Public-Private Partnerships in Mexico: Implications of Engaging With the Food and Beverage Industry for Public Health Nutrition.

BACKGROUND: In the last few years, Mexico adopted public health policies to tackle non-communicable diseases (NCDs), such as front of package nutrition labelling, food marketing restrictions to children, and a soda tax. In parallel, transnational food and beverage industries (F&BIs), their allies, and the government have agreed on public-private partnerships (PPPs) to implement policies or deliver programs. However, research has questioned the benefits of PPPs and exposed its limitations as a suitable mechanism to improve public health. This study analyses how four PPPs between the Mexican government, the F&BI, and allies are working to achieve their goals. We critically assessed the objectives, scope, reported impacts, governance principles and perceived risks and benefits for the public health agenda of these PPPs. METHODS: This qualitative study is based on 26 interviews with key actors, and 170 publicly available documents, including 22 obtained through freedom of information (FOI) requests related to four purposively selected PPPs aiming to improve health. RESULTS: We found that the four PPPs studied had minimal public information available on their implementation and impact. The private partners tend to dictate the design, information management, and implementation of the programs, while promoting their brands. Few independent evaluations of the PPPs exist, and none reported on their effectiveness or public health benefits. Good governance principles, such as accountability, transparency, fairness, participation, integrity, and credibility, were barely followed in each of the cases studied. Public officials did not automatically question the conflict of interest (CoI) of such arrangements. When there were COI, the potential risks these posed did not always outweigh the financial benefits of working with the F&BI and its allies. CONCLUSION: The four PPPs studied produced minimal gains for public health while boosting credibility for the participating transnational F&BIs. It shows the lack of awareness of how these PPPs might be hindering public health gains.

Green one-step synthesis of N-doped carbon quantum dots for fluorescent detection of lemon yellow in soft drinks.

A new fluorescent sensor for the determination of lemon yellow was developed based on nitrogen-doped carbon quantum dots (N-CQDs), which were prepared via a hydrothermal method with dried pomelo peel and L-tyrosine. The N-CQDs exhibited the blue fluorescence with a quantum yield of 28 %. The sensing principle of N-CQDs was quenched by lemon yellow via static quenching. The potential interfering substances showed no influence on the detection of lemon yellow. The limit of detection was 0.023 mg/L and lower than that of national standard. Furthermore, the synthesized N-CQDs have been successfully applied to the measurement of lemon yellow in real samples. Hence, the N-CQDs would be a promising sensor in food analysis.

Hypokalaemia associated with excessive cola-flavoured drinks consumption.

We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.

Current Status and Family Factors Influencing Caries in the Deciduous Teeth of Children 3-6 Years of Age in Families Residing in Rural Heishanzui Township.

PURPOSE: To determine the caries status in children's deciduous teeth and examine the influence of family oral health behaviours on the caries status. MATERIALS AND METHODS: This cross-sectional study included 329 children aged 3-6 years in rural Heishanzui Township, Hebei Province, China, and used a completely random sampling method. These children underwent physical and oral health examinations. The questionnaires were given to the parents and caregivers of the examined children. RESULTS: The prevalence of caries in the deciduous dentition among children aged 3-6 years was 80.55%, with a dmft index of 4.93. Children in the caries group ate sweets, chocolates, and carbonated drinks more frequently than did children in the caries-free group (p < 0.05). Children in the caries-free group brushed their teeth more frequently, with parents helping their children brush, more often than did those in the caries-affected group (p < 0.05). The level of parental education and annual household income also had statistically significant effects on the prevalence of caries in the two groups (p < 0.05). Logistic regression analysis revealed that the frequency of eating sweets was a risk factor for caries in deciduous teeth (odds ratio = 2.20; p < 0.05). CONCLUSION: The prevalence of caries in deciduous teeth among children aged 3-6 years in rural Heishanzui Township was high. Compared to children in the caries-affected group, the families and children in the caries-free group had better oral hygiene behaviours. Moreover, the frequency of eating sweets was shown to be a risk factor for caries in deciduous teeth in children aged 3-6 years.

