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Lipoprotein(a) [Lp(a)] contributes to cardiovascular disease risk. A genetically determined size polymorphism in apolipoprotein(a) [apo(a)], determined by the number of Kringle (K) repeats, inversely regulates Lp(a) levels. Nongenetic factors including dietary saturated fat influence Lp(a) levels. However, less is known about the effects of carbohydrates including dietary sugars. In this double-blind, parallel arm study among 32 overweight/obese adults, we investigated the effect of consuming glucose- or fructose-sweetened beverages providing 25% of energy requirements for 10 weeks on Lp(a) level and assessed the role of the apo(a) size polymorphism. The mean (±SD) age of participants was 54 ± 8 years, 50% were women, and 75% were of European descent. Following the 10-week intervention, Lp(a) level was reduced by an average (±SEM) of -13.2% ± 4.3% in all participants (P = 0.005); -15.3% ± 7.8% in the 15 participants who consumed glucose (P = 0.07); and -11.3% ± 4.5% in the 17 participants who consumed fructose (P = 0.02), without any significant difference in the effect between the two sugar groups. Relative changes in Lp(a) levels were similar across subgroups of lower versus higher baseline Lp(a) level or carrier versus noncarrier of an atherogenic small (≤22K) apo(a) size. In contrast, LDL-C increased. In conclusion, in older, overweight/obese adults, consuming sugar-sweetened beverages reduced Lp(a) levels by ∼13% independently of apo(a) size variability and the type of sugar consumed. The Lp(a) response was opposite to that of LDL-C and triglyceride concentrations. These findings suggest that metabolic pathways might impact Lp(a) levels.

INTRODUCTION: The majority of large public universities have exclusive pouring rights contracts with beverage companies that produce and market sugar-sweetened beverages. Pouring rights contracts contain provisions that conflict with recommendations from major public health organizations that institutions reduce sugar-sweetened beverage availability, marketing, and consumption. This study assessed the following among students at 3 public universities: student perception of pouring rights contracts (the extent to which they favored or opposed pouring rights contracts), the association between student socioeconomic characteristics and perception of pouring rights contracts, student estimates of pouring rights contract revenue, and the association between student pouring rights contract revenue estimates and perception of pouring rights contracts. To contextualize results, actual pouring rights contract revenue as a percentage of total revenues was estimated. METHODS: A cross-sectional exploratory study was conducted among a convenience sample of 1,311 undergraduate sugar-sweetened beverages-consuming students recruited from 3 large and diverse public universities in Northern California. On an online questionnaire, undergraduate students indicated the extent to which they favored or opposed pouring rights contracts on a 10-point scale (oppose=1-5, favor=6-10) and provided a numeric estimate of the percentage of total university revenue they thought their universitys pouring rights contract generated. Regression models were used to analyze differences in perception of pouring rights contracts by student socioeconomic characteristics and estimates of university revenues generated by pouring rights contracts. In addition, pouring rights contracts and financial reports were obtained from the 3 universities to estimate actual pouring rights contract revenue as a percentage of total revenues. Survey data were collected between August and November 2018 and analyzed in August 2022. RESULTS: A large majority of students (81%) opposed pouring rights contracts, and the opposition did not significantly differ by student socioeconomic characteristics, including by levels of food security, need-based financial aid, participation in federal food assistance or healthcare programs, parental education, or parental income (all ps>0.14). The median student estimate for pouring rights contract revenue as a percentage of total university revenue was 10%. In contrast, the estimated actual annual revenue generated from the pouring rights contracts ranged from 0.01% to 0.04% at these schools. Revenue estimates were not significantly associated with participants opposition or favoring of pouring rights contracts (p=0.65). CONCLUSIONS: A large majority of students opposed pouring rights contracts, and this opposition was similar regardless of student socioeconomic characteristics or student estimates of pouring rights contract revenues. Students markedly overestimated (by >100-1,000-fold) the percentage of university revenue that came from pouring rights contracts. University administration should consider student views on pouring rights contracts when deciding whether to exit or continue with pouring rights contracts.

Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.

ObjectiveWorkplace sugar-sweetened beverage (SSB) sales bans can reduce SSB consumption. Because stress and anxiety can promote sugar consumption, we examined whether anxiety among hospital employees during the COVID-19 pandemic was associated with changes in SSB consumption and explored whether this relationship varied by exposure to a workplace SSB sales ban.DesignIn a prospective, controlled trial of workplace SSB sales bans, we examined self-reported anxiety (generalised anxiety disorder-7) and self-reported SSB consumption (fluid ounces/d) before (July 2019) and during (May 2020) the COVID-19 pandemic.SettingHospital sites in two conditions (four with SSB sales bans and three without sales bans) in Northern California.ParticipantsWe sampled 580 participants (hospital employees) from a larger trial of sales bans; all were regular consumers of SSB (minimum 3/week at main trial enrollment). This subsample was chosen based on having appropriately timed data for our study questions.ResultsAcross conditions, participants reduced SSB consumption over the study period. However, participants with higher pandemic-era anxiety scores experienced smaller reductions in SSB consumption after 9 months compared with those with lower anxiety scores (β = 0·65, P < 0·05). When the sample was disaggregated by sales ban condition, this relationship held for participants in the control group (access to SSB at work, β = 0·82, P < 0·05), but not for those exposed to an SSB sales ban (β = 0·42, P = 0·25).ConclusionsSSB sales bans likely reduce SSB consumption through multiple pathways; buffering stress-related consumption may be one mechanism.

To show how sugar-sweetened beverage (SSB) taxes were framed in posts on Twitter (now known as X) through text and images, we conducted a content analysis on a sample of Tweets from California users posted between January 1, 2015 and December 31, 2018 about SSB taxes in Berkeley, San Francisco, Oakland, and/or Albany, California. We evaluated posts for information sources, arguments for or against SSB tax policies, and images used. We found that posts presented a mix of messages through text and images. The majority of posts (64%) included arguments supporting SSB taxes, 28% presented a neutral position (e.g., factual information) or a mix of both pro-and anti-tax arguments, and 8% opposed. One-third of posts included an image, almost half of which appeared to be stock photos from SSB advertisements: many of these were shared by medical and public health users. Some tax supporters also reposted messages and images from opposition campaigns and added their own criticisms. By reposting opponents' anti-tax messages and images of SSBs, tax supporters may have inadvertently promoted SSBs, reinforced opposition to SSB taxes, and normalized SSBs. While advocates effectively shared pro-tax arguments, they should also ensure that accompanying images reflect the solutions they seek, not just the problem they are trying to combat.

PURPOSE: Californias failed attempts to enact a statewide sugary beverage tax presents an opportunity to advance understanding of advocacy coalition behavior. We investigate the participation of advocacy coalitions in Californias statewide sugar-sweetened beverage (SSB) tax policy debate. DESIGN: Document analysis of legislative bills and newspaper articles collected in 2019. SETTING: California. METHOD: A total of 11 SSB tax-related bills were introduced in Californias legislature between 2001-2018 according to the states legislative website. Data sources include legislative bill documents (n = 94) and newspaper articles (n = 138). Guided by the Advocacy Coalition Framework (ACF), we identify advocacy coalitions involved in Californias SSB tax debate and explore strategies and arguments used to advance each coalitions position. RESULTS: Two coalitions (public health, food/beverage industry) were involved in Californias statewide SSB tax policy debate. The public health coalition had higher member participation and referred to scientific research evidence while the industry coalition used preemption and financial resources as primary advocacy strategies. The public health coalition frequently presented messaging on the health consequences and financial benefits of SSB taxes. The industry coalition responded by focusing on the potential negative economic impact of a tax. CONCLUSION: Multiple attempts to enact a statewide SSB tax in California have failed. Our findings add insight into the challenges of enacting an SSB tax considering industry interference. Results can inform future efforts to pass evidence-based nutrition policies.

