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Background: School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. Objectives: To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. Methods: An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11–15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Results: Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = –2.78 g, 95% confidence interval –4.66 to –0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. Limitations: There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. Conclusions: In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. Future research: We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration: This trial is registered as ISRCTN68757496. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information. Plain language summary: Why have we done this research?: We wanted to find out how well secondary schools meet the school food standards in England and how these standards influence the dietary intake and dental health of pupils. We also wanted to explore how secondary schools provide other ways of supporting pupils' healthy eating. What did we do?: We compared schools that are required to meet the school food standards with those that are not required to meet them. We looked at school food, menus, and eating environments in 36 secondary schools and did surveys with 151 staff/governors. We asked 2453 secondary school pupils about their diet and dental health. We held interviews with 21 staff/governors and focus groups with 137 pupils at four schools. We gathered their views on school food and healthy eating. What did we find?: On average, the schools met 64% of the school food standards, regardless of whether they were required to meet them. Pupils in the schools required to meet the standards had lower intakes of sugar and calories at lunchtime than pupils in the schools not required to meet them; however, they ate less fruit and vegetables. Pupils in the schools required to meet the standards ate more confectionery during the school day and drank more sugary drinks overall. There were no differences in the dental health of pupils in the two school groups. School staff told us that some standards were difficult to meet. Catering staff had to think about pupil preferences and financial considerations, as well as the school food standards. Some pupils felt that school food did not meet their needs and preferences. Some pupils disliked the lunchtime experience. Healthy-eating education was not very visible within the curriculum. What does this mean?: Secondary schools are struggling to meet the school food standards and implement actions to support healthy eating. We found no evidence to show that the school food standards have improved dietary intake in secondary school pupils. Scientific summary: Background: National school food standards (SFS) legislation has been in place since 2006. In 2013, the School Food Plan (SFP) was introduced, which contained recommendations for schools to support healthy eating. Following this, in 2015, the government introduced updated SFS legislation. Evaluation of the impact of the 2006 SFS on nutritional intake has focused on primary school-aged children, and evidence relating to secondary school pupils is more limited. To the best of our knowledge, implementation of the updated SFS and the SFP , and their impact on pupil nutritional intake, has not been evaluated in secondary schools. The national SFS legislation applies to state-funded schools in England, except for academies and free schools established between 2010 and 2014. The exemption of these schools provided an opportunity to compare implementation of the SFS and SFP , pupil nutritional intake, and dental health between schools that are mandated and schools that are not mandated to comply with the SFS. However, exempt schools have been encouraged to voluntarily comply with the standards, and in the last 18 months of this study there has been a government expectation that all schools, regardless of their exemption status, should comply with the SFS. Despite their legislative status, there are no formal national arrangements for monitoring or reporting schools' compliance with the SFS. Objectives: The three research objectives were: in secondary schools either mandated (SFS-mandated) or not mandated (SFS-non-mandated) to comply with the national SFS legislation, to compare – school food provision and compliance with the SFS the school food environment/culture and the food curriculum, and implementation of the SFP actions the nutritional intake and dental health of school pupils, focusing on free sugar intake as the primary outcome the costs of food provision, food curriculum delivery and other measures to influence the school food culture and environment. to explore the variation in compliance with the SFS and implementation of SFP actions in secondary schools and use this to develop a typology of schools to use the developed school typology to explore associations between the school types and pupil dietary and dental outcomes. Methods: We conducted an observational, multiple-methods study comprising two phases: (1) collecting a variety of data to assess school SFS/SFP implementation, pupil dietary intake and dental outcomes in SFS-mandated and SFS-non-mandated schools and (2) a qualitative case study with four school sites to understand the experiences of schools in implementing and embedding the SFS and SFP. In addition, we undertook an economic evaluation to assess how the costs and outcomes compared across SFS-mandated and SFS-non-mandated schools. State-funded secondary school academies/free schools were sampled from the Midlands, England, using a stratified sampling approach. Pupils were sampled from one class in each of years 7 (age 11–12 years), 9 (age 13–14 years) and 10 (age 14–15 years) in participating schools. School staff and governors with a role in food provision or education were also recruited. Schools were recruited by invitation, and for participating in the study they received a £300 payment and a report detailing the school's implementation of the SFS/SFP. Case study schools received an additional £150. Written, informed consent was provided by all participants. Parents of invited pupils provided passive consent for their child's participation. Pupils were given a £5 voucher as a thank-you for their participation. Data collection was guided by a logic model and was undertaken at the school and pupil level. It incorporated assessment of food provision (to assess compliance with the SFS); the school food culture, curriculum and environment (to assess implementation of the SFP actions); costs related to food provision and the food culture/curriculum/environment; school contextual data; and pupil nutritional and dental outcomes. School food standards and School Food Plan implementation: Assessment of SFS implementation was guided by published checklists and comprised a 1-day researcher observation of all school mealtimes and food outlets and a review of school menus. Assessment of implementation of SFP actions was guided by published resources for schools and comprised researcher observation, document analysis, and surveys to schools, staff and pupils. Compliance with each SFS was judged as a binary yes/no, and level of implementation of each SFP action was categorised into high, medium or low. The embedding of the SFS and SFP policies overall was assessed through school/catering staff and governor surveys. Contextual data were provided by schools via surveys and/or documents. School-level data were also used to develop a school typology using a two-stage process. In stage 1 we used SFS compliance data to generate school types based on high/medium/low compliance with two sets of standards relating to two key dietary patterns: (1) food/drinks that are energy-dense and/or high in fat or sugar; and (2) variety/balance of food groups. In stage 2, we identified subtypes based on the implementation of selected SFP actions. Pupil outcomes: The primary outcome was pupil free sugar intake (defined as all sugars added to foods by the manufacturer, cook or consumer, and natural sugars found in honey, syrups and unsweetened fruit juices). Secondary nutritional outcomes were percentage of total energy intake (TEI) from free sugars; TEI (kcal); total fat intake (g); fibre intake (g); number of portions of fruit and vegetables (F&V) consumed; number of sugar-sweetened beverages (SSB) consumed; number of confectionery items consumed; and number of foods high in fat, sugar and salt (HFSS) consumed. These nutritional outcomes were calculated for three time periods: the school day lunch; while present at school; and during the full 24-hour period of the same school day. Additional secondary nutritional outcomes were free sugar intake providing ˃ 5% of 24-hour TEI ; consumption of five or more portions of F&V during a 24-hour period; and number of eating/drinking occasions (excluding plain water) during a 24-hour period. Dental outcomes were the presence of dental caries symptoms in the previous 3 months; the number of dental caries symptoms in the previous 3 months; and past dental caries treatment. Data on nutritional outcomes were collected by pupil self-report using an online 24-hour dietary recall (Intake24), with one or two recalls per participant on non-consecutive school days. Dental outcome data and sociodemographic data were collected by pupil self-report using online surveys. Postcodes were mapped to Index of Multiple Deprivation (IMD) 2019 scores and used to obtain water fluoridation levels at participants' homes. Linear or Poisson multilevel models were used to explore differences in pupil outcomes across the SFS-mandated and SFS-non-mandated school groups. The models were adjusted for relevant school-level and pupil-level variables. We explored two-way interaction effects between school SFS-mandated/non-mandated status and lunch source (school-provided vs. obtained from elsewhere), year group and IMD group. We conducted exploratory analyses to compare pupil outcomes across identified school types. Statistical analyses were conducted in Stata version 17 (StataCorp LP, College Station, TX, USA). Economic evaluation: The economic evaluation took the form of a micro-costing and a cost–consequences analysis. Costs to schools associated with school food were collected via a school survey. In addition, public data on catering expenditure were used to supplement the analysis. Pupil expenditure on school food was collected through the online surveys. Outcomes were pupil dietary intake and dental health (detailed above); pupil health-related quality of life (HRQoL), measured via the online surveys using the Child Health Utility 9-Dimensions tool; and school-level educational outcomes relating to absenteeism and attainment (publicly available). Case study: We explored the way in which the SFS , SFP and local school policy or initiatives were introduced, embedded and sustained in the schools, and their perceived influence on the dietary intake of pupils. We selected four schools from the phase 1 sample based on their SFS-mandated/non-mandated status, the percentage of pupils eligible for free school meals (FSM), and their catering model. We conducted four to six interviews per school with relevant staff/governors and three focus groups with pupils from years 7, 9 and 10. All interviews/focus groups were thematically analysed using the Framework approach. Public involvement: At multiple time points, we consulted with public representatives (young people, parents and school staff/governors), who advised on participant information, recruitment, data collection tools, interpretation of the findings and dissemination. Results: Thirty-six schools participated (SFS-mandated, n = 13; SFS-non-mandated, n = 23) and 2453 pupil participants provided nutritional and/or dental outcome data (SFS-mandated, n = 836; SFS-non-mandated, n = 1617). On average, schools were compliant with 64% of SFS , with standards applying to lunchtime provision (average of 81% of standards met) more likely to be implemented than those applied to food provided across the whole school day or outside lunch (average of 43% and 64% standards met, respectively). The standards with low compliance mostly related to the restriction of HFSS foods and drinks. On average, schools implemented 41% of SFP actions to a high level. SFS compliance and SFP implementation were similar across SFS-mandated and SFS-non-mandated schools. School Food Plan assessment revealed a lack of implementation of actions relating to leadership and oversight on school food, engagement (with pupils, parents and the community) and catering practices (catering staff encouraging healthy behaviours and nutritional balance) in the majority of schools. Implementation of actions relating to the lunchtime experience was variable; for example, most schools (77%) had strategies in place to reduce queuing, but many schools (58%) did not ask for feedback on the lunchtime experience from their pupils. Curricular education relating to food and healthy eating was well implemented in most schools, but education around growing and extracurricular