug consumption, injuries and bullying, and oral, visual and hearing health. Sampling was probabilistic, cluster and multistage. Results: Schoolchildren have low consumption of fruits, vegetables (13.1%) and dairy (76.5 %), high consumption of ultra-processed foods (82.4 %), sugary drinks (74.0 %) and fast foods (14.8 %), frequent addition of salt at the table (43.3 %), low compliance with physical activity recommendations (15.0 %) and high sedentary lifestyle (46.3 %), frequent consumption of alcohol (44.7 %) and psychoactive substances (14.7 %), in addition to prevalent situations of bullying (15.4 %), rejection (8.2 %) and verbal aggression (42.7 %). Conclusions: The ENSE shows critical inequalities by gender, ethnicity and social class, throughout the country. The indicators observed in schoolchildren are precursors of various chronic and degenerative diseases and mental illness, which requires the urgent attention of the different social actors in the country.

Introducción: La población escolar es un grupo fundamental para las intervenciones de promoción de la salud, ya que en los niños y adolescentes se sientan las bases de un comportamiento saludable en la vida adulta, que puede ser muy influenciado por la escuela. Objetivo: Describir los factores comportamentales relacionados con la salud de los escolares de 13 a 17 años de edad que cursan educación básica secundaria y media en Colombia. Métodos: Se realizó una encuesta nacional transversal (Encuesta de Salud en Escolares -ENSE-) con los lineamientos de Global School-based Student Health Survey para recolectar información sobre prácticas alimentarias, actividad física, consumo de alcohol y drogas, lesiones e intimidación, y salud bucal, visual y auditiva. El muestreo fue probabilístico, por conglomerados y polietápico. Resultados: Se incluyeron 79.640 escolares de 298 municipios. Los escolares presentaron bajo consumo de frutas, verduras (13.1%) y productos lácteos (76.5 %), alto consumo de alimentos ultraprocesados (82.4 %), bebidas azucaradas (74.0 %) y comidas rápidas (14.8 %); alto uso de sal añadida en la mesa (43.3 %), actividad física inferior a la recomendada (15.0 %) y sedentarismo (46.3 %). Fue frecuente el consumo de alcohol (44.7 %) y sustancias psicoactivas (14.7 %) y reportaron situaciones de intimidación (15.4 %), rechazo (8.2 %) y agresiones verbales (42.7 %). Conclusiones: La ENSE muestra desigualdades por género, etnia y clase social en todo el país. Los hallazgos observados en los escolares son factores de riesgo de enfermedades crónico-degenerativas y mentales, y requieren la atención urgente de los actores sociales del país.

¿Qué necesita nuestra región para fortalecer políticas públicas sobre bebidas azucaradas? diálogo de decisores / What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

A introdução precoce de sucos pode influenciar desfechos antropométricos e consumo alimentar em idade pré-escolar? / Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age?

Resumo Objetivou-se avaliar o impacto do consumo de sucos antes dos 6 meses de idade no Índice de Massa Corporal para Idade (IMC/I) e no consumo alimentar em pré-escolares. Estudo longitudinal com amostra composta por mães e seus filhos (n=103) entre 6 meses e 3 a 6 anos. Peso e estatura foram aferidos e convertidos para o escore z de IMC/I. Para avaliar o consumo alimentar, foi utilizado o Questionário de Frequência Alimentar Infantil. Testes de Qui-Quadrado e t de Student foram utilizados para comparação entre os grupos. Não houve diferença nos parâmetros antropométricos entre pré-escolares que receberam ou não suco antes dos seis meses. Aquelas que tiveram introdução de suco mais precoce (≤150 dias de vida) apresentaram consumo mais frequente (≥1x/dia) de suco artificial (63,8% versus 35,7%; p=0,028) e biscoito recheado (21,3% versus 14,3%; p=0,001) na idade pré-escolar. Crianças que receberam suco do tipo artificial antes dos 6 meses tiveram maior prevalência de consumo de refrigerante entre 1 e 4x/semana (69,2% versus 27,4%; p=0,014) e menor prevalência de consumo de achocolatado pelo menos 1x/dia (38,5% versus 69,4%; p=0,027). Sendo assim, crianças com introdução precoce de suco apresentaram maior consumo de alimentos doces e bebidas açucaradas em fase pré-escolar.