Reducing consumption of sugar-sweetened beverages (SSBs) is a primary public health goal in Thailand, but information on the characteristics of SSB consumers remains limited. This study aims to gain knowledge about the characteristics of SSB consumers in Thailand. Secondary analysis of survey data. The study used data from the Health Behaviour of Population Survey conducted by Thailand's National Statistics Office between February and May 2021. SSB consumption was sourced from a survey question about the consumption of prepackaged sugar-sweetened non-alcoholic beverages. The influence of demographic, socioeconomic, behavioural, habitual, and health factors on mean daily intake and daily consumption was assessed using a two-part model and logistic regression analysis, respectively. Decomposition analysis was conducted to understand how the impact of these factors affecting SSB consumption varied across socioeconomic groups. Frequent SSB consumers exhibited various unhealthy behaviours, including smoking, unhealthy food consumption, low physical activity, and making food selections driven by appetitive motivations. Although higher socioeconomic status was associated with greater consumption of SSBs, it stabilised at elevated income levels. Increased SSB consumption in higher socioeconomic groups was linked to mixed eating habits, being overweight, and occasional drinking, while in lower socioeconomic groups, it was associated with unhealthy behaviours like smoking, regular alcohol drinking, appetitive food choices, and low physical activity. SSB consumption in Thailand is multifactorial, varying by socioeconomic status. These insights are crucial for policy formation aimed at reducing SSB consumption in the country. Policymakers should explore interventions that address overall unhealthy behaviours alongside those targeting overconsumption of SSBs. • A large, nationally representative dataset was analysed to explore the characteristics and determinants of those who consume sugar-sweetened beverages (SSB) in Thailand. • Higher socioeconomic status and unhealthy behaviours like smoking, unhealthy food consumption, and low physical activity are linked to increased SSB consumption. • Food choices influenced by appetitive motivations are associated with higher SSB consumption. [ABSTRACT FROM AUTHOR]

High‐sugar intake is a risk factor for chronic diseases such as cardiovascular disease and type 2 diabetes, but less is known about its role in anxiety disorders. This systematic review aimed to systematically synthesise and assess the existing evidence regarding the association between dietary sugars intake and anxiety disorders. Following PRISMA guidelines, a systematic search of PubMed, MEDLINE, Embase, APA PsycArticles and APA PsycINFO was conducted up to 19th August 2022. Study quality was assessed by the Newcastle‐Ottawa scale (NOS) and the Cochrane risk of bias tool. Eleven studies (10 cross‐sectional and 1 randomised controlled trial [RCT]) were included. Seven cross‐sectional studies had very good quality or good quality, and the quality of the RCT was at low risk of bias. These studies examined sugar‐sweetened beverages (n = 7), sugar‐sweetened foods (n = 4) and/or added sugar (n = 5). The findings suggest a possible positive relationship of added sugar consumption with anxiety disorders, with age as a potential moderator in such association. No conclusions can be drawn on the associations between sugar‐sweetened beverages, sugar‐sweetened foods consumption and anxiety disorders. Due to the included studies being mostly cross‐sectional, the conclusions drawn from the existing evidence should be interpreted with caution. The longitudinal design is warranted to investigate any causal relationship and the potential mechanisms underlying these heterogeneous results. The potential difference in effect at different ages observed in this review should be further examined. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between the cumulative intake of artificially sweetened beverages (ASBs) and sugar-sweetened beverages (SSBs) during young adulthood and the progression of coronary artery calcium (CAC) by midlife, using data from the Coronary Artery Risk Development in Young Adults study. We included 2,466 participants with CAC measurement via computed tomography at the 15th, 20th, and 25th year follow-ups. Dietary intake was assessed using the CARDIA Diet History at baseline and years 7. Cumulative average beverage intake was calculated and categorized. Multivariable Cox regression models adjusted for demographic, lifestyle, and cardiovascular risk factors assessed associations between beverages consumption and CAC progression. Among the included participants, 1107 (44.9 %) were male, 1439 (58.4 %) were white, and the average age was 40.4 years with a standard deviation of 3.5 years. Over a 9.2±1.8-year follow-up, CAC progression was recorded in 715 participants. Higher cumulative ASBs intake was associated with increased CAC progression risk, with hazard ratios (95%CI, P -value) for low and high ASBs consumption being 1.35 (1.14, 1.60; P < 0.001) and 1.54 (1.15, 2.07; P < 0.001) compared to non-consumers. Participants consuming >2 servings/day of SSBs had a 37 % higher CAC progression risk (HR 1.37, 95 % CI 1.14–1.64, P < 0.001). However, no significant association was found between SSB consumption and CAC progression after adjusting for confounders. Prolonged consumption of beverages, especially ASBs, in young adults is linked to an increased risk of CAC progression. [Display omitted] • Cumulative intake of ASBs and SSBs assessed in the CARDIA study. • Long-term ASB intake in young adults is linked to higher risk of CAC progression by midlife. • Higher ASBs intake linked to a 54 % increased risk of CAC progression compared to non-consumers. • The study indicated the need to reconsider dietary guidelines promoting ASBs as a healthier alternative to SSBs. [ABSTRACT FROM AUTHOR]

Objective: Alaska Native children may be at increased risk for dental caries because of added sugar intake from sugar‐sweetened fruit drinks. This study describes development of a questionnaire to (a) assess Alaska Native caregivers' beliefs, knowledge, and behaviors regarding sugar‐sweetened fruit drinks, and (b) describe behavior changes within a community‐based intervention. Methods: Questionnaire development was conducted in three phases with Yup'ik Alaska Native caregivers in Southwest Alaska: (1) initial selection and adaptation of questionnaire items; (2) cognitive testing; and (3) data collection. The Sugar‐Sweetened Fruit Drink Questionnaire (SFDQ) contains 31 culturally‐tailored items across six areas: beliefs/values, environment/skills, knowledge, motivation, self‐efficacy, and behaviors. Results: Eighty‐one percent of caregivers gave their children sugar‐sweetened fruit drinks. Motivations included: what they grew up with (52%), few other options (46%), makes child happy (46%), healthier than soda (45%), and others in community drink them (42%). On average, 93% of caregivers believed drinking a lot of sugar‐sweetened fruit drinks leads to cavities in children and caregivers agreed (mean 4.1 on 5‐point scale, 5 = strongly agree) it is important to limit sugar‐sweetened fruit drinks. Among a sub‐sample of respondents (n = 20), we found low to moderate temporal stability in some SFDQ items over a 10–14 day period, indicating respondent ambivalence and/or uncertainty. Conclusions: Using community‐based participatory research methods, we developed a culturally tailored exploratory questionnaire that will be used to describe changes in caregiver knowledge, beliefs, attitudes, self‐efficacy, and behavior within a planned intervention to reduce sugar‐sweetened fruit drink intake in Alaska Native children. [ABSTRACT FROM AUTHOR]

On November 8, 2016, the citizens of Oakland enacted an initiative imposing a tax on sugar-sweetened beverages (SSBs). The passage was the culmination of interdisciplinary efforts, including critical support from the local dental society, as well as individual dentists. Supporters were motivated by the impact of the consumption of soda and other SSBs on children's health, the long-standing epidemic of dental caries, and the emerging epidemics of obesity and Type 2 diabetes. This article details how the critical support and advocacy of dentistry in collaboration with a wider health professional network and the broader community led to the successful passing of the sugar-sweetened-beverage tax. [ABSTRACT FROM AUTHOR]

Sugars from sugar-sweetened beverages (SSBs) are an important risk factor for tooth decay. The study goal was to determine if there was variation in added sugar intake across communities and between and within households. In this cross-sectional study, intakes of total sugar, added sugar, and sugar-sweetened beverages (SSBs) were estimated for 282 Alaska Native children ages 0–10 years from 131 households in three Yukon-Kuskokwim (YK) Delta communities using biomarker equations based on hair carbon and nitrogen isotope ratios previously developed for the Yup'ik population. ANOVA was used to assess associations between each predictor (community and household) and outcome (estimated total sugars, added sugars, and SSB intake). Between- and within-household variation was estimated using a linear mixed-effects model with a random intercept for households with three or more children. There was no significant difference in mean estimated total sugar (p = 0.29), added sugar (p = 0.24), or SSB intake (p = 0.40) across communities. Significant variations were observed between and within households, with within-household variation amounting to 59% of the between-household variation. Added sugar intake in Alaska Native children from the three study communities is higher than the recommended maximum, and the variation is greater within households than between households. [ABSTRACT FROM AUTHOR]

