Nutrient content of 122 kinds of retail handcrafted milk tea products in Shanghai / 环境与职业医学

Background The retail milk tea industry is in a period of rapid development, but there is little research on its nutrient content, which restricts the nutritional guidance of milk tea. Objective To determine the levels of nutrients in best-selling handcrafted milk tea in Shanghai and analyze the nutritional characteristics. Methods In 2018 and 2021, a total of 13 handcrafted milk tea brands with ≥3 branch stores in Shanghai were selected by searching for milk tea on Meituan and Ele.me food delivery platforms, and a total of 122 types of handcrafted milk tea products were collected from the top three sales [milk tea (including all sweetness levels available), milk cover tea, and fruit tea]. National standard methods were used to detect energy, protein, fat, carbohydrate, sugar, trans fatty acid, calcium, caffeine, and tea polyphenol. Results The median energy of the milk tea samples was 310 kJ (per 100 g sample). The main sources of energy were carbohydrate and fat. The levels of energy, protein, and fat in milk cover tea and milk tea were significantly higher than those in fruit tea (P＜0.05), and there was no significant difference in carbohydrate among them. The total sugar, fructose, and glucose levels in milk tea were significantly lower than those in milk cover tea and fruit tea, and the lactose level in fruit tea was significantly lower than those in milk tea and milk cover tea (P＜0.05). Themedian trans fat acid level in milk cover tea was higher than that in milk tea (P＜0.05). The median levels of caffeine and tea polyphenol were higher in milk tea than in milk cover tea (P＜0.05). The levels of energy, carbohydrate, sucrose, total sugar, and calcium in milk tea were positively correlated with the number of ingredients added (0-3) (r=0.386, 0.371, 0.238, 0.698, 0.466, respectively, P < 0.05). The levels of energy, carbohydrate, and total sugar tended to increase with increasing sweetness (P<0.05), and total sugar was mainly sucrose, followed by fructose and glucose. The total sugar levels of the samples labeled sugar free, light sugar, half sugar, less sugar, and regular sugar were 3.40 (2.20, 4.9), 4.97 (4.25, 5.97), 5.80 (4.31, 6.88), 6.59 (5.17, 8.53), and 7.96 (6.82, 9.20) g, respectively; the proportions of the samples containing more than 0.5 g of total sugar were 93.3% for sugar free milk tea, 47.4% for light sugar milk tea, and 94.0% for regular sugar milk tea; the proportion of the regular sugar samples with sugar content greater than 10 g was 18.0% (all samples with nominal sugar content were measured per 100 g). Conclusion The retail handcrafted milk tea in Shanghai is characterized by high energy, high added sugar, high fat, and low protein. It is necessary to standardize the added sugar content and sweetness labeling, strengthen the nutrition education of milk tea, and guide residents to limit its intake.

Raising awareness of health risks of added sugar and limiting its excessive intake / 环境与职业医学

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.

Progress on the relationship between consumption of added sugar and incidence of gynecologic cancer / 公共卫生与预防医学

Globally, gynecological malignancies are common types of female cancer and the main cause of cancer death among women. Cervical cancer, endometrial cancer and ovarian cancer, which are the main types of gynecological cancers, pose a significant threat to women's health worldwide. Studies have shown that diet plays an important role in the occurrence and development of gynecological cancers such as cervical cancer, endometrial cancer, and ovarian cancer, for which added sugar may be an influencing factor due to its food source characteristic and related biological effect. However, this paper reviewed the research progress on the relationship between consumption of added sugar and gynecological cancers such as endometrial cancer, ovarian cancer and cervical cancer, with a view to providing a reference for the active prevention of gynecological cancer.