Abstract The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student's t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents / Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

RESUMO OBJETIVO Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth - ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh - IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.

Health and economic burden of sugar-sweetened beverages consumption in Brazil / Carga sanitaria y económica del consumo de bebidas azucaradas en Brasil / Carga sanitária e econômica do consumo de bebidas açucaradas no Brasil

Abstract: Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

Resumen: Las bebidas azucaradas (BA) tienen una gran fuente de azúcar añadido y están asociadas con enfermedades no transmisibles (ENT), como la obesidad y la diabetes. Este estudio evaluó el impacto del consumo de las BA en la carga de enfermedad en Brasil, incluidas las muertes, los años de vida ajustados por discapacidad (AVAD) y los costos con la salud. Con el uso de una metodología de tres etapas, se evaluaron los efectos directos de las BA sobre la diabetes, las enfermedades cardiovasculares y el índice de masa corporal (IMC), la influencia del IMC en la incidencia de la enfermedad, y se estimó la carga económica y de salud utilizando los factores atribuibles a la población. Los resultados mostraron que el 2,7% de los casos de sobrepeso/obesidad en adultos y del 11% en niños fueron atribuibles a las BA. El consumo de las BA en Brasil generó 1.814.486 casos, 12.942 muertes, 362.088 AVAD y USD 2.915,91 millones en costos médicos relacionados con diabetes, enfermedades cardiovasculares, enfermedades oncológicas y otras ENT. Es necesario implementar políticas públicas para tratar el consumo de las BA, reconocido este como un factor de riesgo clave para las ENT.

Resumo: As bebidas açucaradas (BAs) são uma grande fonte de açúcar adicionado e estão associadas a doenças não transmissíveis (DNTs), como obesidade e diabetes. Este estudo avaliou o impacto do consumo de BAs sobre a carga de doenças no Brasil, incluindo óbitos, anos de vida ajustados por incapacidade (AVPIs) e custos de saúde. Usando uma metodologia de três estágios, examinamos os efeitos diretos das BAs sobre diabetes, doenças cardiovasculares e índice de massa corporal (IMC), a influência do IMC na incidência de doenças e estimamos o carga econômica e de saúde usando fatores atribuíveis à população. Os resultados mostraram que 2,7% dos casos de sobrepeso/obesidade em adultos e 11% em crianças foram atribuíveis a BAs. O consumo de BAs no Brasil levou a 1.814.486 casos, 12.942 mortes, 362.088 AVPIs e USD 2.915,91 milhões em custos médicos relacionados a diabetes, doenças cardiovasculares, doenças oncológicas e outras DNT. A implementação urgente de políticas públicas é crucial para enfrentar o consumo de BAs, reconhecido como um fator de risco fundamental para as DNT.

Carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador / Burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador / Carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador

RESUMEN Objetivo. Estimar la carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador. Métodos. Se utilizó un modelo de riesgos comparativos para estimar los efectos en muertes, eventos de salud, años perdidos por muerte prematura y discapacidad (AVAD), y costos médicos directos atribuibles al consumo de bebidas azucaradas. Resultados. Un total de 520 muertes (8 cada 100 000 individuos), 214 082 eventos en salud (3 220 cada 100 000 individuos) y 16 643 AVAD podrían ser atribuibles al consumo de bebidas azucaradas en El Salvador, lo que representa $69,35 millones (dólar americano) en costos médicos directos para el año 2020. En particular, los eventos de diabetes tipo 2 (DBT2) atribuibles al consumo de bebidas azucaradas podrían llegar a representar más del 20% del total de casos de DBT2 para el país. Conclusión. Un elevado número de muertes, eventos y costos podrían atribuirse al consumo de bebidas azucaradas en El Salvador.

ABSTRACT Objective. To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods. A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results. A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion. A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador.