Background: Social norms can influence individual health behaviors. Shifts in social norms for smoking were critical for the effectiveness of tobacco control efforts such as excise taxes. Sugar-sweetened beverage (SSB) excise taxes have been implemented in municipalities across the United States to reduce SSB intake and improve health. We sought to identify trends in social norms and attitudes about healthfulness of sugar-sweetened beverage (SSB) consumption in the California Bay Area and examine whether social norms and attitudes changed following SSB taxes. Methods: Data came from annual (2016–2019, 2021) cross-sectional surveys (n = 9128) in lower-income neighborhoods in Oakland, San Francisco, Berkeley, and Richmond. We assessed overall trends and compared pre-post tax changes in Oakland and San Francisco with comparison cities. Results: We observed a 28% reduction in social norms for SSB consumption (people's perceptions of peers' consumption) and variable reductions in attitudes about the healthfulness of SSBs. Relative to comparison cities, post-tax, perceptions of peers' consumption of sports drinks declined in Oakland; attitudes about the healthfulness of sugar-sweetened fruit drinks declined in San Francisco. Conclusions: Among lower-income populations, social norms and attitudes towards the healthfulness of SSBs meaningfully declined over time, with smaller tax-related effects. SSB taxes as well as the local media attention they generate appear to affect people's perceptions of SSBs. Pairing SSB taxes with messaging campaigns may be more effective in de-normalizing SSB consumption. [ABSTRACT FROM AUTHOR]

Background: Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand’s existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place. Methods: Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire. Results: Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions. Conclusions: Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels. [ABSTRACT FROM AUTHOR]

Background: The beverage industry's role in undermining nutrition-related population health is a growing global concern. Industry strategies that affect policy, science, and public opinion are increasingly exposed. However, those used in the retail space—known as market strategies—remain largely unspecified. The purpose of this study was to uncover the market strategies beverage companies use with US retailers to secure their influence and control in the primary setting where the public purchases their products—food retail. Methods: We conducted a qualitative study based on multiple data sources: 49 interviews with industry insiders, including chain retail managers, independent store owners, and sales representatives and distributors of major food and beverage companies; 15 business files shared by participants, including written beverage marketing agreements and contracts; and 27 purposively sampled, publicly-available industry documents. All data were thematically analyzed. Results: We identified that beverage agreements, which dictate the products, space, marketing, and prices of company products in retail settings, are universal regardless of the retailer's market size. While ubiquitous, the agreement terms, services, and treatment beverage companies provided varied widely—with large US retail chains receiving superior opportunities, such as financial incentives and additional services, and independent and small chain retailers often experiencing disadvantaged, more expensive, non-negotiable terms. Despite this, companies also used several strategies that diminished concerns of differential treatment and thus effectively managed their reputation among independent and small chain retailers. Conclusions: Findings suggest a use of the consolidated power among beverage companies with significant implications for the healthfulness of food retail settings. We conclude by highlighting key policy and legal targets that could be leveraged in the US to address power imbalances in the retailer-beverage company relationship and ultimately shift retail towards promoting public health. [ABSTRACT FROM AUTHOR]

Consumption of sugar-sweetened beverages (SSBs) contributes to the risk of developing overweight and obesity in children and adults. Thus, reducing free sugar is a globally recognized public health priority. The implementation of a sugar tax is one way of achieving this goal. This study aimed to investigate the relationship between familiarity with the sugar tax and its importance in reducing obesity, the perceived health consequences of SSBs, situations and reasons for consumption, and the frequency of SSB consumption. A cross-sectional study was conducted in May 2022 among 216 Polish adults (age 18–45). Hierarchical cluster analysis was used to identify three homogeneous clusters with regard to the perceived health consequences of consuming SSBs. A logistic regression model was used to verify the relationship between the frequency of SSB consumption (dependent variable) and other variables. Respondents with higher familiarity with the sugar tax (OR: 0.594; 95% CI: 0.42–0.85) and those in the "Unaware of disease" (OR: 0.437; 95% CI: 0.18–0.94) and "Disease-conscious" (OR: 0.484; 95% CI: 0.24–0.97) clusters were less likely to consume SSBs at least once per week than those in the "Moderately disease-conscious" cluster. Both the place of SSB consumption (i.e., restaurant—OR: 1.847; 95% CI: 1.14–3.64, work or university—OR: 3.217; 95% CI: 1.51–6.88, family home—OR: 2.877; 95% CI: 1.50–5.53) as well as a preference for their taste (OR: 4.54; 95% CI: 1.66–12.45) increased the chance of consuming SSBs at least once a week. In conclusion, it is necessary to continue educating the public about the health consequences of SSB consumption. The use of legislative measures (i.e., sugar tax) also contributes to reducing SSB consumption and can thus counteract the increasing obesity rate. [ABSTRACT FROM AUTHOR]

Media campaigns produce effects when audience members discuss the campaign messages. Fundamental to the understanding of how talk bridges exposure and effect is a knowledge of its content. However, prior attempts to measure talk content have largely been limited to gross characteristics of the interactions. We argue that advances in this line of research require representing post-exposure talk as campaign-induced interpersonal communication (CIC), with a focus on how individuals produce and exchange messages in conversations. Interaction data were gathered in two experiments in which pairs of participants co-viewed, then discussed health-related public service announcements. Analysis of the data produced (a) an empirically-derived typology of talk turns that provided a comprehensive, content-based description of message production and (b) evidence that turn pairs are associated in theoretically meaningful ways in exchanges that displayed properties of deliberative interactions. These findings lay a foundation for future research on the antecedents and outcomes of CIC. [ABSTRACT FROM AUTHOR]

Aim: To assess the association of intake of sugar‐sweetened beverages (SSBs), artificially sweetened beverages (ASBs) and natural juices (NJs) with new‐onset atrial fibrillation (AF) in people with prediabetes or diabetes. Methods: A total of 31 433 participants with prediabetes and diabetes from the UK Biobank were included. Information on the intake of SSBs, ASBs and NJs was accessed by 24‐hour dietary recalls from 2009 to 2012. The study outcome was new‐onset AF. Results: During a median follow‐up of 12.0 years, 2470 (7.9%) AF cases were documented. Both the intake of SSBs (per 1 unit/day increment; adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI]: 1.04‐1.18) and ASBs (per 1 unit/day increment; adjusted HR = 1.08; 95% CI: 1.02‐1.14) were linearly and positively associated with new‐onset AF, while NJ intake was not significantly associated with new‐onset AF (per 1 unit/day increment; adjusted HR = 1.00; 95% CI: 0.93‐1.08). Accordingly, compared with non‐consumers, participants who consumed more than one unit per day of SSBs (adjusted HR = 1.30; 95% CI: 1.11‐1.53) or ASBs (adjusted HR = 1.21; 95% CI:1.05‐1.40) had an increased risk of AF. Substituting 1 unit/day of NJs for SSBs was associated with a 9% (adjusted HR = 0.91; 95% CI: 0.83‐0.99) lower risk of new‐onset AF, while replacing SSBs with ASBs was not significantly associated with new‐onset AF (adjusted HR = 0.97; 95% CI: 0.89‐1.06). Conclusions: Both the intake of SSBs and ASBs were linearly and positively associated with new‐onset AF, while NJ intake did not show a significant association with AF in people with prediabetes or diabetes. Replacing an equivalent amount of SSB intake with NJs, but not ASBs, was associated with a lower risk of AF. [ABSTRACT FROM AUTHOR]