food education was not. Specifically relating to leadership and oversight on school food, governor leadership and engagement with school food, independent checking of compliance of the school with the SFS and governor review of school food uptake data were actions that were poorly implemented across schools (implemented to a low level in 64%, 79% and 74% schools, respectively). None of the governors responding to the staff/governor survey reported that they were involved in managing or overseeing the implementation of the SFS , and only 31% of senior leader respondents stated that they were involved. Compared with pupils in SFS-non-mandated schools and adjusting for other variables, pupils in SFS-mandated schools had lower free sugar intake (–2.78 g, 95% CI –4.66 to –0.90 g) and lower TEI (54.97 kcal; 95% CI –88.87 to –21.07 kcal) at lunch, but there was no significant difference in the percentage of energy intake from free sugars. When TEI was adjusted for, compared with pupils in SFS-non-mandated schools, pupils in SFS-mandated schools had a significantly lower intake of F&V at lunch (–0.20 portions; 95% CI –0.32 to –0.08 portions), during the school day and over 24 hours. There was also significantly higher consumption of confectionery during the school day and SSB over 24 hours in the SFS-mandated schools group than in the SFS-non-mandated school group, when TEI was adjusted for. Participants who had a 100% school-provided lunch had lower lunchtime free sugar, TEI , fat, fibre and F&V intake. There were no significant differences in dental outcomes between the SFS-mandated and SFS-non-mandated school groups, and no clear interaction effects between school SFS-mandated/non-mandated status and lunch source, IMD group or year group. We identified four school types based on SFS compliance and two further subtypes based on SFP implementation in stages 1 and 2 of our school typology development. We noted some differences in pupil nutritional outcomes across the four school types. Compared with type 1 schools (low implementation of obesity/dental health-related SFS and high implementation of dietary variety-related SFS), pupils in the type 2 school (medium implementation of both sets of SFS) had a lower percentage of TEI from free sugar at lunch (–8.12%, 95% CI –14.48% to –1.76%) but higher consumption of confectionery items during the school day [incidence rate ratio (IRR) 2.70, 95% CI 1.30 to 5.59]. Pupils in the type 4 school (high implementation of obesity/dental health-related SFS and dietary variety-related SFS) had a higher consumption of confectionery items at lunch than those in type 1 schools (IRR 2.15, 95% CI 1.16 to 3.98). Twenty-two schools contributed data on costs related to food (SFS-mandated, n = 6; SFS-non-mandated, n = 16). Annual ongoing costs of food provision from a societal perspective included costs to schools, costs to catering providers and volunteer time, and ranged from £8500 to £974,563, with a mean of £207,094. The annual ongoing costs per pupil (from a societal perspective) ranged from £9 to £982, with a mean of £195 (based on the total number of pupils). Staff costs constituted the largest cost category. The average annual ongoing costs of implementing and delivering the SFS and SFP and of food provision was lower in SFS-mandated schools than in SFS-non-mandated schools (£167 vs. £206 per pupil). SFS-mandated schools also reported spending slightly less on catering, on average, than SFS-non-mandated schools (£128 vs. £133 per pupil, based on the total number of pupils). Pupils in SFS-mandated schools reported slightly higher HRQoL than pupils in SFS-non-mandated schools (0.8302 vs. 0.8274); however, potential confounding factors were not adjusted for, and there was variation in the number of missing HRQoL data across SFS-mandated/non-mandated groups. Twenty-one staff/governors and 137 pupils from 4 schools participated in the qualitative case study phase, with variation across the schools in relation to FSM eligibility (9–53%), SFS-mandated/non-mandated status (50% SFS-mandated) and catering model (50% external). Schools described patchy implementation of the SFS , acknowledging that some standards were difficult to adhere to, especially at breakfast/breaktime. Staff described balancing SFS compliance with conflicting priorities around maintaining viable levels of school food uptake, cost/profit and pupil preferences. Drivers of pupils' food choices included convenience, speed, perceived value for money and taste. Some pupils felt that these were not met by school food and described negative lunchtime experiences, which discouraged a sit-down meal and influenced their eating behaviours. Some school staff felt that their influence on pupils' food choices was limited, acknowledging difficult social and environmental contexts. School staff/governors had a low awareness of the SFP and generally were not taking steps to implement it. The time dedicated to healthy eating in relevant lessons was perceived to be low, despite staff acknowledging its importance, while pupils felt that healthy-eating education was sporadic. In general, governors reported minimal oversight of school food and SFS compliance. Conclusions: Our findings suggest that the current SFS are difficult to comply with in a secondary school context, partly due to the style of food provision (e.g. extensive provision at breakfast/breaktime) and the need to provide foods and drinks to meet the pupils' demands to ensure school food uptake and financial viability. There is currently a lack of oversight and monitoring of SFS compliance within schools. Our findings also indicate that the SFP has not achieved the desired outcomes in the secondary school setting, which suggests that a different approach may be needed to better support secondary schools in cultivating a healthy-eating culture. Finally, our findings suggest that even when the SFS are relatively well implemented, this may have no beneficial effect on the nutritional intake of pupils or may even lead to marginally worse nutritional intake. Schools need to be considered as only one part of the food system that influences adolescents' dietary intake, and it is important to address other aspects of this system to substantially influence nutritional intake in this age group. A key focus for future research is to develop alternative models of healthy food provision that better meet the needs of secondary school pupils and to better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration: This trial is registered as ISRCTN68757496. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Background School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. Objectives To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. Methods An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11–15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Results Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = –2.78 g, 95% confidence interval –4.66 to –0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. Limitations There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. Conclusions In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. Future research We need to develop healthy secondary-school food provision models that meet pupils’ preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration This trial is registered as ISRCTN68757496. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information. Plain language summary Why have we done this research? We wanted to find out how well secondary schools meet the school food standards in England and how these standards influence the dietary intake and dental health of pupils. We also wanted to explore how secondary schools provide other ways of supporting pupils’ healthy eating. What did we do? We compared schools that are required to meet the school food standards with those that are not required to meet them. We looked at school food, menus, and eating environments in 36 secondary schools and did surveys with 151 staff/governors. We asked 2453 secondary school pupils about their diet and dental health. We held interviews with 21 staff/governors and focus groups with 137 pupils at four schools. We gathered their views on school food and healthy eating. What did we find? On average, the schools met 64% of the school food standards, regardless of whether they were required to meet them. Pupils in the schools required to meet the standards had lower intakes of sugar and calories at lunchtime than pupils in the schools not required to meet them; however, they ate less fruit and vegetables. Pupils in the schools required to meet the standards ate more confectionery during the school day and drank more sugary drinks overall. There were no differences in the dental health of pupils in the two school groups. School staff told us that some standards were difficult to meet. Catering staff had to think about pupil preferences and financial considerations, as well as the school food standards. Some pupils felt that school food did not meet their needs and preferences. Some pupils disliked the lunchtime experience. Healthy-eating education was not very visible within the curriculum. What does this mean? Secondary schools are struggling to meet the school food standards and implement actions to support healthy eating. We found no evidence to show that the school food standards have improved dietary intake in secondary school pupils. Scientific summary Background National school food standards (SFS) legislation has been in place since 2006. In 2013, the School Food Plan (SFP) was introduced, which contained recommendations for schools to support healthy eating. Following this, in 2015, the government introduced updated SFS legislation. Evaluation of the impact of the 2006 SFS on nutritional intake has focused on primary school-aged children, and evidence relating to secondary school pupils is more limited. To the best of our knowledge, implementation of the updated SFS and the SFP, and their impact on pupil nutritional intake, has not been evaluated in secondary schools. The national SFS legislation applies to state-funded schools in England, except for academies and free schools established between 2010 and 2014. The exemption of these schools provided an opportunity to compare implementation of the SFS and SFP, pupil nutritional intake, and dental health between schools that are mandated and schools that are not mandated to comply with the SFS. However, exempt schools have been encouraged to voluntarily comply with the standards, and in the last 18 months of this study there has been a government expectation that all schools, regardless of their exemption status, should comply with the SFS. Despite their legislative status, there are no formal national arrangements for monitoring or reporting schools’ compliance with the SFS. Objectives The three research objectives were: in secondary schools either mandated (SFS-mandated) or not mandated (SFS-non-mandated) to comply with the national SFS legislation, to compare – school food provision and compliance with the SFS the school food environment/culture and the food curriculum, and implementation of the SFP actions the nutritional intake and dental health of school pupils, focusing on free sugar intake as the primary outcome the costs of food provision, food curriculum delivery and other measures to influence the school food culture and environment. to explore the variation in compliance with the SFS and implementation of SFP actions in secondary schools and use this to develop a typology of schools to use the developed school typology to explore associations between the school types and pupil dietary and dental outcomes. Methods We conducted an observational, multiple-methods study comprising two phases: (1) collecting a variety of data to assess school SFS/SFP implementation, pupil dietary intake and dental outcomes in SFS-mandated and SFS-non-mandated schools and (2) a qualitative case study with four school sites to understand the experiences of schools in implementing and embedding the SFS and SFP. In addition, we undertook an economic evaluation to assess how the costs and outcomes compared across SFS-mandated and SFS-non-mandated schools. State-funded secondary school academies/free schools were sampled from the Midlands, England, using a stratified sampling approach. Pupils were sampled from one class in each of years 7 (age 11–12 years), 9 (age 13–14 years) and 10 (age 14–15 years) in participating schools. School staff and governors with a role in food provision or education were also recruited. Schools were recruited by invitation, and for participating in the study they received a £300 payment and a report detailing the school’s implementation of the SFS/SFP. Case study schools received an additional £150. Written, informed consent was provided by all participants. Parents of invited pupils provided passive consent for their child’s participation. Pupils were given a £5 voucher as a thank-you for their participation. Data collection was guided by a logic model and was undertaken at the school and pupil level. It incorporated assessment of food provision (to assess compliance with the SFS); the school food