RESUMO Objetivo. Estimar a carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador. Métodos. Foi utilizado um modelo de risco comparativo para estimar os efeitos sobre óbitos, eventos de saúde, anos perdidos devido a morte prematura ou vividos com incapacidade (AVAI) e custos médicos diretos atribuíveis ao consumo de bebidas açucaradas. Resultados. Um total de 520 mortes (8 por 100 00 indivíduos), 214 082 eventos de saúde (3 220 por 100 000 indivíduos) e 16 643 AVAI podem ser atribuídos ao consumo de bebidas açucaradas em El Salvador, o que representa US$ 69,35 milhões em custos médicos diretos para o ano de 2020. Os eventos de diabetes mellitus tipo 2 (DM2) atribuíveis ao consumo de bebidas açucaradas, em especial, podem representar mais de 20% do total de casos de DM2 no país. Conclusões. Um número elevado de mortes, eventos de saúde e custos pode ser atribuído ao consumo de bebidas açucaradas em El Salvador.

Knowledge level and influencing factors of sugar-sweetened beverages among Chinese adults aged 18-64 years in 2021 / 环境与职业医学

Background Excessive intake of sugar-sweetened beverages (SSBs) is harmful to health. In recent decades, the consumption of SSBs by Chinese residents has increased rapidly, increasing the risk of death and burden of disease. Objective To analyze the knowledge level and influencing factors of SSBs for Chinese residents aged 18-64 years in 2021. Methods A multi-stage cluster random sampling approach was used to conduct a questionnaire survey among residents aged 18-64 years in 302 survey sites across the country in 2021, and 98567 valid questionnaires were obtained. Four questions are about SSBs among the questionnaire's 5 dimensions. Respondents who answered 3 or more questions correctly were considered to have a basic understanding of SSBs. Frequency and weighted proportion were used for description. With individual as level 1 and resident council (village council) as level 2, a two-level logistic regression model was applied to examine the influencing factors. A null model was used to determine whether the two-level logistic regression model was appropriate. Results The knowledge awareness rate of SSBs was 57.0% among the Chinese residents aged 18-64 years in 2021. The knowledge point with the lowest correct rate was "It is best to consume no more than 25 grams of added sugar per day" (22.6%), while the one with the highest correct rate was "Excessive intake of SSBs can increase the risk of obesity and diabetes" (81.1%). The results of the null model showed that SSBs knowledge level had a clustering effect at resident council (village council) level (t=25.00, P<0.0001), so a two-level model fit better than a one-level model. The results of the two-level logistic model revealed that residents who were female (OR=1.14, 95%CI: 1.11, 1.18) or working in medical and health (OR=1.36, 95%CI: 1.27, 1.45) and education institutions (OR=1.16, 95%CI: 1.07, 1.24) had a higher knowledge level compared to males or residents of other occupations. The knowledge level was lower among residents in central (OR=0.87, 95%CI: 0.77, 0.97) and western (OR=0.85, 95%CI: 0.75, 0.94) areas than in eastern areas. Those with chronic diseases (OR=0.81, 95%CI: 0.78, 0.84) and who did not know if they had a chronic disease (OR=0.75, 95%CI: 0.72, 0.78) had a lower knowledge level than those without chronic diseases. Compared with 18-24 years, the knowledge level was higher in ages 35-44 years (OR=1.07, 95%CI: 1.02, 1.12) and lower in ages 55-64 years (OR=0.92, 95%CI: 0.86, 0.97), and not different from the ages 25-34 years and 45-54 years. The knowledge level increased with the level of education, the trend was statistically significant (P＜0.001). Conclusion Only about half of Chinese adults aged 18-64 years had a basic understanding of SSBs in 2021. The awareness rate of added sugar intake was low in particular. The knowledge levels of male, central and western, or less educated populations were even lower. Awareness of the negative health outcomes of SSBs was high among the population.

Knowledge, Attitude, and Practice of Sugar-Sweetened Beverage (SSB) Among University Students in Klang Valley, Malaysia