Assessment of anthropogenic particles content in commercial beverages.

Microplastic (MPs) pollution is a current global concern that is affecting all environmental compartments and food sources. In this work, anthropogenic particles occurrence (MPs and natural and synthetic cellulosic particles), have been determined in 73 beverages packed in different containers. Overall, 1521 anthropogenic particles were found, being the lowest occurrence in water samples (7.2 ± 10.1 items·L-1) while beer had the highest (95.5 ± 91.8 items·L-1). Colourless/white particles were the most detected followed by blue and red colours. The highest mean size was 783 ± 715 µm in soft drinks. Cellulosic, both natural and semisynthetic particles, were the composition mostly found but regarding plastic polymers, it was polyester. Phenoxy resin particles from the can coatings were also identified in all metal containers which indicates that leaching from the packaging may be happening. The total estimated daily intake were 0.077 and 0.159 items·kg-1 body weight (b.w.)·day-1 for children and adult population, respectively.

Adherence to the national guidance on foods and drinks to limit or avoid during pregnancy in England: the PEAR Study.

OBJECTIVE: The National Health Service (NHS) England website provides guidance on foods/drinks to avoid or limit during pregnancy because of microbiological, toxicological or teratogenic hazards. The aims were to determine adherence and whether demographic characteristics were associated with adherence. DESIGN: Cross-sectional study. SETTING: Online survey of postpartum women resident in England during pregnancy. PARTICIPANTS: Recently, postpartum women resident in England during their pregnancy (n 598; median age 33 (IQR 30-36) years) completed an online questionnaire (April-November 2022). Questions included those on consumption of twenty-one food/drink items that the NHS advises pregnant women to avoid/limit. The study is part of the Pregnancy, the Environment And nutRition (PEAR) Study. Summary statistics were used to determine proportions adhering to the guidance. Adjusted logistic regression was used to model the associations of adherence with demographic characteristics. RESULTS: Adherence was generally high (>90 % for eight of ten food/drink items to be avoided). However, among pre-pregnancy consumers, several items were not completely avoided, for example, 81 % (128/158) for game meat/gamebirds, 37 % (176/478) for cured meats and 17 % (81/467) for soft cheeses. Greater educational attainment (e.g. caffeinated soft drinks OR 2·25 (95 % CI 1·28, 3·94)), greater maternal age (e.g. oily fish 1·64 (1·05, 2·56)) and lower parity (e.g. caffeinated coffee 0.28 (0.11, 0.69)) were the most usual characteristics associated with adherence. CONCLUSION: Evidence of concerning levels of non-adherence for some food/drink items suggests a case for more education on some of the guidance, particularly for women with lower educational attainment, greater parity and greater maternal age. Further research on barriers to the implementation of the guidance is needed.

Association between soft drinks intake and low glomerular filtration rate in Mexican adults: Results from RenMex.

BACKGROUND & AIMS: To evaluate the association between soft drinks (SDs) consumption and estimated glomerular filtration rate (eGFR) in a Mexican adult population. METHODS: We used data from the RenMex consortium (n = 2095) that included the Mexican Teachers Cohort Study (34-65 years), the Health Workers Cohort Study (18-90 years), and the Comitán Study (19-91 years). In this cross-sectional study, we assessed SDs consumption (cola and flavored soda) using a food frequency questionnaire (FFQ) and estimated eGFR using the CKD Epidemiology Collaboration equation. Quantile regression was used to assess the association between SDs consumption and eGFR with eGFR as a continuous variable. Multinomial logistic regression models were used for eGFR categories derived from quantile regression (mildly decreased eGFR, ≥72.9-87.9 mL/min/1.73 m2 and moderately decreased eGFR, <72.9 mL/min/1.73 m2). RESULTS: Mean age of study participants was 47.2 years, 67.5% were women, and 12.2% had diabetes. eGFR was <60 mL/min/1.73 m2 in 3.7% of study participants. Mildly decreased eGFR was present in 14.8%, and moderately decreased eGFR was present in 10.1% of study participants. Quantile regression results showed that SDs consumption was associated with lower eGFR at the 10th, 25th, 50th and 75th percentile. Based on the final adjusted multinomial model, ≥7 servings/week was positively associated with moderately decreased eGFR relative to <1 serving/week (Relative Risk Ratio = 1.95; 95% CI: 1.07-3.57). CONCLUSION: Our results suggest that higher SDs consumption is associated with lower eGFR. Encouraging healthy dietary choices should be part of the management and prevention of CKD.

Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study.

BACKGROUND: The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England. METHODS AND FINDINGS: We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males. CONCLUSIONS: We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.

Association of consumption of sugar-sweetened beverages with elevated blood pressure among college students in Yunnan Province, China.

OBJECTIVE: Although some studies have examined the association between eating behaviour and elevated blood pressure (EBP) in adolescents, current data on the association between sugar-sweetened beverages (SSB) and EBP in adolescents in Yunnan Province, China, are lacking. SETTING: Cluster sampling was used to survey freshmen at a college in Kunming, Yunnan Province, from November to December. Data on SSB consumption were collected using an FFQ measuring height, weight and blood pressure. A logistic regression model was used to analyse the association between SSB consumption and EBP, encompassing prehypertension and hypertension with sex-specific analyses. PARTICIPANTS: The analysis included 4781 college students. RESULTS: Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 35·10 % (1678/4781) and 39·34 % (1881/4781) of patients, respectively. After adjusting for confounding variables, tea beverage consumption was associated with elevated SBP (OR = 1·24, 95 % CI: 1·03, 1·49, P = 0·024), and carbonated beverage (OR = 1·23, 95 % CI: 1·04, 1·45, P = 0·019) and milk beverage (OR = 0·81, 95 % CI: 0·69, 0·95, P = 0·010) consumption was associated with elevated DBP in college students. Moreover, fruit beverage (OR = 1·32, 95 % CI: 1·00, 1·75, P = 0·048) and milk beverage consumption (OR = 0·69, 95 % CI: 0·52, 0·93, P = 0·014) was associated with elevated DBP in males. CONCLUSION: Our findings indicated that fruit and milk beverage consumption was associated with elevated DBP in males, and no association was observed with EBP in females.

Post-treatment of soft drink industrial wastewater using a new antibacterial ultra-filtration membrane prepared of Polyethersulfone blended with boehmite-tannic acid-graphene quantum dot.

Polymeric membranes have garnered great interest in wastewater treatment; however, fouling is known as their main limitation. Therefore, the blending of hydrophilic nanoparticles in polymeric membranes' structure is a promising approach for fouling reduction. Herein, a hydrophilic boehmite-tannic acid-graphene quantum dot (BM-TA-GQD) nanoparticle was synthesized and blended in a polyethersulfone polymeric membrane in different percentages. The fabricated membranes were characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM) images, water contact angle, porosity measurement, and antibacterial and antifouling properties. Surface SEM images of the modified membranes showed good dispersion of nanoparticles up to 0.5 wt%, which resulted in hydrophilicity and pure water flux enhancement. Based on AFM images, the mean roughness (Sa) of the fabricated membranes decreased from 2.07 to 0.84 nm for the bare and optimum membranes, respectively. In terms of performance, increasing the nanoparticle percentages up to 0.5 wt% resulted in the flux recovery ratio developing from 44.58% for the bare membrane to 71.35% for the 0.5 wt% BM-TA-GQD/PES membrane (optimum membrane). The antibacterial property of fabricated membranes was studied against biologically treated soft drink industrial wastewater (BTSDIW) as a bacterial source. The results showed that the turbidity of solutions containing permeated wastewater from the modified membranes (0.1, 0.5, and 1 wt% of BM-TA-GQD) was lower than that obtained from the unmodified membrane. These results confirmed the antibacterial properties of fabricated membranes. Finally, the optimal membrane (0.5 wt% BM-TA-GQD) was examined for post-treatment of the BTSDIW. An effluent COD of 13 mg/L and turbidity of 2 NTU showed a successful performance of the filtration process. PRACTITIONER POINTS: Ultrafiltration PES membranes were modified by different loadings of BM-TA-GQD. Hydrophilicity improvement was achieved by adding BM-TA-GQD nanoparticles. Expansion of size and number of macro-voids in modified membranes was confirmed. Membrane roughness was reduced in the BM-TA-GQD blended membranes. The optimum membrane was efficient in COD and turbidity removal.