culture, curriculum and environment (to assess implementation of the SFP actions); costs related to food provision and the food culture/curriculum/environment; school contextual data; and pupil nutritional and dental outcomes. School food standards and School Food Plan implementation Assessment of SFS implementation was guided by published checklists and comprised a 1-day researcher observation of all school mealtimes and food outlets and a review of school menus. Assessment of implementation of SFP actions was guided by published resources for schools and comprised researcher observation, document analysis, and surveys to schools, staff and pupils. Compliance with each SFS was judged as a binary yes/no, and level of implementation of each SFP action was categorised into high, medium or low. The embedding of the SFS and SFP policies overall was assessed through school/catering staff and governor surveys. Contextual data were provided by schools via surveys and/or documents. School-level data were also used to develop a school typology using a two-stage process. In stage 1 we used SFS compliance data to generate school types based on high/medium/low compliance with two sets of standards relating to two key dietary patterns: (1) food/drinks that are energy-dense and/or high in fat or sugar; and (2) variety/balance of food groups. In stage 2, we identified subtypes based on the implementation of selected SFP actions. Pupil outcomes The primary outcome was pupil free sugar intake (defined as all sugars added to foods by the manufacturer, cook or consumer, and natural sugars found in honey, syrups and unsweetened fruit juices). Secondary nutritional outcomes were percentage of total energy intake (TEI) from free sugars; TEI (kcal); total fat intake (g); fibre intake (g); number of portions of fruit and vegetables (F&V) consumed; number of sugar-sweetened beverages (SSB) consumed; number of confectionery items consumed; and number of foods high in fat, sugar and salt (HFSS) consumed. These nutritional outcomes were calculated for three time periods: the school day lunch; while present at school; and during the full 24-hour period of the same school day. Additional secondary nutritional outcomes were free sugar intake providing ˃ 5% of 24-hour TEI; consumption of five or more portions of F&V during a 24-hour period; and number of eating/drinking occasions (excluding plain water) during a 24-hour period. Dental outcomes were the presence of dental caries symptoms in the previous 3 months; the number of dental caries symptoms in the previous 3 months; and past dental caries treatment. Data on nutritional outcomes were collected by pupil self-report using an online 24-hour dietary recall (Intake24), with one or two recalls per participant on non-consecutive school days. Dental outcome data and sociodemographic data were collected by pupil self-report using online surveys. Postcodes were mapped to Index of Multiple Deprivation (IMD) 2019 scores and used to obtain water fluoridation levels at participants’ homes. Linear or Poisson multilevel models were used to explore differences in pupil outcomes across the SFS-mandated and SFS-non-mandated school groups. The models were adjusted for relevant school-level and pupil-level variables. We explored two-way interaction effects between school SFS-mandated/non-mandated status and lunch source (school-provided vs. obtained from elsewhere), year group and IMD group. We conducted exploratory analyses to compare pupil outcomes across identified school types. Statistical analyses were conducted in Stata version 17 (StataCorp LP, College Station, TX, USA). Economic evaluation The economic evaluation took the form of a micro-costing and a cost–consequences analysis. Costs to schools associated with school food were collected via a school survey. In addition, public data on catering expenditure were used to supplement the analysis. Pupil expenditure on school food was collected through the online surveys. Outcomes were pupil dietary intake and dental health (detailed above); pupil health-related quality of life (HRQoL), measured via the online surveys using the Child Health Utility 9-Dimensions tool; and school-level educational outcomes relating to absenteeism and attainment (publicly available). Case study We explored the way in which the SFS, SFP and local school policy or initiatives were introduced, embedded and sustained in the schools, and their perceived influence on the dietary intake of pupils. We selected four schools from the phase 1 sample based on their SFS-mandated/non-mandated status, the percentage of pupils eligible for free school meals (FSM), and their catering model. We conducted four to six interviews per school with relevant staff/governors and three focus groups with pupils from years 7, 9 and 10. All interviews/focus groups were thematically analysed using the Framework approach. Public involvement At multiple time points, we consulted with public representatives (young people, parents and school staff/governors), who advised on participant information, recruitment, data collection tools, interpretation of the findings and dissemination. Results Thirty-six schools participated (SFS-mandated, n = 13; SFS-non-mandated, n = 23) and 2453 pupil participants provided nutritional and/or dental outcome data (SFS-mandated, n = 836; SFS-non-mandated, n = 1617). On average, schools were compliant with 64% of SFS, with standards applying to lunchtime provision (average of 81% of standards met) more likely to be implemented than those applied to food provided across the whole school day or outside lunch (average of 43% and 64% standards met, respectively). The standards with low compliance mostly related to the restriction of HFSS foods and drinks. On average, schools implemented 41% of SFP actions to a high level. SFS compliance and SFP implementation were similar across SFS-mandated and SFS-non-mandated schools. School Food Plan assessment revealed a lack of implementation of actions relating to leadership and oversight on school food, engagement (with pupils, parents and the community) and catering practices (catering staff encouraging healthy behaviours and nutritional balance) in the majority of schools. Implementation of actions relating to the lunchtime experience was variable; for example, most schools (77%) had strategies in place to reduce queuing, but many schools (58%) did not ask for feedback on the lunchtime experience from their pupils. Curricular education relating to food and healthy eating was well implemented in most schools, but education around growing and extracurricular food education was not. Specifically relating to leadership and oversight on school food, governor leadership and engagement with school food, independent checking of compliance of the school with the SFS and governor review of school food uptake data were actions that were poorly implemented across schools (implemented to a low level in 64%, 79% and 74% schools, respectively). None of the governors responding to the staff/governor survey reported that they were involved in managing or overseeing the implementation of the SFS, and only 31% of senior leader respondents stated that they were involved. Compared with pupils in SFS-non-mandated schools and adjusting for other variables, pupils in SFS-mandated schools had lower free sugar intake (–2.78 g, 95% CI –4.66 to –0.90 g) and lower TEI (54.97 kcal; 95% CI –88.87 to –21.07 kcal) at lunch, but there was no significant difference in the percentage of energy intake from free sugars. When TEI was adjusted for, compared with pupils in SFS-non-mandated schools, pupils in SFS-mandated schools had a significantly lower intake of F&V at lunch (–0.20 portions; 95% CI –0.32 to –0.08 portions), during the school day and over 24 hours. There was also significantly higher consumption of confectionery during the school day and SSB over 24 hours in the SFS-mandated schools group than in the SFS-non-mandated school group, when TEI was adjusted for. Participants who had a 100% school-provided lunch had lower lunchtime free sugar, TEI, fat, fibre and F&V intake. There were no significant differences in dental outcomes between the SFS-mandated and SFS-non-mandated school groups, and no clear interaction effects between school SFS-mandated/non-mandated status and lunch source, IMD group or year group. We identified four school types based on SFS compliance and two further subtypes based on SFP implementation in stages 1 and 2 of our school typology development. We noted some differences in pupil nutritional outcomes across the four school types. Compared with type 1 schools (low implementation of obesity/dental health-related SFS and high implementation of dietary variety-related SFS), pupils in the type 2 school (medium implementation of both sets of SFS) had a lower percentage of TEI from free sugar at lunch (–8.12%, 95% CI –14.48% to –1.76%) but higher consumption of confectionery items during the school day [incidence rate ratio (IRR) 2.70, 95% CI 1.30 to 5.59]. Pupils in the type 4 school (high implementation of obesity/dental health-related SFS and dietary variety-related SFS) had a higher consumption of confectionery items at lunch than those in type 1 schools (IRR 2.15, 95% CI 1.16 to 3.98). Twenty-two schools contributed data on costs related to food (SFS-mandated, n = 6; SFS-non-mandated, n = 16). Annual ongoing costs of food provision from a societal perspective included costs to schools, costs to catering providers and volunteer time, and ranged from £8500 to £974,563, with a mean of £207,094. The annual ongoing costs per pupil (from a societal perspective) ranged from £9 to £982, with a mean of £195 (based on the total number of pupils). Staff costs constituted the largest cost category. The average annual ongoing costs of implementing and delivering the SFS and SFP and of food provision was lower in SFS-mandated schools than in SFS-non-mandated schools (£167 vs. £206 per pupil). SFS-mandated schools also reported spending slightly less on catering, on average, than SFS-non-mandated schools (£128 vs. £133 per pupil, based on the total number of pupils). Pupils in SFS-mandated schools reported slightly higher HRQoL than pupils in SFS-non-mandated schools (0.8302 vs. 0.8274); however, potential confounding factors were not adjusted for, and there was variation in the number of missing HRQoL data across SFS-mandated/non-mandated groups. Twenty-one staff/governors and 137 pupils from 4 schools participated in the qualitative case study phase, with variation across the schools in relation to FSM eligibility (9–53%), SFS-mandated/non-mandated status (50% SFS-mandated) and catering model (50% external). Schools described patchy implementation of the SFS, acknowledging that some standards were difficult to adhere to, especially at breakfast/breaktime. Staff described balancing SFS compliance with conflicting priorities around maintaining viable levels of school food uptake, cost/profit and pupil preferences. Drivers of pupils’ food choices included convenience, speed, perceived value for money and taste. Some pupils felt that these were not met by school food and described negative lunchtime experiences, which discouraged a sit-down meal and influenced their eating behaviours. Some school staff felt that their influence on pupils’ food choices was limited, acknowledging difficult social and environmental contexts. School staff/governors had a low awareness of the SFP and generally were not taking steps to implement it. The time dedicated to healthy eating in relevant lessons was perceived to be low, despite staff acknowledging its importance, while pupils felt that healthy-eating education was sporadic. In general, governors reported minimal oversight of school food and SFS compliance. Conclusions Our findings suggest that the current SFS are difficult to comply with in a secondary school context, partly due to the style of food provision (e.g. extensive provision at breakfast/breaktime) and the need to provide foods and drinks to meet the pupils’ demands to ensure school food uptake and financial viability. There is currently a lack of oversight and monitoring of SFS compliance within schools. Our findings also indicate that the SFP has not achieved the desired outcomes in the secondary school setting, which suggests that a different approach may be needed to better support secondary schools in cultivating a healthy-eating culture. Finally, our findings suggest that even when the SFS are relatively well implemented, this may have no beneficial effect on the nutritional intake of pupils or may even lead to marginally worse nutritional intake. Schools need to be considered as only one part of the food system that influences adolescents’ dietary intake, and it is important to address other aspects of this system to substantially influence nutritional intake in this age group. A key focus for future research is to develop alternative models of healthy food provision that better meet the needs of secondary school pupils and to better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration This trial is registered as ISRCTN68757496. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