@#Introduction: Excessive sugar consumption is a major global health concerns as it plays a significant role in the development of non-communicable diseases. Sugar-sweetened beverages (SSB) are a major source of added sugar in daily life that can lead to many health concerns. Understanding of the knowledge, attitudes, and practices (KAP) related to SSB intake is a key component of healthy beverage intake. Therefore, this study aimed to determine the prevalence of SSBs intake and the level of knowledge, attitude, and practice (KAP) of university students during the recovery phase of COVID-19 in 2022. Methods: This cross-sectional study involved 176 young adults aged 18-26 years old who completed a self-administered questionnaire. The questionnaire consisted of demographic and KAP data related to SSBs. Descriptive statistics were outlined, and a chi-square test was conducted to compare categorical variables. Results: Based on the frequency of beverage intake, sugar-sweetened coffee, or tea (39.8%) was the most frequently consumed SSB daily (at least once daily) while regular soft drink (52.3%) was the most consumed SSB among the participants on a weekly basis (≤6 times per week). Overall, the majority of university students had a positive attitude towards SSB intake (90.6%) but poor knowledge (51.7%) and poor practice (80.7%) levels. Gender and weight status were significantly related to the attitude and knowledge scores (p< 0.05). Conclusion: The prevalence of SSB intake among young adults should be addressed. Comprehensive education and intervention are vital to improving the knowledge and practice about proper SSB intake as part of healthy eating lifestyles.

Development and Validation of FFQ for Assessing SugarSweetened Beverages (SSB) and High-Energy Dense Foods Intake among Malaysian Adolescents

@#Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K > 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.

The Escalating Health Threats from Ultra-processed and High Fat, Salt, and Sugar Foods: Urgent Need for Tailoring Policy

With its colonial past, and a glaring problem of poverty and hunger, India oft fails to acknowledge a new, rapidly growing problem of overnutrition. With the economic boost and entry of various foreign players from the food industry, Indian citizens have been increasingly exposed to ultra-processed, high in sugar, salt and fat foods (HFSS foods). The last decade or so has seen an exponential rise in the consumption of such foods, leading to increasing prevalence of overweight- and obesity-related illnesses like diabetes, hypertension, etc. In this scenario, examining the efficacy of policy-related measures in reducing consumption of these harmful foods and preventing the associated health issues is paramount. Across the globe, several countries have explored options from taxation on HFSS foods to restricting marketing to children, as well as different practices for front of the pack labeling. In the context of India and its increasing burden of preventable, diet-related illnesses, the urgent need of instituting these preventive policies at national scale cannot be neglected.

Lessons learned from fostering tobacco taxes in the Americas and implications for other health taxes / Enseñanzas extraídas de la promoción de los impuestos al tabaco en las Américas e implicaciones para otros impuestos relacionados con la salud / Lições aprendidas com o incentivo a impostos sobre o tabaco nas Américas e implicações para outros impostos de saúde

ABSTRACT During the past decade progress has been made from a public health perspective in advancing tobacco taxation policies in the World Health Organization's Region of the Americas, and there are important lessons to be learned from this experience. This report aims to systematize and distill the key lessons learned, both by documenting progress and paving the way toward a comprehensive approach to taxing other health-harming products, particularly those considered to be drivers of the noncommunicable disease epidemic, such as alcohol and sugar-sweetened beverages. A thorough review of publications and institutional documents was undertaken and discussions were held with experts about the experiences of the past decade. Broadly, the lessons can be characterized according to the main mechanisms that have fostered progress. These are the robust, consistent and standardized monitoring of tobacco taxes that has enabled comparisons between countries and across time; the setting of tax policy within a framework of multisectoral policy coherence; and the development of guidelines and the generation of independent evidence to support tobacco taxes and tackle harmful industry interference. Currently, progress in these areas is lagging for taxes on alcohol and sugar-sweetened beverages. Applying the lessons learned from the extensive experience with tobacco taxation can help advance progress in taxes on alcohol and sugar-sweetened beverages and capture the potential synergies to be gained from building a comprehensive approach. Although more work is needed in developing and implementing taxation policies across all three products, the findings from this report can assist in strengthening their public health objectives to tackle noncommunicable diseases and improve population health.