Ultra-Processed Food Classification, their Contribution to Sodium and Added Sugar Availability, and its Relationship with Nutritional Status among Adults in Terengganu, Malaysia

@#Introduction: This cross-sectional study aims to determine the provision of foods according to NOVA classifications (an ultra-processed classification), to assess contribution of sodium and added sugar availability in each of NOVA food groups, and to evaluate nutritional status as well as to determine the relationship between sodium, added sugar availability of each NOVA foods groups and nutritional status among adults in Terengganu. Materials and methods: About 200 respondents aged between 18 and 59 years old from Kuala Nerus, Terengganu were recruited. Their dietary intake from two days of 24-hour dietary recall underwent NOVA classification and analyzed through Nutritionist Pro. All respondents had their blood pressure and fasting blood glucose taken. Spearman’s rank correlation was used to evaluate the relationship between sodium and added sugar each of NOVA food groups and the nutritional status. Results: The total energy intake of the respondents was 1818 kcal + 375.05 per day. The energy contribution of ultra-processed group was 24%. The sodium and added sugar contribution of ultra-processed group were 26% and 63%, respectively. The mean blood pressure and median of blood glucose were normal at 114/79 mmHg and 5.3 mmol/L, respectively. No significant correlation was found between sodium, added sugar availability of each NOVA food groups and nutritional status at p<0.05. Conclusion: Further studies involving vigorous research design need to be carried out in order to really understand the implication of ultra-processed food consumption towards the nutritional status of Malaysian population, as highlighted in the Malaysian Nutrition Research Priorities (2016-2020).

Consumption of Added Sugars and Lipid Profiles in Korean Population from a Cohort Study

OBJECTIVES: The purpose of the study was to examine the relationship between added sugar consumption and dyslipidemia. METHODS: Final study subjects consisted of 18,713 participants after the exclusion of participants with dyslipidemia or under lipid lowering medications at baseline. Added sugar levels were categorized into tertiles [men: Low or =22.0 g; women: Low or =15.0 g]. Dyslipidemia was analyzed based on two of the most recent guidelines identified from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the 2009 Korean Society of Lipidology and Atherosclerosis (KSLA). We used Kaplan-Meier and Cox proportional hazard models to estimate the hazard ratio (HR) with 95% confidence interval (CI) of dyslipidemia. RESULTS: High added sugar was associated with hypercholesteremia (HR, 1.22; 95% CI, 1.06-1.40), high LDL cholesterolemia (1.29; 1.13-1.48), and low HDL cholesterolemia (1.26; 1.10-1.44) based on the KSLA Standard in men. In women, the high added sugar was only related to the risk for hypercholesteremia (1.26; 1.07-1.49) based on the KSLA Standard. A similar trend was shown in both men and women with application of NCEP-ATP III standard. CONCLUSION: In this study, an increase in added sugar consumption was associated with an increased risk of dyslipidemia in men. Additional studies assessing the association between cardiovascular and other diseases should be conducted in the future.

Influence of rice and added sugar intakes on fasting plasma glucose and triacylglycerol levels amongst a population sample of Malaysian adults

Introduction: A recently published meta-analysis showed that each additional serving of rice increased risk of type 2 diabetes mellitus (DM) by an alarming 11%. We investigated whether this phenomenon is seen in the Malaysian population by studying the effect of rice intake and added sugar consumption on fasting plasma glucose (FPG) and fasting triacylglycerol (TAG). Methods: Ninety subjects (60 females, 30 males, aged 30-70 years), adequate to detect a weak-to-moderate Pearson correlation of r=0.26 at a=0.05 and power= 0.80, were recruited by convenience sampling from six communities in the Klang Valley, Malaysia. Fasting blood samples were collected by finger-prick and analysed for FPG (AccuCek, Roche) and TAG (Accutrend, Roche). Macronutrient intakes, including rice, were obtained by a single interview using a previously-evaluated food frequency questionnaire (FFQ) and quantitated as grams by the DietPLUS V2 programme. Added sugar intakes by subjects were estimated using an Added Sugar Intake excel programme. Results: Rice contributed to 85% of dietary carbohydrates, accounting for 41.8 % kcal of the average 1750- kcal diet. Rice intakes or added sugar consumption did not have a significant correlation (p>0.05) with FPG nor fasting TAG. Added sugar consumption, which averaged 44g/person/day (5% kcal) was markedly lower than the 137g/person/day reported elsewhere for the Malaysian population. Conclusion: High consumption of rice as a risk factor of type 2 DM was not indicated in the present study. Since white rice consumption varied 10-fold in the present subjects, the reduction in daily intake of this staple food represents a feasible option for cutting back on calorie intake for overweight or obese individuals.