With downward pressure on the value of almond hulls (AHs), the major byproduct from the largest tree nut crop globally, the streamlined production of several grades of cellulose nanofibrils (CNFs) toward novel aerogels with concurrent sugar extraction was introduced to synergistically drive these products toward commercial adoption. Hot water extraction produced 50% lignocellulose (LC) with equal water-soluble sugars from AH of a soft-shell variety. Aqueous NaOH and NaClO2/KOH treatments isolated ca. 15% alkali cellulose and 12% cellulose, respectively. Coupled 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO) oxidation and blending yielded 88, 91, and 95% LC micro-/nanofibrils (LCMNFs), alkali cellulose nanofibrils (ACNFs), and cellulose nanofibrils (CNFs) with, respectively, 0.76, 1.02, and 0.84 mmol/g surface carboxyls in a similar 4:1 width-to-thickness aspect ratio and ultrahigh length-to-thickness aspect ratios (800-1900). The LCMNF aerogel was mostly wet-resilient, wet-stable, and dry/wet shape-recoverable, whereas the most charged ACNFs gave the stiffest aerogel [31.6 kPa/(mg/cm3)].

Objective: The recommended level of five fruits and vegetables per day is reached by a minority of French children. No-added sugars fruit puree (NASFP) can be consumed as a complement of fresh fruit to meet the recommendation for fruits and vegetables. The objective was to simulate the nutritional impact of an increase in consumption of NASFP among French children, together with a reduction in sweetened foods. Design: The study was conducted on French children aged 1–17 years. The simulation consisted in introducing NASFP on four different eating occasions (breakfast, lunch, snack and dinner) to reach one serving and removing the same serving of sweetened foods. Intakes in nutrients to favour, nutrients to limit and prevalence of adequacy to nutritional requirements were compared between observed and simulated diets in the whole sample and in five different age groups. Setting: France. Participants: Children from 1 to 17 years of age in the last available French representative dietary survey (INCA3). Results: Simulated diets were more nutrient-dense thanks to increases in nutrients to favour from NASFP (especially fibres, iodine, Se, and vitamin A and C) associated with reductions in energy and nutrients to limit (especially free sugars) coming from sweetened foods. Prevalence of adequacy increased from 2 to 14·5 points for fibres and from 4·5 to 12 points for free sugars according to age group and eating occasion. Conclusion: Promoting NASFP in replacement of sweetened products is a promising strategy to improve the nutritional quality of French children's diet through a better adherence to national guidelines. [ABSTRACT FROM AUTHOR]