RESUMEN Desde una perspectiva de salud pública, en los últimos diez años se ha avanzado en la formulación de políticas de aplicación de impuestos al tabaco en la Región de las Américas de la Organización Mundial de la Salud, y se pueden extraer importantes enseñanzas de esta experiencia. Este informe tiene como objetivo sistematizar y extraer las enseñanzas clave, tanto al documentar el progreso como al allanar el camino hacia un enfoque integral para gravar otros productos dañinos para la salud, particularmente los que se considera que están impulsando la epidemia de las enfermedades no transmisibles, como las bebidas alcohólicas y las bebidas azucaradas. Se llevó a cabo una revisión exhaustiva de las publicaciones y los documentos institucionales, y se celebraron debates con expertos sobre las experiencias del último decenio. En términos generales, las enseñanzas pueden caracterizarse según los principales mecanismos que han fomentado el progreso. Estos mecanismos son: un seguimiento sólido, sistemático y estandarizado de los impuestos al tabaco que ha permitido realizar comparaciones entre países y períodos; el establecimiento de políticas fiscales en un marco de coherencia de las políticas multisectoriales; y la formulación de pautas y obtención de evidencia independiente para apoyar los impuestos sobre el tabaco y hacer frente a la interferencia nociva de la industria. Actualmente, el progreso en estas áreas está rezagado en el caso de los impuestos sobre las bebidas alcohólicas y las bebidas azucaradas. La aplicación de las enseñanzas obtenidas en la amplia experiencia con la tributación del tabaco puede contribuir a avanzar en los impuestos sobre las bebidas alcohólicas y las bebidas azucaradas, así como a las posibles sinergias que se obtendrán de la elaboración de un enfoque integral. Aunque es necesario seguir trabajando más en la formulación y ejecución de políticas tributarias para los tres productos, los hallazgos de este informe pueden contribuir a fortalecer los objetivos de salud pública para abordar las enfermedades no transmisibles y mejorar la salud de la población.

RESUMO Na última década, sob a perspectiva da saúde pública, houve progresso no avanço das políticas de tributação do tabaco na Região das Américas da Organização Mundial da Saúde, e há lições importantes a serem aprendidas com essa experiência. Este relatório visa a sistematizar e sintetizar as principais lições aprendidas, documentando o progresso e abrindo o caminho para uma abordagem integral de tributação de outros produtos prejudiciais à saúde, especialmente produtos considerados fatores impulsionadores da epidemia de doenças não transmissíveis, como o álcool e as bebidas açucaradas. Realizou-se uma revisão completa de publicações e documentos institucionais e discussões com especialistas sobre as experiências da última década. De modo geral, as lições podem ser caracterizadas segundo os principais mecanismos que promoveram o progresso. São eles: o monitoramento robusto, consistente e padronizado dos impostos sobre o tabaco, o que permitiu fazer comparações entre países e ao longo do tempo; a criação de políticas fiscais em um marco de coerência multissetorial nas políticas; e o desenvolvimento de diretrizes e a geração de evidências independentes para apoiar os impostos sobre o tabaco e combater a interferência nociva da indústria tabagista. Atualmente, o progresso nessas áreas está atrasado em termos de impostos sobre o álcool e as bebidas açucaradas. A aplicação das lições aprendidas com a vasta experiência obtida com a tributação do tabaco pode ajudar a avançar nos impostos sobre o álcool e as bebidas açucaradas e capturar as potenciais sinergias obtidas com a elaboração de uma abordagem integral. Embora seja preciso mais trabalho para desenvolver e implementar políticas de tributação para os três produtos, os achados deste relatório podem ajudar a fortalecer os objetivos de saúde pública de combater as doenças não transmissíveis e melhorar a saúde da população.

Estudios recientes sobre bebidas azucaradas en Colombia: una revisión no sistemática / Recent studies on sugar sweetened beverages in Colombia: a non-systematic review

Este artículo presenta una revisión de la literatura reciente sobre el consumo de bebidas azucaradas (BA) en Colombia. A partir de una revisión no sistemática de literatura se escogieron 20 estudios, agrupados en las siguientes categorías: 5 realizados con base en la Encuesta Nacional de Situación Nutricional; 7 estudios subnacionales y 5 relacionados con impuestos a BA; los 3 restantes corresponden al abordaje de la prensa colombiana a las BA y a estrategias regulatorias para reducir su consumo. Inicialmente se presenta una síntesis de los principales hallazgos de cada uno de los estudios incluidos,seguido de una discusión a la luz de la bibliografía regional sobre el consumo de BA y las estrategias para reducir esa práctica. La revisión realizada permite afirmar que Colombia cuenta con información importante sobre el consumo de BA, por esa razón es momento de implementar políticas públicas efectivas que reduzcan el consumo de esos productos

This article presents a review of recent literature about the consumption of sugar sweetened beverages (SSBs) in Colombia. Based on a non-systematic review, 20 studies were chosen, which were grouped into the following categories: 5 carried out based on the National Survey of Nutritional Situation; 7 subnational studies and 5 related to taxes on SSBS; the remaining 3 correspond to the Colombian press's approach to SSB sand regulatory strategies aimed at reducing their consumption. Initially, the authors show a synthesis of the main findings of every research selected, then they are discussed in the light of the regional literature about sugar SSBs consumption and the strategies to reduce it. The review of the selected literature allows to affirm that Colombia has important information about the consumption of sugar sweetened beverages, for that reason it is time to take effective measures to reduce the consumption of these products.