Maternal caffeine, coffee and cola drink intake and the risk of gestational diabetes - Kuopio Birth Cohort.

AIMS: Coffee intake is associated with a decreased risk of type 2 diabetes among non-pregnant people. We aimed to investigate the association between caffeine, coffee and cola drink intake in early pregnancy and the risk of gestational diabetes (GDM). METHODS: Kuopio Birth Cohort (KuBiCo) is a prospective cohort study including pregnant women who were followed at the prenatal clinics in outpatient healthcare centers and gave birth in Kuopio University Hospital, Finland (n=2214). Maternal diet during the first trimester of pregnancy was assessed using a 160-item food frequency questionnaire. GDM was diagnosed by oral glucose tolerance test according to the Finnish national guidelines mainly between 24 and 28 gestational weeks. RESULTS: Women with moderate coffee intake in the first trimester were less likely diagnosed with GDM than women without coffee intake in an age-adjusted model (OR 0.87; 95% CI 0.76-0.99; p = 0.03), but the association was attenuated in multi-adjusted models (p = 0.11). No association was found between caffeine intake and GDM. One third (32.4%) of pregnant women consumed caffeine over the recommendation (> 200 mg/d). Women who consumed cola drinks more than the median (33.3 mL/d) had an increased risk of GDM (OR 1.29; 95% CI 1.02-1.63, p = 0.037) in multi-adjusted model compared to those who consumed less. CONCLUSIONS: Caffeine intake during the first trimester of pregnancy was not associated with the risk of GDM but a minor non-significant decrease was seen with moderate coffee intake. Although the average consumption of cola drinks was low in the KuBiCo cohort, higher consumption was associated with an increased risk of GDM. Further studies are needed to evaluate the safe amount of coffee during pregnancy, since the recommended caffeine intake was exceeded in almost half of the coffee drinkers.

Parliamentary reaction to the announcement and implementation of the UK Soft Drinks Industry Levy: applied thematic analysis of 2016-2020 parliamentary debates.

OBJECTIVE: The UK Soft Drinks Industry Levy (SDIL) (announced in March 2016; implemented in April 2018) aims to incentivise reformulation of soft drinks to reduce added sugar levels. The SDIL has been applauded as a policy success, and it has survived calls from parliamentarians for it to be repealed. We aimed to explore parliamentary reaction to the SDIL following its announcement until two years post-implementation in order to understand how health policy can become established and resilient to opposition. DESIGN: Searches of Hansard for parliamentary debate transcripts that discussed the SDIL retrieved 186 transcripts, with 160 included after screening. Five stages of Applied Thematic Analysis were conducted: familiarisation and creation of initial codebooks; independent second coding; codebook finalisation through team consensus; final coding of the dataset to the complete codebook; and theme finalisation through team consensus. SETTING: The United Kingdom Parliament. PARTICIPANTS: N/A. RESULTS: Between the announcement (16/03/2016) - royal assent (26/04/2017), two themes were identified 1: SDIL welcomed cross-party 2: SDIL a good start but not enough. Between royal assent - implementation (5/04/2018), one theme was identified 3: The SDIL worked - what next? The final theme identified from implementation until 16/03/2020 was 4: Moving on from the SDIL. CONCLUSIONS: After the announcement, the SDIL had cross-party support and was recognised to have encouraged reformulation prior to implementation. Lessons for governments indicate that the combination of cross-party support and a policy's documented success in achieving its aim can help cement the resilience of it to opposition and threats of repeal.