Abstract Objective: To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. Design: Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child’s age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5–< 10 % and ≥ 10 %EFS) using cross-classification analysis. Setting: Australia. Participants: 858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data. Results: Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation. Conclusions: The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children’s FSI and compare to the WHO free sugars guidelines to identify those ‘at risk’.

Caries is a chronic infectious disease that occurs in the hard tissues of teeth. The interaction of oral microorganisms, host, food and time leads to the occurrence and progression of caries. Free sugar is an important food factor in the occurrence of dental caries. This paper reviews the research progress on the relationship between free sugar and caries in recent years, providing a reference for further clarifying the mechanism of the occurrence and progression of caries caused by free sugar and exploring the methods of caries prevention. The cariogenic mechanism of free sugar is multifaceted. Free sugar can not only be used by oral microorganisms in dental plaque biofilms to produce acid and synthesize intracellular and extracellular polysaccharides but also cause an imbalance in oral microecology and enhance gene expression related to the cariogenic toxicity of oral microorganisms. Based on the correlation between free sugar and caries, it is important to limit the intake amount and frequency of free sugar to prevent caries. This can be achieved mainly by formulating public health policies for reducing sugar, creating a low-sugar family environment with good eating habits, using sugar substitutes and using fluoride. There are few studies on the relationship between free sugar and oral microecology. More research is needed to better understand the effect of free sugar on oral microecology and its mechanism and to validate the caries-preventing effect of various sugar reduction measures. We believe such studies would open up new avenues for the effective prevention of caries.

Carbohydrates play a crucial role in the development of chronic diseases, and although research in this area is expanding, the precise definition of carbohydrate quality remains unclear. Currently, commonly utilized indicators encompass dietary fiber content, whole grain intake, free sugars intake and the glycemic index (GI). High-quality carbohydrate foods typically exhibit high dietary fiber content, consist of whole grain components, contain low levels of free sugars, and possess a low GI. The GI, in particular, directly influences the human blood sugar response and serves as a vital measure for describing carbohydrate quality. This article provides a comprehensive overview of the factors that influence the GI, focusing on three aspects: digestion and absorption, processing methods, and starch composition and structure. It further examines the GI values of various food sources. The rate of digestion and absorption, as well as diverse processing methods, can influence the GI. Additionally, the composition and structure of starch directly affect the GI. Amylose and amylopectin exhibit dissimilar structural compositions, with amylopectin containing more amylase binding sites than amylose, leading to a higher digestion rate. Consequently, foods with elevated amylose content tend to have relatively low GI values. Additionally, starch can be categorized into three types (A-type, B-type, and C-type) based on the crystal form of amylopectin present in the starch. Among these types, A-type starch is the most readily digestible, while B-type and C-type starch exhibit low GI characteristics due to their reduced digestibility. By studying the microstructure of starch, researchers can gain valuable insights into the influencing factors of the GI, thereby introducing a fresh perspective to the assessment of food carbohydrate quality.

Abstract Objective: The recommended level of five fruits and vegetables per day is reached by a minority of French children. No-added sugars fruit puree (NASFP) can be consumed as a complement of fresh fruit to meet the recommendation for fruits and vegetables. The objective was to simulate the nutritional impact of an increase in consumption of NASFP among French children, together with a reduction in sweetened foods. Design: The study was conducted on French children aged 1–17 years. The simulation consisted in introducing NASFP on four different eating occasions (breakfast, lunch, snack and dinner) to reach one serving and removing the same serving of sweetened foods. Intakes in nutrients to favour, nutrients to limit and prevalence of adequacy to nutritional requirements were compared between observed and simulated diets in the whole sample and in five different age groups. Setting: France. Participants: Children from 1 to 17 years of age in the last available French representative dietary survey (INCA3). Results: Simulated diets were more nutrient-dense thanks to increases in nutrients to favour from NASFP (especially fibres, iodine, Se, and vitamin A and C) associated with reductions in energy and nutrients to limit (especially free sugars) coming from sweetened foods. Prevalence of adequacy increased from 2 to 14·5 points for fibres and from 4·5 to 12 points for free sugars according to age group and eating occasion. Conclusion: Promoting NASFP in replacement of sweetened products is a promising strategy to improve the nutritional quality of French children’s diet through a better adherence to national guidelines.

Objective: To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. Design: Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers' and Infants' Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5–< 10 % and ≥ 10 %EFS) using cross-classification analysis. Setting: Australia. Participants: 858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data. Results: Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation. Conclusions: The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's FSI and compare to the WHO free sugars guidelines to identify those 'at risk'. [ABSTRACT FROM AUTHOR]

Polysaccharide fractions were isolated from the aerial part of Serratula centauroides. The monosaccharide compositions of the polysaccharide fractions were determined by HPLC-UV. The quantitative contents of free sugars in the aerial part and subterranean organs of S. centauroides growing in the Republic of Buryatia were determined by capillary electrophoresis. The effect of mechanically activated milling of the aerial part of S. centauroides on the sugar yield was studied. [ABSTRACT FROM AUTHOR]

A high consumption of sugar leads to an increase in caloric intake, which in turn will lead to a higher risk of developing health issues. Foods contain both naturally occurring sugars and added sugars. The World Health Organization recommends that the daily intake of free sugars be below 10% of the total daily energy intake. Food performs a key role in maintaining an adequate glycaemic control in people with diabetes. However, there is a low compliance to dietary recommendations, namely in the amount of sugar intake. This review article aims to assess and compare the intake of various types of sugars in the general population and among individuals with and without a diabetes diagnosis, identify the food sources that contribute to the intake of free and added sugars, and understand their impact on health. Studies performed on the general population found that the consumption of sugar was high, and that children and teens are more likely to exceed the recommended amounts. It was found that diabetics consume less total and added sugar than non-diabetics, as well as a less sugary drinks. Guidelines and public health policy measures aimed at limiting the intake of free and added sugars are needed in order to minimize the consumption of foods high in empty calories.

Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health. This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20–36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021). An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk. https://clinicaltrials.gov/ NCT03554954, 13 Sept. 2018. • Carbohydrate quality of the Singapore middle-aged and older adult population is poor. • High carbohydrate quality was associated with generally higher intakes of fiber, protein, and micronutrients. • Meeting the carbohydrate metrics was associated with lower odds of pre-hypertensive blood pressure. • Meeting the dietary fibre recommended daily allowance was associated with a lower waist circumference. [ABSTRACT FROM AUTHOR]

Free sugars overconsumption is associated with an increased prevalence of risk factors for metabolic diseases such as the alteration of the blood lipid levels. Natural fruit juices have a free sugar composition quite similar to that of sugar-sweetened beverages. Thus, could fruit juice consumption lead to the same adverse effects on health as sweetened beverages? We attempted to answer this question by reviewing the available evidence on the health effects of both sugar-sweetened beverages and natural fruit juices. We determined that, despite the similarity of fruits juices to sugar-sweetened beverages in terms of free sugars content, it remains unclear whether they lead to the same metabolic consequences if consumed in equal dose. Important discrepancies between studies, such as type of fruit juice, dose, duration, study design, and measured outcomes, make it impossible to provide evidence-based public recommendations as to whether the consumption of fruit juices alters the blood lipid profile. More randomized controlled trials comparing the metabolic effects of fruit juice and sugar-sweetened beverage consumption are needed to shape accurate public health guidelines on the variety and quantity of free sugars in our diet that would help to prevent the development of obesity and related health problems.