Price Elasticity Of Demand And The Impact Of Taxing Sugar-Sweetened Beverages In Malaysia

@#The Malaysian government implemented an excise tax of MYR 0.40 per L on sugar-sweetened beverages in July 2019. Excise tax is imposed on sweetened drinks containing more than 5 g of sugar per 100 ml, flavoured Ultra High Temperature milk-based drinks, and fruit juices with more than 7 g and 12 g of sugar per 100 ml, respectively. We analysed the impact of excise tax on the consumption of SSBs by developing a demand model for SSBs to estimate the elasticity of demand using a two-way fixed-effect model. The tax increased the price of 1 L SSBs by 8.33%, and we estimated it to decrease the consumption of SSBs by 9.25%. The estimated own-price elasticity of demand for SSBs was −1.11 (95% CI: −1.97 to −0.25). Price of SSB is a determinant for SSB demand, but income or the price of milk are not. The estimated excise revenue calculated was MYR 357.61 million. However, industry responses via product reformulation and pass-through rates could reduce revenue and enhance or reduce health impacts.

Association Between Sugar-Sweetened Beverage Consumption And Body Mass Index Among University Students In Kuala Nerus, Terengganu, Malaysia

@#Overweight and obesity are major health concerns in Malaysia, which are linked to other health consequences such as type 2 diabetes mellitus, cardiovascular diseases and several others. Among dietary factors, sugar-sweetened beverages (SSBs) are reported to be one of the leading factors of weight gain and a higher body mass index (BMI). Sugar-sweetened beverages are beverages with added sugar that only add calories to an individual’s normal diet and they represent the largest contributor to the added sugars intake. This study was aimed to determine the prevalence of SSB consumption among university students in Kuala Nerus, Terengganu, as well as to investigate the association between the students’ SSB consumption and their BMI. A cross-sectional study was conducted among 350 Universiti Sultan Zainal Abidin (UniSZA) Gong Badak Campus and Universiti Malaysia Terengganu (UMT) students by using the convenience sampling. Each participant was given a questionnaire consisting of socio-demographic details, anthropometric assessment and beverage intake. The results revealed that half of the students consumed 2 cups (500 mL) of SSBs on average days (49.4%), whereas 21.7% of them consumed at least 3 cups daily. It was found that sweetened tea was the students’ most preferred SSB and there was also an association between the SSB consumption and the BMI. In conclusion, university students in Kuala Nerus drink 2 cups of SSBs daily and sweetened tea is their preferred SSB. Since the students’ SSB consumption influences their BMI, these students must be aware on the contents of SSB and the related health consequences in order to reduce the consumption of these beverages and hence, reduce their BMI to a healthy level.

Sugar-sweetened beverages consumption in midlife and risk of late-life cognitive impairment in Chinese adults / 中华流行病学杂志