Development and Validation of a Food Frequency Questionnaire (FFQ) for Assessing Sugar Consumption among Adults in Klang Valley, Malaysia

Introduction: The aim of this study was to develop and validate a semiquantitative food frequency questionnaire (FFQ) for assessing habitual added sugar consumption of adults in the Klang Valley. Methods: In the development phase, a 24-hour dietary recall (24-hr DR) was used to determine food items to be included into the FFQ among adults from three major ethnicities (n=51). In the validation phase, the FFQ was further validated against a reference method which was a multiple-pass 24-hr DR among 125 adults in Klang Valley. The response rate for the latter phase was 96.1%. Results: The semi-quantitative FFQ consisting of 64 food items was categorised into 10 food groups. The mean added sugar intake determined by the reference method was 44.2 ± 20.2 g/day while that from the FFQ was 49.4 ± 21.4 g/day. The difference in mean intake between the two methods was 5.2 g (95% CI = 2.6-7.9; SD = 14.9, p<0.05) or 11.8%. Pearson correlation was r=0.74 (p<0.001) for the two methods while Spearman rank correlations for the various food groups ranged between 0.11 (cake and related foods) to 0.61 (self-prepared drinks), with most groups correlating significantly (p<0.05). Cross-classification of subjects into quintiles of intake showed 47.2% of the subjects correctly classifying into the same quintile, 34.4% into adjacent quintiles while none were grossly misclassified. The Bland-Altman plot was concentrated in the y-axis range (-24.14 g to 34.8 g) with a mean of 5.22 g. Conclusion: This semi-quantitative FFQ provides a validated tool for estimating habitual intake of added sugar in the adult population of the Klang Valley.

A Survey on Added Sugar Intakes from Snacks and Participation Behaviors of Special Event Days Sharing Sweet Foods among Adolescents in Korea

This study was performed to investigate added sugar intakes from processed food-snacks and participation behaviors of special event days sharing sweet foods among adolescents in Korea. Questionnaire survey (n = 959), dietary survey (n = 71) by food record method for 3 days, and snack survey (n = 230) for 3 days were carried out, and subjects were overlapped among three surveys. As a result, middle school students (MS) preferred milks and fermented milks while high school students (HS) preferred breads and fast foods as a snack (p < 0.01). MS and HS took snacks three to six times a week, and HS took snacks more frequently than MS (p < 0.05). Most subjects participated in special event days sharing sweet foods such as friend's birthday (68.4%), Peppro's day (61.5%) and Valentine's day (42.6%). As for merits of these events, MS said 'they could get along with their friends' and 'relieve stress', while HS said 'they could enjoy their own events' and 'confess their affection to whom they like' (p < 0.01). A group of cookies, biscuits, breads and, cakes was major source of added sugars followed by beverages, sweet jellies of red bean, chocolates and candies for subjects. For MS and HS, daily total added sugar intakes from whole processed food-snacks were 30.5 +/- 23.5 g/d (3.0-137.9 g/d) and 31.7 +/- 23.2 g/d (1.2-126.1 g/d), and ratios of daily total energy taken from added sugars of whole processed food-snacks in proportion to daily total energy taken from diet (energy percent of added sugars from snacks) were 6.3 +/- 4.7% (0.6-26.1%) and 6.3 +/- 4.4% (0.3-23.9%), respectively. These results showed that subjects frequently participated in special event days sharing sweet foods. In addition, energy percent of added sugars from snacks was more than the UL suggested by WHO/FAO for some subjects. Therefore, it is highly critical to monitor adolescents' sugar intakes on a long-term basis and to take nutritional management on their high sugar intakes.