Public health interest in reducing the intake of sugar-sweetened soft drinks has resulted in various guidelines and initiatives related to their consumption, together with an increase in availability and sales of low and no-sugars versions. The aim of this review was to gain insight regarding individual-level amounts and types of soft drinks consumed across the lifecycle as reported in nationally representative surveys in Europe. The review highlighted significant gaps and challenges regarding the availability of recent country-specific soft drink consumption data including heterogeneity in categorisations used in reporting soft drinks. Nonetheless, crude estimates of mean intake (across countries) indicated that total soft drinks and soft drinks with sugars was highest in adolescents and lowest in infants/toddlers and older adults. For infants/toddlers, crude mean intakes of soft drinks with reduced/no sugars were higher than soft drinks with sugars. The review also found that consumption of total soft drinks is decreasing with a shift to consumption of soft drinks with reduced/no sugars in replacement of sugars-containing soft drinks. This review provides valuable insight into what data are currently available on soft drink consumption in Europe with heterogeneity in categorisations, terminology, and definitions of soft drinks observed. [ABSTRACT FROM AUTHOR]

Carbohydrate foods (≥40% energy from carbohydrates) are the main source of energy in the US diet. In contrast to national-level dietary guidance, many regularly consumed carbohydrate foods are low in fiber and whole grains but high in added sugar, sodium, and/or saturated fat. Given the important contribution of higher-quality carbohydrate foods to affordable healthy diets, new metrics are needed to convey the concept of carbohydrate quality to policymakers, food industry stakeholders, health professionals, and consumers. The recently developed Carbohydrate Food Quality Scoring System is well aligned with multiple key healthy messages on nutrients of public health concern from the 2020–2025 Dietary Guidelines for Americans. Two models are described in a previously published paper: one for all non-grain carbohydrate-rich foods (e.g., fruits, vegetables, legumes) known as the Carbohydrate Food Quality Score-4 (CFQS-4), and one for grain foods only known as the Carbohydrate Food Quality Score-5 (CFQS-5). These CFQS models provide a new tool that can guide policy, programs, and people towards improved carbohydrate food choices. Specifically, the CFQS models represent a way to unify and reconcile diverse ways to describe different types of carbohydrate-rich foods (e.g., refined vs. whole, starchy vs. non-starchy, dark green vs. red/orange) and make for more useful and informative messaging that better aligns with a food's nutritional and/or health contributions. The present paper's aims are to show that the CFQS models can inform future dietary guidelines and help support carbohydrate food recommendations with other health messages aimed at promoting foods that are nutrient-dense, fiber-rich, and low in added sugar. [ABSTRACT FROM AUTHOR]

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Background and Aims: The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies. We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies.Methods and Results: Using nationally-representative cross-sectional surveys from Brazil (2008-09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015), and the US (2015-16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified. Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies.Conclusions: Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles. [ABSTRACT FROM AUTHOR]

Abstract Background Sugar-sweetened beverages have obesogenic and diabetogenic effects ascribed to free sugars. These include added sugars and naturally occurring sugars in juices. A meta-analysis indicates that some foods with added sugars are associated with lower type 2 diabetes rates. To expand the evidence relevant to free sugars from solid sources, we examined a young to middle-aged population with respect to overweight and gestational diabetes (GDM) outcomes. Methods We studied female participants (12–50 years old) from the 2004–2005 Canadian Community Health Survey 2.2 (CCHS) with data linked to the hospital Discharge Abstract Database (DAD) until 2017, providing 13 years of follow-up. We estimated free sugars by solid and liquid sources from 24-h dietary recalls as percent total energy intake (TE%), and computed body mass index (BMI). We applied ICD-10 diagnostic codes for deliveries and GDM to DAD. We conducted multivariable logistic regression analyses to evaluate associations between free sugars with overweight at baseline (cross-sectional component) and, in those who delivered, with GDM during follow-up (nested case control component). We compared those with consumption above versus below various thresholds of intake for free sugars, considering solid and liquid sources separately (2.TE%, 5TE%, 10TE% and 15TE% thresholds). Results Among 6305 participants, 2505 (40%) were overweight, defined as BMI ≥ 85th percentile below 18 years and BMI ≥ 25 kg/m2 for adults. Free sugars from solid sources were associated with lower odds of overweight above versus below the 2.5TE% (adjusted odds ratio [adjOR] 0.80, 95%CI 0.70–0.92), 5TE% (adjOR 0.89, 95%CI 0.79–0.99), and 10TE% (adjOR 0.86, 95%CI 0.75–0.97) thresholds. Free sugars from liquid sources were associated with greater odds of overweight across the 2.5TE% (adjOR 1.20, 95%CI 1.07–1.36), 10TE% (adjOR 1.17, 95%CI 1.02–1.34), and 15TE% (adjOR 1.43, 95%CI 1.23–1.67) thresholds. There were 113 cases of GDM among the 1842 women who delivered (6.1%). Free sugars from solid sources were associated with lower odds of GDM above versus below the 5TE% threshold (adjOR 0.56, 95%CI 0.36–0.85). Conclusions Our findings support limiting free sugars from liquid sources, given associations with overweight. We did not identify adverse associations of free sugars from solid sources across any of the thresholds examined.

This cross-sectional study aimed to investigate the relationship between food sources of free sugars and weight status among children and adolescents aged 2–19 years in Japan (1438 males and 1340 females) from the 2016 National Health and Nutrition Survey, Japan. We estimated the percentage of energy intake (% E) from free sugars from total food sources (FStotal), solid foods (FSsolids), and beverages (FSliquids), using one-day weighed dietary record data. Weight status was determined based on body mass index (BMI) z-scores and the prevalence of overweight and obesity. The mean energy intakes of FStotal, FSsolids, and FSliquids were 5.8%, 4.1%, and 1.8% in males and 6.2%, 4.6%, and 1.6% in females, respectively. After controlling for potential confounding factors, including energy intake, there was no association of free sugars intake from all food sources with BMI z-scores or with the prevalence of overweight and obesity, except for a marginal association between higher FSsolids and lower estimated BMI z-scores in females (p = 0.05). The present findings indicate that among children and adolescents in Japan, who have a relatively low mean intake of free sugars, consuming free sugars from any food source is unlikely to have an adverse effect on weight status. [ABSTRACT FROM AUTHOR]