Associations between household food environment and daily intake of regular and diet soft drinks per BMI status of European children: Feel4Diabetes Study.

The objective of this study was to investigate how the availability of food in the household environment is associated with a daily intake of regular and diet soft drinks in European children, considering BMI status. This cross-sectional study utilised baseline data from 12 211 schoolchildren participating in the Feel4Diabetes European lifestyle modification intervention. Sociodemographics, soft drink intake and household food availability data were collected using parent-completed questionnaires. Anthropometry was recorded, and children were classified into BMI categories according to the International Obesity Task Force cut-offs. In the multivariate logistic regression analysis controlled for children's sex, mother's BMI, and educational level, frequent household availability of fruit juice (sugar added), regular soft drinks and salty snacks compared to less frequent were positively associated with daily regular soft drink intake in children, regardless of BMI group (ORs range 1.59-6.69). Conversely, frequent availability of fruit juice (no added sugar) was inversely related to regular soft drink intake in both BMI groups, as was the availability of fresh fruit in the overweight/obesity group, and the availability of diet soft drinks in the underweight/normal-weight (ORs range 0.31-0.54). In conclusion, habitual household availability of selected energy-dense foods/beverages was positively associated with a daily intake of regular soft drinks in European children, regardless of BMI status. Contrastingly, household availability of fresh fruit, fruit juice (no added sugar) and diet soft drinks were inversely associated with regular soft drink intake. Programmes focusing on reducing children's soft drink intake should consider reducing the availability of sugar-added beverages in the household food environment and encouraging water consumption, as a practical, healthier alternative suggestion.

Temporal trends of carbonated soft-drink consumption among adolescents aged 12-15 years from eighteen countries in Africa, Asia and the Americas.

Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.

Caffeinated Soda Intake in Children Is Associated with Neurobehavioral Risk Factors for Substance Misuse.

BACKGROUND AND OBJECTIVES: Use of psychotropic substances in childhood has been associated with both impulsivity and other manifestations of poor executive function as well as escalation over time to use of progressively stronger substances. However, how this relationship may start in earlier childhood has not been well explored. Here, we investigated the neurobehavioral correlates of daily caffeinated soda consumption in preadolescent children and examined whether caffeinated soda intake is associated with a higher risk of subsequent alcohol initiation. METHODS: Using Adolescent Brain Cognitive Development study data (N = 2,092), we first investigated cross-sectional relationships between frequent caffeinated soda intake and well-known risk factors of substance misuse: impaired working memory, high impulsivity, and aberrant reward processing. We then examined whether caffeinated soda intake at baseline predicts more alcohol sipping at 12 months follow-up using a machine learning algorithm. RESULTS: Daily consumption of caffeinated soda was cross-sectionally associated with neurobehavioral risk factors for substance misuse such as higher impulsivity scores and lower working memory performance. Furthermore, caffeinated soda intake predicted a 2.04 times greater likelihood of alcohol sipping after 12 months, even after controlling for rates of baseline alcohol sipping rates. CONCLUSIONS: These findings suggest that previous linkages between caffeine and substance use in adolescence also extend to younger initiation, and may stem from core neurocognitive features thought conducive to substance initiation.

Negative emotions increase unhealthy eating: Evidence from the Wuhan lockdown during COVID-19.

This paper studies how negative emotions like stress, anxiety, and boredom can affect unhealthy food consumption. Using the Wuhan lockdown as an external shock, we examine the changes in food consumption in a city that was not in lockdown. We applied the difference-in-differences method to a large scanner dataset from a retail monopoly in China. Our findings reveal that negative emotions induced by the pandemic lockdown significantly elevated consumer spending on unhealthy food items such as crisps, sugary beverages, regular soda, and low-alcohol beverages. Notably, the effect of unhealthy food consumption was more pronounced among younger and wealthier demographics. Triggering factors, like information about confirmed new deaths and infections as well as proximity to local hospitals, were found to strongly influence the consumption of unhealthy foods. Overall, the lockdown's impact extended beyond short-term increases in snack consumption to substantial increases in overall dietary and nutritional intake.

Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: a controlled interrupted time series analysis.

OBJECTIVE: To determine changes in household purchases of drinks 1 year after implementation of the UK soft drinks industry levy (SDIL). DESIGN: Controlled interrupted time series. PARTICIPANTS: Households reporting their purchasing to a market research company (average weekly n=22 091), March 2014 to March 2019. INTERVENTION: A two-tiered tax levied on soft drinks manufacturers, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g sugar/100 mL (high tier) are taxed at £0.24/L, drinks with ≥5 to <8 g sugar/100 mL (low tier) are taxed at £0.18/L. MAIN OUTCOME MEASURES: Absolute and relative differences in the volume of, and amount of sugar in, soft drinks categories, all soft drinks combined, alcohol and confectionery purchased per household per week 1 year after implementation. RESULTS: In March 2019, compared with the counterfactual, purchased volume of high tier drinks decreased by 140.8 mL (95% CI 104.3 to 177.3 mL) per household per week, equivalent to 37.8% (28.0% to 47.6%), and sugar purchased in these drinks decreased by 16.2 g (13.5 to 18.8 g), or 42.6% (35.6% to 49.6%). Purchases of low tier drinks decreased by 170.5 mL (154.5 to 186.5 mL) or 85.8% (77.8% to 93.9%), with an 11.5 g (9.1 to 13.9 g) reduction in sugar in these drinks, equivalent to 87.8% (69.2% to 106.4%). When all soft drinks were combined irrespective of levy tier or eligibility, the volume of drinks purchased increased by 188.8 mL (30.7 to 346.9 mL) per household per week, or 2.6% (0.4% to 4.7%), but sugar decreased by 8.0 g (2.4 to 13.6 g), or 2.7% (0.8% to 4.5%). Purchases of confectionery and alcoholic drinks did not increase. CONCLUSIONS: Compared with trends before the SDIL was announced, 1 year after implementation, volume of all soft drinks purchased combined increased by 189 mL, or 2.6% per household per week. The amount of sugar in those drinks was 8 g, or 2.7%, lower per household per week. Further studies should determine whether and how apparently small effect sizes translate into health outcomes. TRIAL REGISTRATION NUMBER: ISRCTN18042742.

Relación entre la erosión dental y el consumo de bebidas refrescantes en escolares de 12 a 16 años de un centro educativo en Perú / Relationship between dental erosion and the consumption of refreshing drinks in schoolchildren from 12 to 16 years of age at an educational center in Peru

Objetivo: Determinar la relación entre la erosión dental y el consumo de bebidas refrescantes en escolares de 12 a 16 años del Centro Educativo Juan Velasco Alvarado, en el distrito de Pillco Marca, Perú. Materiales y métodos: Se realizó un estudio observacio- nal, transversal de una muestra de 135 niños de 12 a 16 años. Se seleccionaron historias clínicas que contaran con datos so- bre variables demográficas, la valoración del tipo de erosión dental según la clasificación de Eccles y que hayan respondi- do la encuesta sobre el consumo de las bebidas refrescantes (gaseosas, rehidratantes y jugos). Para evaluar la asociación entre las variables se aplicó la prueba chi-cuadrado; el nivel de significación establecido fue de p<0,05. Resultados: La frecuencia de la erosión dental en los es- colares fue del 54,1%. Un 3,7% consumía bebidas refrescan- tes de 3 a 5 veces por semana, un 45,9% consumía 2 veces por semana, y el 50,4% no consumía o consumía menos de 2 ve- ces a la semana. Las gaseosas que más frecuentemente se con- sumían fueron la Coca-Cola (20,7%) y la Kola Real (20%). El 43,7% no ingería ningún tipo de bebida gaseosa. Se halló una asociación entre la erosión dental y la ingesta de bebidas refrescantes (chi-cuadrado 84,77, p<0,05), con una ingesta de 2 veces por semana o más (chi-cuadrado 62,589, p<0,05). La erosión dental fue más frecuente en aquellos alumnos que in- gerían ambas bebidas, gaseosas y rehidratantes en su dieta, comparado con solo gaseosas o rehidratantes (p=0,048). Conclusiones: Las bebidas refrescantes resultaron ser no- civas para la erosión dental, cuando estas bebidas se toman al menos dos veces por semana (AU)