Objective@#To evaluate whether midlife consumption of sugar-sweetened beverages (SSBs), including juices and soft drinks, were associated with late-life cognitive impairment in Chinese adults.@*Methods@#Follow up was conducted for participants from Singapore Chinese Health Study, a population-based prospective cohort, for 16-23 (mean 20) years. The information about their SSBs consumption were collected at baseline survey from 1993 to 1998 by using a validated food frequency questionnaire and their cognition status were evaluated by using a Singapore-modified Mini-Mental State Examination Scale in the 3rd follow-up visit during 2014- 2016. Multivariable logistic regression models were used to estimate the ORs and 95%CIs.@*Results@#A total of 16 948 participants were included in the analysis and 2 443 of them were identified as cognitive impairment using education-specific cutoffs. Sex, age, ancestral home, education level, physical activity level, total diet fiber intake level, BMI, alcohol drinking were significantly associated with cognitive impairment (P<0.05). After adjusted the above variables, potential dietary variables and disease status, no significant association was observed between SSBs consumption and cognitive impairment (P>0.05). Compared with those who never or hardly ever drank soft drinks, no significant differences in cognitive impairment risk were observed for those who drank soft drinks 2 or more times a week (OR=0.91, 95%CI: 0.77-1.08), those who drank 1 time a week (OR=1.00, 95%CI:0.82-1.23) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.80-1.09) (trend P=0.306). Compared with those who never or hardly ever drank juices, no significant differences in cognitive impairment risk were observed for those who drank juices 2 or more times a week (OR=1.03, 95%CI:0.88-1.20), those who drank 1 time a week (OR=0.96, 95%CI: 0.82-1.12) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.82-1.08) (trend P=0.930). No significant interactions were found with age, sex, and BMI status.@*Conclusion@#SSBs consumption in midlife was not significantly associated with risk of late-life cognitive impairment in Singaporean Chinese adults with relatively low consumption levels. Further researches are needed to verify the results.

Sugar-sweetened beverages consumption in midlife and risk of late-life cognitive impairment in Chinese adults / 中华流行病学杂志

To evaluate whether midlife consumption of sugar-sweetened beverages (SSBs), including juices and soft drinks, were associated with late-life cognitive impairment in Chinese adults. Follow up was conducted for participants from Singapore Chinese Health Study, a population-based prospective cohort, for 16-23 (mean 20) years. The information about their SSBs consumption were collected at baseline survey from 1993 to 1998 by using a validated food frequency questionnaire and their cognition status were evaluated by using a Singapore-modified Mini-Mental State Examination Scale in the 3(rd) follow-up visit during 2014- 2016. Multivariable logistic regression models were used to estimate the and 95s. A total of 16 948 participants were included in the analysis and 2 443 of them were identified as cognitive impairment using education-specific cutoffs. Sex, age, ancestral home, education level, physical activity level, total diet fiber intake level, BMI, alcohol drinking were significantly associated with cognitive impairment (0.05). Compared with those who never or hardly ever drank soft drinks, no significant differences in cognitive impairment risk were observed for those who drank soft drinks 2 or more times a week (=0.91, 95: 0.77-1.08), those who drank 1 time a week (=1.00, 95:0.82-1.23) and those who drank 1-3 times a month (=0.94, 95: 0.80-1.09) (trend =0.306). Compared with those who never or hardly ever drank juices, no significant differences in cognitive impairment risk were observed for those who drank juices 2 or more times a week (=1.03, 95:0.88-1.20), those who drank 1 time a week (=0.96, 95: 0.82-1.12) and those who drank 1-3 times a month (=0.94, 95: 0.82-1.08) (trend =0.930). No significant interactions were found with age, sex, and BMI status. SSBs consumption in midlife was not significantly associated with risk of late-life cognitive impairment in Singaporean Chinese adults with relatively low consumption levels. Further researches are needed to verify the results.

Unhealthy food consumption and prevalence of overweight and obesity of school children aged 6-11 years old / Монголын Анагаах Ухаан