Background: Latino children in the United States (US) have a higher prevalence of overweight/obesity compared to white children. Previous studies suggest that acculturation to the US is associated with health behaviors such as diet, body mass index (BMI), and physical activity. However, the role of parental acculturation remains understudied, particularly with the use of validated measures. Objective: The objective of this study was to evaluate parental acculturation and its association with parental interpersonal factors and health behaviors in the preschool-aged child. Methods: Data were analyzed from 187 Latino parents in Nevada. Parents completed a self-reported, cross-sectional survey. Acculturation was assessed using Norris' 4-item validated acculturation measure. The average age of the preschool-aged children was 45.5 months, and their mean BMI percentile was 96.4% (SD ± 18.7). The mean parental acculturation score was 2.1 (SD ± 1.2). Children were physically active an average of 4.9 (SD ± 2.0) days per week. After controlling for covariates, the results indicated that parental acculturation was positively associated with physical activity and sugar-sweetened beverage consumption. However, parental acculturation was not associated with child BMI percentile, or the consumption of fruits, vegetables, and sweet snacks. Conclusions: These findings can inform future research on culturally tailored intervention strategies to boost physical activity and reduce sugar-sweetened beverage intake among Latino preschool-aged children. [ABSTRACT FROM AUTHOR]

Objective To understand the intake of added sugars among primary school students, to analyze the sources and influencing factors of intake, and to propose improvement measures. [WTHZ]Methods [WTBZ]A stratified cluster sampling method was used to select 12,603 primary school students in Lianyungang as the research subjects. A food atlas-based questionnaire was used to investigate the intake of foods with added sugars and calculate daily intake of added sugars. [WTHZ]Results [WTBZ]The median added sugar intake of primary school students was 22.1 g/day, 45.7% of students consumed more than 25 g/day, and 21.7% of students consumed more than 50 g/day. Sugar-sweetened beverages, flavored yogurt, pastries and sweets were the four main sources of added sugar intake among primary school students (accounting for 38.3%, 24.0%, 14.1% and 12.1% respectively). Multiple linear regression analysis showed that boys, higher grade, higher BMI, and less sleep were associated with increased intake of added sugars. [WTHZ]Conclusions [WTBZ]The excessive intake of added sugar by primary school students in Lianyungang was quite prominent. On the one hand, nutrition education should be carried out to publicize the harm of excessive intake of added sugar. On the other hand, it isrecommended to include the added sugar content in the nutrition label to guide teenagers to choose healthy food. [ABSTRACT FROM AUTHOR]

Excessive screen time and the consumption of sugar-sweetened beverages are found to be independent predictors of depressive symptoms. However, the potential interaction effect of screen time and sugar-sweetened beverages, that is, whether one exposure factor strengthens the association of another with depressive symptoms, remains unclear. A large-scale adolescent health surveillance survey was conducted in 27 schools in eight regions across China. A total of 22,868 students were recruited to complete an eligible questionnaire to provide details of their screen time and sugar-sweetened beverage consumption. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Multiplicative and additive interaction models were performed to estimate the interaction effects of screen time and sugar-sweetened beverages on depressive symptoms, and whether the relationship varied by age group was also examined. The multivariate logistic regression model showed that even if the confounding factors were controlled, screen time and sugar-sweetened beverages were still risk factors for depressive symptoms in adolescents. Interaction models indicated that screen time and sugar-sweetened beverages in combination were related to greater odds of depressive symptoms. Compared with late adolescents, early adolescents had a higher probability of depressive symptoms when exposed to the joint effects. Our study may hopefully deepen the understanding of the association between screen time and sugar-sweetened beverages and depressive symptoms. Future research should further explore how and why screen time and sugar-sweetened beverages affect individuals more profoundly in early adolescence than in late adolescence and how to mitigate this. [ABSTRACT FROM AUTHOR]

Media campaigns can create change in their audiences directly via message exposure and indirectly via conversations about the campaign. An experiment (N =  232) exposed regular consumers of sugar-sweetened beverages to either strong or weak messages that advocated reduced consumption, then allowed conversation or did not. There was evidence of direct media effects in that heavy drinkers who privately judged the messages as effective reported higher intended consumption reduction. However, when conversation was allowed, it erased the desired effect of campaign messages on intended reduction. Heavy drinkers had less favorable conversations about strong campaign messages than weak ones. Further, analytic language (e.g. but, because) augmented the persuasiveness of strong messages among heavy drinkers, but detracted from the persuasiveness of weak messages. Thus, we observed a complex interplay between intra personal processes devoted to the accurate assessment of campaign messages and inter personal processes that defended existing levels of sugary beverage consumption. [ABSTRACT FROM AUTHOR]

The implementation of school-based obesity-prevention programs is understudied. Kids SIP smart ER is a 6-month, school-based, behavioral intervention for Appalachian middle school students and includes a teacher implementation strategy. Kids SIP smart ER effectively reduced students' sugar-sweetened beverages (SSB) when Researcher-Led. However, Teacher-Led effectiveness and fidelity are unknown. To explore the relative SSB effects when Kids SIP smart ER was Researcher-Led versus Teacher-Led and to examine teacher fidelity. This study of secondary outcomes used a quasi-experimental analytic approach of a Hybrid Type 1 effectiveness–implementation and cluster randomized controlled tria (RCT) of Kids SIP smart ER. Student SSB behaviors and teacher self-rated fidelity were assessed, respectively, with the validated Beverage Intake Questionnaire (BEVQ-15) and lesson-specific checklists. Analyses included descriptive statistics and modified two-part models with time-fixed effects and school-year cohort cluster controls. The analytic sample included students from six control schools (n = 220), six Researcher-Led intervention schools (n = 306), and five Teacher-Led intervention schools (n = 218), as well as eight teachers. Teacher-Led intervention students decreased SSB by −14.3 ounces/day (95% confidence interval = −15.4, −13.2; P <.001). Relative to control and to Researcher-Led intervention, the Teacher-Led treatment effect among students was −11.6 ounces SSB/day (P <.001, effect size = 0.75) and −4.3 (P =.004, effect size = 0.25), respectively. Teachers returned fidelity checklists for 90% of planned lessons. Fidelity averaged 94% (SD = 4.0%) among returned forms and 85% (SD = 18.9%) when missing forms were counted as zeros. Teachers can implement Kids SIP smart ER with high fidelity and produce statistically and clinically meaningful improvements in students' SSB behaviors. Findings have implications for the sustained implementation of Kids SIP smart ER and other school-based obesity-prevention programs. Clinical Trial information : NCT03740113. [ABSTRACT FROM AUTHOR]