In the present study, the fluctuations in fatty acids, tocopherols, organic acids, and free sugars content of cardoon blades collected at sixteen harvest dates (samples B1–B16, corresponding to principal growth stages (PGS) between 1 and 9) were evaluated. A total of 26 fatty acids were identified, with palmitic (C16:0, 19.9–40.13%), α-linolenic (C18:3n3, 6.39–33.2%), and linoleic (C18:2n6c, 9–34.8%) acids being present in higher relative abundances in most of the samples, while lipid content was the highest in samples of late (B15) and intermediate (B8–B10) stages of maturity. The α- and γ-tocopherols were the only detected vitamin E isoforms, while α-isoform presented the highest concentration (80–8567 µg/100 g dw) in all the studied samples, except for samples B9–B11, for which the γ-tocopherol was detected in higher concentrations. Moreover, samples B1 and B14 showed the highest content of total tocopherols (8352 and 10,197 µg/100 g dw, respectively). The identified organic acids were oxalic, quinic, malic, citric, and fumaric. Malic acid was present in higher concentrations in almost all the samples analyzed, except for samples B3 and B15, in which the presence of oxalic acid stood out. Regarding the free sugar's composition, fructose, glucose, sucrose, trehalose, and raffinose were the only detected compounds, with sucrose being present in higher concentrations in almost all the samples (1.662–10.8 g/100 g dw), while samples at younger maturation stages, namely samples B4 and B5, presented the highest concentrations of total sugars. In conclusion, the obtained results demonstrate the influence that the growth cycle may have on the chemical composition of this tissue (blades) of the species. Moreover, having a more complete knowledge regarding its composition and identifying the stage of maturation which is most appropriate for obtaining a greater amount of certain bioactive compounds will help to increase the added value of this multi-purpose crop. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the effects of three biostimulant products (Nomoren (N), Twin Antistress (TW), x-Stress (XS) and control treatment (C: no biostimulants added)) on the nutritional value, chemical composition and bioactive properties of greenhouse tomato fruit grown under full (W+: 100% of field capacity) and deficit irrigation (W–: 70% of field capacity) conditions. Fat content was the highest for the fully irrigated plants that received no biostimulants (CW+), while proteins and carbohydrates and energetic value were the highest in the XSW+ treatment. The content of the main detected sugars (fructose, glucose and trehalose) varied depending on the irrigation and biostimulant treatment. The highest amounts of individual and total organic acids and tocopherols were recorded in fully irrigated plants treated with Twin Antistress (TW), whereas the lowest overall values were observed under deficit irrigation for plants that received the XS treatment. The most abundant fatty acids were palmitic (27.5–36.0%) and linoleic acid (27.4–35.4%), followed by oleic (9.2–21.2%), linolenic (5.4–13.1%) and stearic acid (5.3–6.8%). Moreover, the highest values of β-carotene and lycopene were recorded for the CW- and NW+ treatments, respectively. The TWW+ showed the highest antioxidant activity for both assays tested (TBARS and OxHLIA). Most of the tested extracts showed lower antibacterial activity against the tested bacteria compared to the positive controls. On the other hand, CW+, XSW+ and XSW- treatments showed higher antifungal activity (MIC values) than positive controls. In conclusion, each biostimulant product had a different effect on the determined characteristics depending on the level of irrigation. Therefore, more research is needed to better identify the mechanisms of action and the physiological processes, after which the tested biostimulants may be used to standardize the application of such products in tomato cultivation. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess changes in the basic quality parameters induced by controlled lactic fermentation of fruiting bodies of the button mushroom (Agaricus bisporus). Lactiplantibacillus plantarum 299v with documented probiotic properties and L. plantarum EK3, i.e., an isolate obtained from spontaneously fermented button mushrooms, were used as starter strains. The fruiting bodies of fresh, blanched, and fermented mushrooms were analyzed at different stages of the lactic fermentation process. The content of free sugars (high-performance liquid chromatography with charged aerosol detector method; HPLC-CAD) and organic acids (high-performance liquid chromatography with diode array detector method; HPLC-DAD) was determined both in the mushroom fruiting bodies and in the brine. Five free sugars (ribose, trehalose, sucrose, glucose, and fructose), mannitol, and six organic acids (lactic, malic, succinic, citric, acetic, and fumaric acids) were detected in the samples. Lactic acid dominated in the final products. The starter cultures exhibited varying degrees of utilization of available mushroom sugars and sucrose used as an additional substrate. Sucrose was utilized at a higher rate and in greater amounts by the L. plantarum EK3 isolate. This starter culture was characterized by a significantly higher final amount of produced lactic acid, a lower pH value, and higher numbers of LAB (lactic acid bacteria). These important quality parameters largely determine the stability of fermented products. Based on the analysis results and the high scores in the organoleptic evaluation of the fermented mushrooms, the L. plantarum EK3 isolate can be recommended as an appropriate starter culture for lactic fermentation of mushroom fruiting bodies. [ABSTRACT FROM AUTHOR]

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One "Spanish Reference Sample" (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler's or growing up milk and fortified and enriched milks, here called "Adapted Milk Consumers Sample" (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases. [ABSTRACT FROM AUTHOR]

Existing metrics of carbohydrate food quality have been based, for the most part, on favorable fiber- and free sugar-to-carbohydrate ratios. In these metrics, higher nutritional quality carbohydrate foods are defined as those with >10% fiber and <10% free sugar per 100 g carbohydrate. Although fiber- and sugar-based metrics may help to differentiate the nutritional quality of various types of grain products, they may not aptly capture the nutritional quality of other healthy carbohydrate foods, including beans, legumes, vegetables, and fruits. Carbohydrate food quality metrics need to be applicable across these diverse food groups. This report introduces a new carbohydrate food scoring system known as a Carbohydrate Food Quality Score (CFQS), which supplements the fiber and free sugar components of previous metrics with additional dietary components of public health concern (e.g., sodium, potassium, and whole grains) as identified by the Dietary Guidelines for Americans. Two CFQS models are developed and tested in this study: one that includes four dietary components (CFQS-4: fiber, free sugars, sodium, potassium) and one that considers five dietary components (CFQS-5: fiber, free sugars, sodium, potassium, and whole grains). These models are applied to 2596 carbohydrate foods in the Food and Nutrient Database for Dietary Studies (FNDDS) 2017–2018. Consistent with past studies, the new carbohydrate food scoring system places large percentages of beans, vegetables, and fruits among the top scoring carbohydrate foods. The whole grain component, which only applies to grain foods (N = 1561), identifies ready-to-eat cereals, oatmeal, other cooked cereals, and selected whole grain breads and crackers as higher-quality carbohydrate foods. The new carbohydrate food scoring system shows a high correlation with the Nutrient Rich Food (NRF9.3) index and the Nutri-Score. Metrics of carbohydrate food quality that incorporate whole grains, potassium, and sodium, in addition to sugar and fiber, are strategically aligned with multiple 2020–2025 dietary recommendations and may therefore help with the implementation of present and future dietary guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Before implementing the WHO sugar recommendations, more studies are needed concerning its application to given contexts., Objective: To identify free sugars intake levels associated with a minimum caries risk in primary dentition METHODS: Using probability proportionate to size technique and cluster sampling, 813 children aged 4-5-years were selected from preschools in the Colombo district, Sri Lanka. A 67-item quantitative food frequency questionnaire was developed and validated to evaluate free sugars intake. Dental caries was assessed clinically using dmft index. For the selection of cut-off values for free sugars intake levels, ROC curves were used., Results: The median (IQR) amount of free sugars intake was 57.9 (33.2 -95.8) g/day or 21.1 % (12.5 %-35.9 %) of total energy requirement, with a frequency of 4.0 (2.7-6.1) times/day. Dental caries prevalence was 42.9 % (n = 349). Among all possible risk factors, free sugars intake as a percentage of total energy requirement (p < 0.001) and frequency of free sugars intake (p < 0.001) were significantly associated with the presence of dental caries. The percentage of free sugars that discriminates against a possible highest number of children with dental caries (99 %) was determined as 4 %, of the total energy requirement of a child, which is approximately 12 g/day (3 level teaspoons/day). Sugar intake once a day has a 97 % sensitivity in identifying children with dental caries. These cut-off values do not differ among the group who brush twice a day with fluoridated toothpaste., Conclusion: For optimal caries prevention, children's free sugar intake should limit to <5 % of their total energy intake or consume less frequently than once daily., Clinical Significance: This study provides facts that policy makers and dental clinicians can use for dietary recommendations in Sri Lanka, which they will include in the next revision of the booklet, "Uniform Oral Health Messages for Sri Lankans". Additionally, health professionals and health information materials will disseminate these recommendations to the public., Competing Interests: Declaration of competing interest The authors declare that they have no conflict-of-interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy‐related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well‐established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy‐related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50–75% probability), low for non‐alcoholic fatty liver disease and type 2 diabetes (> 15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations. [ABSTRACT FROM AUTHOR]

Abstract Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy‐related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well‐established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy‐related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50–75% probability), low for non‐alcoholic fatty liver disease and type 2 diabetes (> 15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.