Background @#Overweight and obesity are conditions of over nutrition resulting from consumption of more calories than the body requires leading to excess body fat accumulation. The prevalence of both overweight and obesity is increasing globally in all age groups in high, middle, and low-income countries and is largely attributed to the “nutrition transition” with a shift from traditional diets to readily available and inexpensive, low-nutrient unhealthy foods high in energy [1]. </br> The move away from traditional to “junk” foods often occurs at the same time as the move of populations away from daily physical activity and increase in sedentary activities such as time spent in front of a phone, computer, or television, furthering increasing the risk of becoming overweight. People who are overweight or obese are at higher risk for serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis. The increase in overweight and obesity is accompanied by a dramatic increase in prevalence of above mentioned chronic conditions in the worldwide. While the long-term repercussions of overweight and obesity are severe, they are largely preventable and treatable through healthy diets and healthy lifestyle behaviors [2].@*Materials and Methods@#The fifth National nutrition survey (NNSV) was implemented in 21 provinces (aimags) in 4 socio-economic regions (Central, Eastern, Khangai, and Western) and the capital city of Ulaanbaatar. Given the regional differences in dietary patterns and nutrition status, target populations were stratified into 5 strata based on 4 regions and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design. In total, 1750 school children data on demographic and dietary information collected by interview methods and anthropometric measurement results were used in this study. @*Ethical considerations@#The survey protocol was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted by order of director of Scientific committee of PHI on 28th June, 2016. Ethical approval for conducting the NNS V was obtained from the Medical Ethics Committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent were obtained from adult caregivers of each children. @*Results@#Consumption of unhealthy or junk (high-calorie, low-nutrient) foods in the past week was nearly universal (99.0%) among school children 6-11 years of age. Over half of children (51.4%) consumed junk foods at least once per week and 45.7% consumed junk foods a few times a week. Consumption of sugar-sweetened beverages was high with 80.9% of children consuming these at least once in the past week. Overall consumption of fried foods was lower than consumption of junk foods or sugar-sweetened beverages with 22.7% of children not consuming any fried foods in the past week and only 8.5% of children consuming fried foods a few times per week. Consumption of sweet foods was high with nearly all children having consumed sweet foods in the past week, 45.9% of children 6-11 years having consumed sweet foods a few times per week. </br> The prevalence of overweight (BMI > +1 SD) was 22.2% and prevalence of obesity (BMI > +2 SD) was 6.4%. Overweight prevalence was higher in boys (26.6%) compared to girls (17.8%) and in urban (23.9%) compared to rural (17.6%) areas with the highest prevalence in Ulaanbaatar (25.6%) compared to other regions. Children 6 years old (26.1%) and 7 years old (25.6%) had a higher prevalence of overweight than older children.@*Conclusion@#</br> 1. Consumption of unhealthy foods and drinks is common to 6-11 year olds group, with almost all children (99.2%) consuming any type of unhealthy foods and drinks at least once per week, in particular, 8 out of 10 children were found consuming sugary drinks and/or deep fried food. </br>2. The consumption of unhealthy foods was not differing by child’s sex, there were revealed significant differences between living area and regions. Proportion of the school children 6-11 years of age was relatively higher in Ulaanbaatar city and urban settings. </br>3. The prevalence of overweight and obesity in school children aged 6-11years sharply increased from 2010 NNS IV level and reached 22.2% and 6.4%, respectively. Among children with obesity consumption of any unhealthy foods and sugary drinks were 1.4–1.9 times higher than nonobese children, respectively.

Consumption of sugar-sweetened carbonated beverage and juice/fruit-flavored drink among residents aged 15 years and above in 2013 in Shanghai / 上海预防医学

Objective To determine the consumption of sugar-sweetened carbonated beverage and juice/fruit-flavored drink among residents aged 15 years and above in 2013 in Shanghai. Methods Data was extracted from the 2013 Shanghai Non-communicable Disease and Risk Factors Surveillance, in which multi-stage cluster sampling was performed.A total of 25 657 subjects aged ≥15 years across the city were selected for analysis. Results In the study, 34.42% (95%CI:32.33%-36.51%) and 37.85% (95%CI:35.37%-40.32%) of the subjects consumed sugar-sweetened carbonated beverage and juice/fruit-flavored drink in 2013 in Shanghai.The proportions declined with age (P for trend < 0.001), while increased with education level (P for trend < 0.001).They were 65.28% and 69.82% among students, which were much higher than other occupations.Men consumed more sugar-sweetened carbonated beverage than women (37.31% vs 31.37%), whereas less juice/fruit-flavored drink (36.14% vs 39.65%).Among the subjects consumed sugar-sweetened carbonated beverage (n=6 254) or juice/fruit-flavored drink (n=6 701), 52.20% (95%CI:49.41%-54.98%) and 54.04% (95%CI:51.09%-56.98%) consumed 1-3 times a week.The daily average amount of sugar-sweetened carbonated beverage and juice/fruit-flavored drink were 98.64 mL (95%CI:88.92-108.37) and 88.85 mL (95%CI:73.73-103.97), respectively, which were higher among the young (< 45 years old), male and students. Conclusion In 2013 in Shanghai, the consumption of sugar-sweetened carbonated beverage and juice/fruit-flavored drink is highly prevalent among residents aged 15 years and above, especially among the young, male, well-educated and students.Intervention should be tailored to reduce the consumption among at-risk population.