Background: Sugar-sweetened beverages (SSBs) account for a significant proportion of sugar in the diet of children and are directly associated with obesity in this group. While there have been many studies on adolescent SSB consumption, few studies have examined the predictors of SSB consumption in primary-school-aged children. The aim of this study was to understand the degree to which a child's consumption across a range of beverages is influenced by their own attitudes and by their parents' attitudes and parents' consumption behaviours. Methods: A survey of 1611 Australian parent–child dyads asked children (aged 4–11) and their parents to rate a variety of drinks in terms of healthiness, taste, and cost and indicate the amount of these drinks consumed in a typical week. Zero-inflated regression analyses were conducted to identify the strength of association between children's weekly beverage consumption, their perceptions of each beverage, their parents' perceptions, and their parents' weekly beverage consumption. Results: Parental consumption of a specific beverage was the strongest predictor of child consumption of that beverage, more so than the children's perceptions of the beverage. Conclusions: These findings provide insights for developing parent and child education programmes to reduce SSB consumption. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Understanding the impact of the overall construct of ultra-processed foods on diabetes risk can inform dietary approaches to diabetes prevention. In this study, we aimed to evaluate the association between ultra-processed food consumption and risk of diabetes in a community-based cohort of middle-aged adults in the USA. We hypothesised that a higher intake of ultra-processed foods is associated with a higher risk of incident diabetes. Methods: The study included 13,172 participants without diabetes at baseline (1987–1989) in the Atherosclerosis Risk in Communities (ARIC) study. Dietary intake was assessed with a 66-item semiquantitative food frequency questionnaire, and foods were categorised by processing level using the Nova classification system. Ultra-processed food was analysed categorically (quartiles of energy-adjusted intake) and continuously (per one additional serving/day). We used Cox regression to evaluate the association of ultra-processed food intake with risk of diabetes with adjustment for sociodemographic characteristics, total energy intake, health behaviours and clinical factors. Results: Over a median follow-up of 21 years, there were 4539 cases of incident diabetes. Participants in the highest quartile of ultra-processed food intake (8.4 servings/day on average) had a significantly higher risk of diabetes (HR 1.13; 95% CI 1.03, 1.23) compared with participants in the lowest quartile of intake after adjustment for sociodemographic, lifestyle and clinical factors. Each additional serving of ultra-processed food consumed daily was associated with a 2% higher risk of diabetes (HR 1.02; 95% CI 1.00, 1.04). Highest quartile consumption of certain ultra-processed food groups, including sugar- and artificially sweetened beverages, ultra-processed meats and sugary snacks, was associated with a 29%, 21% and 16% higher risk of diabetes, respectively, compared with the lowest quartile. Conclusions/interpretation: We found that a higher intake of ultra-processed food was associated with higher risk of incident diabetes, particularly sugar- and artificially sweetened beverages, ultra-processed meats and sugary snacks. Our findings suggest interventions reducing ultra-processed food consumption and specific food groups may be an effective strategy for diabetes prevention. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) considered it as an effective strategy to reduce sugar consumption. The gradual intake of sugar-sweetened beverages (SSBs) has a significant public health concern, in relation to dental caries, obesity, and other non-communicable diseases (NCDs). Many countries have implemented taxes on sugar-sweetened beverages to reduce their consumption. This review deals with the dual benefits of sugar-sweetened beverages taxes one is by reducing the prevalence of dental diseases and the second by generating revenue for public health initiatives. Certain case studies from countries like Mexico, India, and UK, have shown positive impact of sugar-sweetened beverages taxes on both oral health and economic sustainability. There are some challenges like potential regressive effects and industry opposition, and some of the evidence has shown sugar-sweetened beverages taxes can greatly reduce sugar consumption, enhance public health outcomes, and decline healthcare costs. A few recommendations like allocating tax revenue to oral health education, implementing graduated tax rates based on sugar content, and launching awareness campaigns can help in improving the oral health status of the population. Globally, sugar-sweetened beverages taxes play a promising public health strategy to overcome the rising burden of oral diseases as well as other non-communicable diseases.

Abstract Background Social norms can influence individual health behaviors. Shifts in social norms for smoking were critical for the effectiveness of tobacco control efforts such as excise taxes. Sugar-sweetened beverage (SSB) excise taxes have been implemented in municipalities across the United States to reduce SSB intake and improve health. We sought to identify trends in social norms and attitudes about healthfulness of sugar-sweetened beverage (SSB) consumption in the California Bay Area and examine whether social norms and attitudes changed following SSB taxes. Methods Data came from annual (2016–2019, 2021) cross-sectional surveys (n = 9128) in lower-income neighborhoods in Oakland, San Francisco, Berkeley, and Richmond. We assessed overall trends and compared pre-post tax changes in Oakland and San Francisco with comparison cities. Results We observed a 28% reduction in social norms for SSB consumption (people’s perceptions of peers’ consumption) and variable reductions in attitudes about the healthfulness of SSBs. Relative to comparison cities, post-tax, perceptions of peers’ consumption of sports drinks declined in Oakland; attitudes about the healthfulness of sugar-sweetened fruit drinks declined in San Francisco. Conclusions Among lower-income populations, social norms and attitudes towards the healthfulness of SSBs meaningfully declined over time, with smaller tax-related effects. SSB taxes as well as the local media attention they generate appear to affect people’s perceptions of SSBs. Pairing SSB taxes with messaging campaigns may be more effective in de-normalizing SSB consumption.

Abstract Background Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand’s existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place. Methods Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire. Results Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions. Conclusions Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.

Abstract Background The beverage industry’s role in undermining nutrition-related population health is a growing global concern. Industry strategies that affect policy, science, and public opinion are increasingly exposed. However, those used in the retail space—known as market strategies—remain largely unspecified. The purpose of this study was to uncover the market strategies beverage companies use with US retailers to secure their influence and control in the primary setting where the public purchases their products—food retail. Methods We conducted a qualitative study based on multiple data sources: 49 interviews with industry insiders, including chain retail managers, independent store owners, and sales representatives and distributors of major food and beverage companies; 15 business files shared by participants, including written beverage marketing agreements and contracts; and 27 purposively sampled, publicly-available industry documents. All data were thematically analyzed. Results We identified that beverage agreements, which dictate the products, space, marketing, and prices of company products in retail settings, are universal regardless of the retailer’s market size. While ubiquitous, the agreement terms, services, and treatment beverage companies provided varied widely—with large US retail chains receiving superior opportunities, such as financial incentives and additional services, and independent and small chain retailers often experiencing disadvantaged, more expensive, non-negotiable terms. Despite this, companies also used several strategies that diminished concerns of differential treatment and thus effectively managed their reputation among independent and small chain retailers. Conclusions Findings suggest a use of the consolidated power among beverage companies with significant implications for the healthfulness of food retail settings. We conclude by highlighting key policy and legal targets that could be leveraged in the US to address power imbalances in the retailer-beverage company relationship and ultimately shift retail towards promoting public health.

BACKGROUND: The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition. METHODS: This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay-milk, soda, tea with sugar, sweets, and chips/biscuits-using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups. RESULTS: Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with childrens frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store. CONCLUSION: Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal-child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit childrens consumption of unhealthy foods and beverages from an early age.

Sugar-sweetened beverages (SSB) contribute to illness, especially among marginalized communities and children targeted by the beverage industry. SSB taxes can reduce consumption, illness burden, and health inequities, while generating revenue for health programs, and as one way to hold the industry responsible for their harmful products and marketing malpractices. Supporters and opponents have debated SSB tax proposals in news coverage - a key source of information that helps to shape public policy debates. To learn how four successful California-based SSB tax campaigns were covered in the news, we conducted a content analysis, comparing how SSB taxes were portrayed. We found that pro-tax arguments frequently reported data to expose the beverage industry's outsized campaign spending and emphasize the health harms of SSBs, often from health professionals. However, pro-tax arguments rarely described the benefits of SSB taxes, or how they can act as a tool for industry accountability. By contrast, anti-tax arguments overtly appealed to values and promoted misinformation, often from representatives from industry-funded front groups. As experts recommend additional SSB tax proposals, and as the industry mounts legislative counter-tactics to prevent them, advocates should consider harnessing community representatives as messengers and values-based messages to highlight the benefits of SSB taxes.

ObjectiveTo examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors.DesignA controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban n 315; control n 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban.SettingSutter Health, a large non-profit healthcare delivery system in Northern California.ParticipantsFull-time employees at Sutter Health screened for heavy SSB consumption.ResultsParticipants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI -4·9, -0·5) fewer ounces of SSB per d while at work, and 4·3 (95 % CI -8·4, -0·2) fewer total ounces per d, compared to controls. Sales ban participants with an elevated BMI or waist circumference had greater post-intervention reductions in workplace SSB consumption.ConclusionsWorkplace sales bans can reduce SSB consumption in ethnically diverse employee populations, including those at higher risk for cardiometabolic disease.