Aim: Determine the relation between dental erosion and the consumption of the refreshing drinks in schoolchildren from 12 to 16 years of Juan Velasco Alvarado Educational Center, from Pillco Marca district, Peru. Materials and methods: An observational, cross-sec- tional study was carried out on a sample of 135 children from 12 to 16 years of age. From all the medical records avail- able, the final selection included the ones that had data on demographic variables, the assessment of the type of dental erosion according to the Eccles classification and that had answered the survey on the consumption of refreshing drinks (soft drinks, rehydrating drinks and juices). To evaluate the association between the variables, the chi-square test was ap- plied; the established significance level was p<0.05. Results: The frequency of dental erosion in schoolchil- dren was 54.1%. 3.7% consumed refreshing drinks 3 to 5 times a week, 45.9% consumed 2 times a week, and 50.4% did not consume or consumed less than 2 times a week. The soft drinks most frequently consumed were Coca-Cola (20.7%) and Kola Real (20%). 43.7% did not ingest any type of soft drink. An association was found between dental erosion and the intake of refreshing drinks (chi-square 84.77, p<0.05), with an intake of at least twice a week (chi-square 62.589, p<0.05). Dental erosion was more frequent in those students who ingested both soft drinks and rehydrating drinks in their diet, compared to only soft drinks or only rehydrating drinks (p=0.048 Conclusions: Refreshing drinks turned out to be harmful in relation to dental erosion, when these drinks are taken at least twice a week (AU)

Representational shifts: increasing motivation for bottled water through simulation-enhancing advertisements.

BACKGROUND: Despite its numerous health benefits, consumers' daily water consumption is below recommend levels while soft drink consumption remains high. Previous research has shown that the degree to which drinks are cognitively represented in terms of consumption and enjoyment (i.e., through simulations of consumption and reward) predicts desire and intake. Here, we examined whether simulation-enhancing advertisements that frame water in terms of consumption and reward change cognitive representations and increase motivation for a fictitious bottled water. METHODS: In three pre-registered online experiments (Nexp1 = 984; Nexp2 = 786; Nexp3 = 907), UK participants viewed three advertisements that either highlighted the rewarding consumption experience of water (e.g., "Refresh all your senses with this smooth, cool water"; simulation-enhancing ads), the health consequences of drinking water (e.g., "This water takes care of your health"; health-focused ads), or control ads. We assessed cognitive representations of the bottled water with a semantic feature production task, and we coded the words used as consumption and reward features or positive long-term health consequences features. We assessed motivation through ratings of the attractiveness of the water (Exp. 1 only), desire to drink it, and willingness to pay for it (WTP). RESULTS: In line with our hypotheses, participants represented the bottled water more in terms of consumption and reward after viewing simulation-enhancing advertisements, and more in terms of positive long-term health consequences after viewing health-focused advertisements. There was no direct effect of advertisement condition on motivation ratings. However, significant indirect effects showed that simulation-enhancing advertisements increased desire and WTP through the proportion of consumption and reward features, whereas health-focused advertisements increased motivation through an increase in the proportion of positive long-term health consequences features. The effects through consumption and reward were stronger. CONCLUSIONS: These findings are consistent with research suggesting that the experience of immediate reward from drinking water underlies intake. Public health interventions should emphasize the enjoyment of drinking water, rather than the long-term health benefits.