Diet habit is associated with mental health which has been suggested to be an independent risk factor. Nevertheless, evidence concerning the association between beverage consumption and age-specific mental health remains limited. Here we estimate the association between six types of beverages and depression and anxiety disorders. We included 188,355 participants who completed at least one dietary questionnaire and were free of depression and anxiety disorders at baseline from the UK-Biobank. Cox proportional hazard models and substituting analyses were used. (i) During an average of 11.15 years of follow-up, 5884(3.12 %) participants with incident depression and 6445(3.42 %) anxiety disorders were documented. (ii)In individuals aged <60 years, the consumption of SSBs (sugar-sweetened beverages) and ASBs (artificially-sweetened beverages) (>1 serving/day) was associated with higher hazard of depression disorders (SSBs: HR 1.14, 95 % CI 1.02–1.28; ASBs: HR 1.23, 95 % CI 1.09–1.38); whereas, intakes of pure fruit/vegetable juices (PiSs) and coffee were associated with lower hazard of depression disorders(PiSs: HR 0.81, 95 % CI 0.72–0.92; coffee: HR 0.88, 95 % CI 0.81–0.96). (iii)In individuals aged ≥60 years, higher intakes of PiSs and coffee were related to lower hazard of depression and anxiety disorders. (iv)Replacing PiSs or coffee with SSBs was significantly associated with reduced depression and anxiety disorders in individuals aged <60 years while replacing PiSs or coffee with milk was consistently correlated with lower depression and anxiety disorders in those aged over 60 years. Individual beverages showed divergent associations with depression and anxiety disorders at different age levels, which underscores the potential relationship of prudent beverage choices in mitigating the risk of mental health. [Display omitted] • This is the large-scale prospective study with >180,000 participants to unravel the association between beverage consumption and mental disorders. • In people aged <60 years, intake of sugar-sweetened beverages and artificially sweetened beverages was linked to higher risk of depression. • In people aged ≥60 years, consumption of coffee and pure fruit/vegetable juices was inversely related to depression and anxiety. [ABSTRACT FROM AUTHOR]

Purpose: Many universities maintain pouring rights contracts (PRCs) with beverage companies wherein one company exchanges sponsorship payments for exclusive beverage marketing rights. Separately, universities may have healthy beverage initiatives (HBIs) to encourage healthier choices on campus. This study aimed to assess how and how frequently PRCs included provisions related to health and nutrition to examine how PRCs may support or undermine HBIs. Design: Cross-sectional. Setting: U.S. public universities with >20,000 students. Sample: 131 PRCs obtained from 124 of 143 universities in 2019-2020. Measures: Primary outcomes were the presence of provisions that could encourage or discourage promotion of healthy beverages (water, diet soda, unsweetened coffee or tea, and 100% juice), and any other provisions explicitly or implicitly referencing health or nutrition. Analysis: Descriptive statistics. Results: Twelve contracts (9%) had explicit commitments from the company or university to promote healthy beverages or adhere to nutrition standards, including five committing to support HBIs, four committing to healthy vending policies, and three describing activities to promote healthy beverage brands. Ten (8%) had provisions explicitly inhibiting water promotion and 55 (42%) had provisions that could be interpreted that way. Eleven (8%) included other health and nutrition provisions, such as funding for unspecified wellness activities. Conclusion: Most university beverage contracts did not expressly aim to support healthy choices, and more than half had provisions potentially limiting universities' ability to implement HBIs. When present, nutrition standards were weak. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate changes in sensory ratings (liking, sweetness intensity, "just about right" (JAR) level of sweetness) of 0–10.7% w/w sugar in soda after 1 and 2 wk of replacing sugar-sweetened soda consumption with unsweetened, flavored, sparkling water. Methods: Consumers of sugar-sweetened sodas (17 men and women, average age 28 years) replaced their sodas with unsweetened, flavored sparkling waters for 2 wk. Changes in sensory ratings were evaluated for sodas ranging from 0–10.7% w/w added sugar. In a secondary analysis, cluster analysis identified "Sweet Likers" (liking increased with sugar concentration) and "Sweet Moderates" (liking peaked in the middle of the concentration range) in the baseline ratings, and models for changes in sensory ratings were reevaluated by sweet-liking group. Results: The primary analyses showed no significant effects of the intervention on sweetness intensity or liking ratings. However, the secondary analysis showed that Sweet Likers reduced liking ratings for all sodas, but particularly for the highest concentration (p = 0.0021) after the intervention. Sweet Moderates, however, increased liking ratings after the intervention, driven by an increase in liking for the lower concentrations of sugar (p = 0.0058). Additionally, Sweet Moderates increased their overall ratings for sweetness intensity in sodas (p = 0.00074). Conclusion: These results suggest that the intervention may have been more successful in shifting sensory perception and acceptance of less-sweet sodas for Sweet Moderates than for Sweet Likers. These results should be verified in a larger sample that intentionally recruits by sweet liker status, to see if initial liking for sweetness may be a critical factor in interventions aiming to improve liking of less sweet beverages. Highlights: Consumers of sugary soda replaced their sodas with unsweetened, flavored sparkling water for 2 weeks, rating a range of sugar in soda in terms of sweetness intensity and liking for sweetness before, during, and after the intervention. No changes were significant in the sensory ratings for the whole group, but if the subjects are separated by baseline "sweet-liking," the "Sweet Likers" reduced liking for the highest concentration of sugar in soda, while the "Sweet Moderates" increased liking ratings for the lowest and zero concentrations of sugar in soda. [ABSTRACT FROM AUTHOR]

Background: Parents and families have a role to play in helping children develop healthy behaviours that will carry over into adulthood. The sugary drink and fruit juice consumption is significantly related to unhealthy weight gain in childhood. Hence, this study was planned to assess parental knowledge, attitudes, and practices about juice and sugar-sweetened beverages (SSBs) among parents of children (2–24 months) and identify factors that contribute to their early introduction. Methods and Material: A cross-sectional study was conducted on 400 children-parent dyads (2–24 months). A questionnaire regarding the knowledge and attitudes about initiating fruit juice and SSB among children was prepared with 6 statements that were validated for contents by two subject experts. Each of the questions was designed to be answered on a Five-point Likert-type scale. STATA 14.2 version was used to analyse data. Results: Out of 400, 14 (26.9%) and 125 (68%) parents planned to introduce SSBs and juices respectively in the first year life of their child. None of the parents had an excellent knowledge score. There was no significant difference reported between parents with less than high school and those with high school/graduation educated in their intention to introduce juice and SSBs (P = 0.68) to their babies in the first year of life and about its knowledge (P = 0.82). Most parents with lower socio-economic status (58.6%) showed less likeliness to introduce juices and SSBs to their child’s diet as reflected by a statistically significant (P = 0.01) knowledge score. Conclusion: There was a knowledge gap among parent’s of children irrespective of their education level and socio-economic status.

Abstract Background Past research has focused on the analysis of the association between sugar-sweetened beverages consumption and screen time, respectively, and an indicator of physical fitness in adolescents. However, no studies have analyzed the interaction between sugar-sweetened beverage consumption and screen time on physical fitness index. Methods Demographic information, lifestyle, sugar-sweetened beverage consumption and screen time were investigated and physical fitness indicators were tested in 8136 adolescents aged 13–18 years from six geographic regions of China using stage-stratified whole population sampling. The chi-square test and one-way ANOVA were used to compare the covariates. The Kruskal-Wallis test was used to compare physical fitness index between different sugar-sweetened beverage consumption and screen time groups. Generalized linear model ordered logistic regression analysis was used to analyze the interaction between sugar-sweetened beverage consumption and ST on physical fitness index. Results The differences in physical fitness index among different sugar-sweetened beverage consumers in child adolescents were all statistically significant in boys, girls, and in total (H-value of 72.415, 16.859, and 78.544, P 120 min/d (OR = 2.27, 95% CI:1.78, 2.89) had the the highest risk of reduced physical fitness index (P

Abstract Background Evaluating sugar-sweetened beverage (SSB) taxation often relies on simulation models. We assess how assumptions about the response to SSB taxation affect the projected body weight change and subsequent health and economic impacts related to type 2 diabetes mellitus (T2DM) using Germany as an example. Methods In the main analysis, we estimated changes in energy intake by age and sex under a 20% value-added tax on SSBs in Germany using marginal price elasticities (PE) and applied an energy equilibrium model to predict body weight changes. We then quantified the impact of several assumption modifications: SSB own-PE adjusted for consumption (M1)/based on alternative meta-analysis (M2); SSB consumption adjusted for underreporting (M3); substitution via marginal (M4a) or adjusted (M4b) cross-PE/as % of calorie change (M4c). We also assessed scenarios with alternative tax rates of 10% (S1) or 30% (S2) and including fruit juice (S3). We calculated overweight and obesity rates per modification and scenario. We simulated the impact on T2DM, associated healthcare costs, and disability-adjusted life years (DALYs) over the lifetime of the 2011 German adult population with a Markov model. Data included official demographics, national surveys, and meta-analyses. Results A 20% value-added tax in Germany could reduce the number of men and women with obesity by 210,800 [138,800; 294,100] and 80,800 [45,100; 123,300], respectively. Over the population’s lifetime, this would lead to modest T2DM-related health and economic impacts (76,700 DALYs [42,500; 120,600] averted; €2.37 billion [1.33; 3.71] costs saved). Policy impacts varied highly across modifications (all in DALYs averted): (M1) 94,800 [51,500; 150,700]; (M2) 164,200 [99,500; 243,500]; (M3) 52,600 [22,500; 91,100]; (M4a) -18,100 [-111,500; 68,300]; (M4b) 25,800 [-31,400; 81,500]; (M4c) 46,700 [25,300; 77,200]. The variability in policy impact related to modifications was similar to the variability between alternative policy scenarios (all in DALYs averted): (S1) 26,400 [9,300; 47,600]; (S2) 126,200 [73,600; 194,500]; (S3) 342,200 [234,200; 430,400]. Conclusions Predicted body weight reductions under SSB taxation are sensitive to assumptions by researchers often needed due to data limitations. Because this variability propagates to estimates of health and economic impacts, the resulting structural uncertainty should be considered when using results in decision-making.

Background: Past research has focused on the analysis of the association between sugar-sweetened beverages consumption and screen time, respectively, and an indicator of physical fitness in adolescents. However, no studies have analyzed the interaction between sugar-sweetened beverage consumption and screen time on physical fitness index. Methods: Demographic information, lifestyle, sugar-sweetened beverage consumption and screen time were investigated and physical fitness indicators were tested in 8136 adolescents aged 13–18 years from six geographic regions of China using stage-stratified whole population sampling. The chi-square test and one-way ANOVA were used to compare the covariates. The Kruskal-Wallis test was used to compare physical fitness index between different sugar-sweetened beverage consumption and screen time groups. Generalized linear model ordered logistic regression analysis was used to analyze the interaction between sugar-sweetened beverage consumption and ST on physical fitness index. Results: The differences in physical fitness index among different sugar-sweetened beverage consumers in child adolescents were all statistically significant in boys, girls, and in total (H-value of 72.415, 16.859, and 78.544, P < 0.001). The differences were also statistically significant when comparing the physical fitness index of Chinese adolescents of different screen time in boys, girls, and total (H-Value of 46.307, 21.552, and 65.287, P < 0.001). Overall, using sugar-sweetened beverage consumption ≤ 1time/week and screen time < 60 min/d as the reference group, after adjusting for relevant covariates, adolescents in the group with an sugar-sweetened beverage consumption of ≥ 5 time/week and screen time > 120 min/d (OR = 2.27, 95% CI:1.78, 2.89) had the the highest risk of reduced physical fitness index (P < 0.001). Conclusion: Associations of sugar-sweetened beverage consumption and screen time with physical fitness indices among Chinese adolescents. Both increased sugar-sweetened beverage consumption and prolonged ST further increased the risk of lower physical fitness index in adolescents. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Parents and families have a role to play in helping children develop healthy behaviours that will carry over into adulthood. The sugary drink and fruit juice consumption is significantly related to unhealthy weight gain in childhood. Hence, this study was planned to assess parental knowledge, attitudes, and practices about juice and sugar-sweetened beverages (SSBs) among parents of children (2–24 months) and identify factors that contribute to their early introduction. Methods and Material: A cross-sectional study was conducted on 400 children-parent dyads (2–24 months). A questionnaire regarding the knowledge and attitudes about initiating fruit juice and SSB among children was prepared with 6 statements that were validated for contents by two subject experts. Each of the questions was designed to be answered on a Five-point Likert-type scale. STATA 14.2 version was used to analyse data. Results: Out of 400, 14 (26.9%) and 125 (68%) parents planned to introduce SSBs and juices respectively in the first year life of their child. None of the parents had an excellent knowledge score. There was no significant difference reported between parents with less than high school and those with high school/graduation educated in their intention to introduce juice and SSBs (P = 0.68) to their babies in the first year of life and about its knowledge (P = 0.82). Most parents with lower socio-economic status (58.6%) showed less likeliness to introduce juices and SSBs to their child's diet as reflected by a statistically significant (P = 0.01) knowledge score. Conclusion: There was a knowledge gap among parent's of children irrespective of their education level and socio-economic status. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms have become a public health issue of common concern in countries all over the world, and have many negative impacts on university students' study and life. Depressive symptoms are influenced by many factors, including sugar-sweetened beverages (SSBs) consumption and duration of physical activity. However, no study has been conducted on the association between sugar-sweetened beverage consumption, duration of physical exercise, and depressive symptoms among Tibetan university students at high altitudes. Methods: In this study, a self-assessment survey of SSBs consumption, duration of physical exercise, and depressive symptoms was conducted on 6,259 (2,745 boys, 43.86%) Tibetan university students aged 19-22 years in Lhasa and Ganzi areas, China, using stratified whole population sampling. The associations were also analyzed using one-way analysis of variance, binary logistic regression analysis, and ordered logistic regression analysis in the generalised linear model. Results: The proportions of mild depression symptoms, moderate depression symptoms, and major depressive symptoms among Tibetan boys university students in high-altitude areas of China were 18.0, 22.9, and 1.5%, respectively; the proportions of girls students were 20.1, 21.9, and 1.5%, respectively, 1.5%, and the differences in the detection rates of depressive symptoms between sex were statistically significant (χ² value=14.253, p < 0.01). Ordered logistic regression analyses showed that using duration of physical exercise >60min/d and SSBs ≤1 times/week as the reference group, the duration of physical exercise<30 min/d and SSBs ≥5 times/week groups had the highest risk of developing depressive symptoms was the highest risk (OR=6.98, 95% CI: 5.05-9.65; p<0.001). Conclusion: This study confirmed that there was a positive association between SSBs consumption and depressive symptoms and a negative association between the duration of physical exercise and depressive symptoms among Tibetan university students at high altitudes in China. In the future, SSBs consumption should be effectively controlled and the duration of physical exercise should be increased to reduce the occurrence of depressive symptoms and promote the physical and mental health of Tibetan university students in high-altitude areas. [ABSTRACT FROM AUTHOR]

Background A high intake of sugar-sweetened beverages (SSBs) is associated with the risk of several chronic diseases, including ischemic heart disease (IHD) and stroke. This study aimed to model the impact of a 20% tax on all SSBs for IHD and stroke among Brazilian adults. Methods This was an ex-ante risk comparative study. The model applied a 20% tax on SSBs and projected the incidence, prevalence and mortality of IHD and stroke over a 20-year period (2019–39). Using data on consumption, previously published cross- and own-price elasticities of SSBs, and relative risk, we estimated changes in IHD and stroke burden. Results Our model predicts that a 20% SSB tax may reduce new cases of IHD by ~13%, especially among women, and avert ~8% of the deaths attributable to IHD over 20 years. These results represent a decrease of 19 543 new cases and 8466 and 7274 fewer deaths in the period for men and women, respectively. Estimates of reduction in incidence, prevalence and deaths from stroke were not significant over 20 years. Conclusions Even under conservative assumptions, our study found that a small reduction in SSB consumption led to a substantial decrease in IHD incidence and mortality in Brazil. [ABSTRACT FROM AUTHOR]

Background: Sugar-sweetened beverages, favored by various groups, particularly adolescents, are associated with an increasing risk of obesity and diabetes mellitus. According to preliminary research conducted at SMAN 1 Serang, approximately 60% of students have a high level of sugar-sweetened beverages consumption. Role of peers and social media exposure is considered to have an association with level of sugarsweetened beverage consumption in adolescents. Objectives: This research aimed to determine association between role of peers and social media exposure with level of sugar-sweetened beverages consumption in adolescents at SMAN 1 Serang. Methods: The analytic observational research was carried out using a cross-sectional design. The study population consisted of 1,085 students from classes X and XI, while the sample size comprised 300 students who were selected using stratified random sampling and the data obtained were analyzed with chi-square test. Independent variables were measured with a questionnaire consisting of 13 closed-ended questions, while the dependent variable was measured with a Food Frequency Questionnaire. Results: The majority of respondents had a high level of sugar-sweetened beverages consumption (54.3%), bad role of peers (55.7%), and exposure to social media (74.0%). Moreover, this research showed the association between the role of peers (p=0.0001) and social media exposure (p=0.037) with level of sugar-sweetened beverages consumption. Conclusions: This research showed a significant association between role of peers and social media exposure with level of sugar-sweetened beverages consumption in adolescents. Therefore, forming peer groups and using social media were expected to increase students' awareness, causing a substantial reduction in beverages consumption. [ABSTRACT FROM AUTHOR]

This study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p <.01), and being female was associated with 35 minutes more screen time per day (p <.01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses. [ABSTRACT FROM AUTHOR]

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health. [ABSTRACT FROM AUTHOR]

Background: As the global consumption of sugary and non-sugar sweetened beverages continues to rise, there is growing concern about their health impacts, particularly among pregnant women and their offspring. Objective: This study aimed to investigate the consumption patterns of various beverages among pregnant women in Shanghai and their potential health impacts on both mothers and offspring. Method: We applied a multi-stage random sampling method to select participants from 16 districts in Shanghai. Each district was categorised into five zones. Two towns were randomly selected from each zone, and from each town, 30 pregnant women were randomly selected. Data were collected through face-to-face questionnaires. Follow-up data on births within a year after the survey were also obtained. Result: The consumption rates of total beverages (TB), sugar-sweetened beverages (SSB), and non-sugar sweetened beverages (NSS) were 73.2%, 72.8%, and 13.5%, respectively. Logistic regression analysis showed that compared to non-consumers, pregnant women consuming TB three times or less per week had a 38.4% increased risk of gestational diabetes mellitus (GDM) (OR = 1.384; 95% CI: 1.129–1.696) and a 64.2% increased risk of gestational hypertension (GH) (OR = 1.642; 95% CI: 1.129–2.389). Those consuming TB four or more times per week faced a 154.3% higher risk of GDM (OR = 2.543; 95% CI: 2.064–3.314) and a 169.3% increased risk of GH (OR = 2.693; 95% CI: 1.773–4.091). Similar results were observed in the analysis of SSB. Regarding offspring health, compared to non-consumers, TB consumption four or more times per week was associated with a substantial increase in the risk of macrosomia (OR = 2.143; 95% CI: 1.304–3.522) and large for gestational age (LGA) (OR = 1.695; 95% CI: 1.219–2.356). In the analysis of NSS, with a significantly increased risk of macrosomia (OR = 6.581; 95% CI:2.796–13.824) and LGA (OR = 7.554; 95% CI: 3.372–16.921). Conclusion: The high level of beverage consumption among pregnant women in Shanghai needs attention. Excessive consumption of beverages increases the risk of GDM and GH, while excessive consumption of NSS possibly has a greater impact on offspring macrosomia and LGA. [ABSTRACT FROM AUTHOR]

Background: Evaluating sugar-sweetened beverage (SSB) taxation often relies on simulation models. We assess how assumptions about the response to SSB taxation affect the projected body weight change and subsequent health and economic impacts related to type 2 diabetes mellitus (T2DM) using Germany as an example. Methods: In the main analysis, we estimated changes in energy intake by age and sex under a 20% value-added tax on SSBs in Germany using marginal price elasticities (PE) and applied an energy equilibrium model to predict body weight changes. We then quantified the impact of several assumption modifications: SSB own-PE adjusted for consumption (M1)/based on alternative meta-analysis (M2); SSB consumption adjusted for underreporting (M3); substitution via marginal (M4a) or adjusted (M4b) cross-PE/as % of calorie change (M4c). We also assessed scenarios with alternative tax rates of 10% (S1) or 30% (S2) and including fruit juice (S3). We calculated overweight and obesity rates per modification and scenario. We simulated the impact on T2DM, associated healthcare costs, and disability-adjusted life years (DALYs) over the lifetime of the 2011 German adult population with a Markov model. Data included official demographics, national surveys, and meta-analyses. Results: A 20% value-added tax in Germany could reduce the number of men and women with obesity by 210,800 [138,800; 294,100] and 80,800 [45,100; 123,300], respectively. Over the population's lifetime, this would lead to modest T2DM-related health and economic impacts (76,700 DALYs [42,500; 120,600] averted; €2.37 billion [1.33; 3.71] costs saved). Policy impacts varied highly across modifications (all in DALYs averted): (M1) 94,800 [51,500; 150,700]; (M2) 164,200 [99,500; 243,500]; (M3) 52,600 [22,500; 91,100]; (M4a) -18,100 [-111,500; 68,300]; (M4b) 25,800 [-31,400; 81,500]; (M4c) 46,700 [25,300; 77,200]. The variability in policy impact related to modifications was similar to the variability between alternative policy scenarios (all in DALYs averted): (S1) 26,400 [9,300; 47,600]; (S2) 126,200 [73,600; 194,500]; (S3) 342,200 [234,200; 430,400]. Conclusions: Predicted body weight reductions under SSB taxation are sensitive to assumptions by researchers often needed due to data limitations. Because this variability propagates to estimates of health and economic impacts, the resulting structural uncertainty should be considered when using results in decision-making. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? The study addresses the global health concern of sugar overconsumption, particularly focusing on the prevalence of sugar‐sweetened beverage consumption among young people.The study tested three different health promotion campaign concepts, designed to reduce sugar‐sweetened beverage intake and promote water consumption as a healthier alternative. A total of 402 young adults (18–29) were recruited from a university campus and an online panel. Participants were randomly assigned to view one of three campaign images: one advocating for substituting sugar‐sweetened beverages with water, and two exclusively promoting water consumption. These images were assessed through an online survey, which included questions on emotional response, salience, attitudes and intentions towards various beverages.Participants exposed to the campaign emphasising the benefits of water showed a greater intention to increase water consumption and reduce both sugar‐ and non‐sugar‐sweetened beverages compared with the other groups. There were no significant differences observed for the beverage choice task across the campaigns.The findings suggest that messaging focusing on the benefits of water holds promise in encouraging healthier beverage consumption intentions among young adults. The lack of significant differences in the beverage choice task across the campaigns indicates a need for further research to explore long‐term behaviour change effects.By highlighting the benefits of water consumption, campaigns may have the potential to positively influence beverage choices and promote healthier habits. Continued research in this area can provide valuable insights for developing more impactful interventions aimed at reducing sugar‐sweetened beverage consumption. [ABSTRACT FROM AUTHOR]

The increase in childhood obesity is one of the biggest public health problems of the 21st century. Among the contributing dietary factors is the high consumption of sugar-sweetened beverages (SSB) and sweetened fruit juices (SFJ). On the other hand, regular consumption of milk and dairy products has decreased in many countries over the years, although research has shown an inverse association between dairy consumption and obesity. The aim of this study was to determine the effects of a dietary intervention within a multidisciplinary structured programme on reducing the consumption of SSB and SFJ and simultaneously increasing the consumption of milk and diary products in obese children/adolescents. The study included 100 participants of both sexes who had been diagnosed with obesity and participated in a five-day multidisciplinary structured programme focused on dietary intrevention. Standard anthropometric measurements and a validated questionnaire were used during the study. The mean age of the participants was 12.61±1.90 years, body mass index (BMI) was 98.38±1.26 percentiles; mean consumption of SSB was 1.68 ± 2.89 dL; SFJ was 3.72±5.09 dL and milk and dairy products was 3.10±2.35 dL per day at the start of the intervention. After the five-day programme, patients were reeducated once a month for the first six months, then every two months for up to 24 months. After 24 months, a significant decrease in SSB and SFJ intake (p<0.001) and an increase in milk and dairy products intake (p=0.002) were observed. The percentiles of the BMI also decreased after 24 months (p<0.001). The dietary intervention had a positive effect on the anthropometric values and the change in the dietary habits of the participants, with a focus on the consumption of milk and dairy products. [ABSTRACT FROM AUTHOR]