Pure 100% fruit juice (100%FJ) provides a source of nutrients and bioactive substances, such as flavonoids, carotenoids and pectin, and counts as a serving of fruit in several countries. Nevertheless, 100%FJ has been the subject of debate since it also contains free sugars and provides less fibre than whole fruits. Sugar recommendations, when translated into policy, are designed to limit population consumption of free sugars. The World Health Organization (WHO) free sugars classification does not differentiate between added sugars and free sugars naturally occurring in 100%FJ and other foods. Hence, there is an implication that all sources of free sugars are equally detrimental and should be reduced. But is this the case? Since WHO's original 2003 classification, a considerable amount of evidence has been published on 100%FJ and its impact on health. This paper provides an update, focussing on meta‐analyses where available. These show protective associations for cardiovascular health at intakes of up to 200 ml/day, and significant improvements in vascular function, blood pressure and inflammation at higher intakes. Evidence on obesity, metabolic markers and type 2 diabetes risk – where studies have clearly differentiated consumption data for 100%FJ – suggests no clinically significant negative impact of 100%FJ at a wide range of intakes, unless diets are in positive energy balance. Data on nutrient adequacy from observational studies indicate positive associations between 100%FJ and intakes of whole fruits, vitamin C, vitamin A, folate and potassium. Since the evidence does not appear to show that drinking moderate amounts of 100%FJ is harmful to metabolic health or weight management, free sugars reduction policies should focus on sources that represent a genuine health risk and make a negligible contribution to nutrient adequacy. 100%FJ at intakes of up to 150 ml/day and consumed at mealtimes to protect dental health should remain part of 5 A DAY advice. [ABSTRACT FROM AUTHOR]

A high intake of free sugars (FS) is assumed to be associated with overweight and obesity as well as type 2 diabetes mellitus and cardiovascular diseases. Therefore, the World Health Organization (WHO) recommends an intake of FS of less than 10% of daily total energy intake (TEI). The purpose of this study was to update the FS intake data for the French population, including children and adolescents as well as adults, based on the 2019 French Food Behavior and Consumption survey (CCAF). FS intakes were assessed at 67 g/day (15.3% of TEI) in children and adolescents as well as 57 g/day (10.5% of TEI) in adults. The main FS contributors were cakes/pastries, sugary drinks and fruit juices in children as well as sugary products, cakes/pastries and fruit juices in adults. The contribution of FS intakes to TEI fell with age, from 15.6% of TEI in 3–6 years children to around 8–9% for adults older than 50 years. On average, children were above the WHO recommendation of FS intake, but adults were close to or even below the threshold of 10% TEI. These observations are of great importance to prospective public health activities focusing on changes in FS intakes. [ABSTRACT FROM AUTHOR]

Background: Sugar-sweetened beverages have obesogenic and diabetogenic effects ascribed to free sugars. These include added sugars and naturally occurring sugars in juices. A meta-analysis indicates that some foods with added sugars are associated with lower type 2 diabetes rates. To expand the evidence relevant to free sugars from solid sources, we examined a young to middle-aged population with respect to overweight and gestational diabetes (GDM) outcomes.Methods: We studied female participants (12-50 years old) from the 2004-2005 Canadian Community Health Survey 2.2 (CCHS) with data linked to the hospital Discharge Abstract Database (DAD) until 2017, providing 13 years of follow-up. We estimated free sugars by solid and liquid sources from 24-h dietary recalls as percent total energy intake (TE%), and computed body mass index (BMI). We applied ICD-10 diagnostic codes for deliveries and GDM to DAD. We conducted multivariable logistic regression analyses to evaluate associations between free sugars with overweight at baseline (cross-sectional component) and, in those who delivered, with GDM during follow-up (nested case control component). We compared those with consumption above versus below various thresholds of intake for free sugars, considering solid and liquid sources separately (2.TE%, 5TE%, 10TE% and 15TE% thresholds).Results: Among 6305 participants, 2505 (40%) were overweight, defined as BMI ≥ 85th percentile below 18 years and BMI ≥ 25 kg/m2 for adults. Free sugars from solid sources were associated with lower odds of overweight above versus below the 2.5TE% (adjusted odds ratio [adjOR] 0.80, 95%CI 0.70-0.92), 5TE% (adjOR 0.89, 95%CI 0.79-0.99), and 10TE% (adjOR 0.86, 95%CI 0.75-0.97) thresholds. Free sugars from liquid sources were associated with greater odds of overweight across the 2.5TE% (adjOR 1.20, 95%CI 1.07-1.36), 10TE% (adjOR 1.17, 95%CI 1.02-1.34), and 15TE% (adjOR 1.43, 95%CI 1.23-1.67) thresholds. There were 113 cases of GDM among the 1842 women who delivered (6.1%). Free sugars from solid sources were associated with lower odds of GDM above versus below the 5TE% threshold (adjOR 0.56, 95%CI 0.36-0.85).Conclusions: Our findings support limiting free sugars from liquid sources, given associations with overweight. We did not identify adverse associations of free sugars from solid sources across any of the thresholds examined. [ABSTRACT FROM AUTHOR]

Aims: Cellulase‐producing Enterococcus species isolated from the rumen of Tibetan yak (Bos grunniens) were characterized, and their combined effects on the silage quality of various forages were studied. Methods and Results: The two isolated strains with high cellulolytic potential were identified as Enterococcus faecalis (EF85) and E. faecium (EF83) by 16S rRNA sequencing. Both EF85 and EF83 could grow well at 15–55°C, pH 3·0–6·0 and in 3·0–6·5% NaCl. The cellulase secreted by EF85 and EF83 showed good stability at temperatures from 20 to 45°C and pH from 4·5 to 7·0. A commercial inoculant (CLP), a commercial cellulase (CE) and the two cellulolytic strains (EF85 + EF83) were added to whole‐crop corn, sweet sorghum and Napier grass ensiling for 120 days respectively. In Napier grass silage, all inoculants significantly increased lactic acid content and ratio of lactic to acetic acid and decreased pH, butyric acid and ammonia nitrogen contents. The acid detergent fibre and cellulose contents in EF85 + EF83 treatment were significantly lower than those in the other treatments. In whole‐crop corn and sweet sorghum silages, all additives had no significant effect on the fermentation quality, while CE and EF85 + EF83 markedly enhanced cellulose degradation and increased free sugar content. Conclusion: The combined inoculation of the cellulolytic strain EF85 and EF83 to various forages reduced the fibre content of the resulting silages. Significance and Impact of the Study: Few studies involved inoculation of silage with Enterococcus species in different forage types. The isolated cellulolytic strains of E. faecalis EF85 and E. faecium EF83 could be a great alternative for commercial inoculants and enzymes in silage production. [ABSTRACT FROM AUTHOR]

Purpose: To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. Methods: This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5–18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. Results: Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5–18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. Conclusion: The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group. [ABSTRACT FROM AUTHOR]

Effect of capsaicinoids in hot pepper powder (HP) contains various chemical compounds, including capsaicin and dihydrocapsaicin, which are the main ingredients of the spicy taste. To evaluate the effect of HP on the microbial community in kimchi fermentation, kimchi [kimchi‐HP, kimchi‐HPE and kimchi‐HPER made by adding HP, HP alcohol extract (HPE) and HPE residues (HPER)] was fermented at 4°C for 28 days. The pH and titratable acidity of the samples and the number of bacteria changed with fermentation time. Kimchi‐HPER had significantly higher total viable and lactic acid bacteria (LAB) than other samples after 28 days of fermentation. The capsaicinoids content did not differ before and after fermentation, whereas the major free sugar content decreased, and the mannitol content increased. The principal component analysis (PCA) biplots showed similar patterns between kimchi‐HP and ‐HPE. It was confirmed that Leuconostoc and Weissella were related to the initial fermentation, and Lactobacillus was involved in late fermentation. Kimchi‐HP and kimchi‐HPE increased the ratio of Lactobacillus sakei and decreased that of Leuconostoc mesenteroides compared to kimchi‐HPER. Overall, these results revealed that capsaicinoids contained in HP affected Lactobacillus proliferation and mannitol increase during kimchi fermentation. [ABSTRACT FROM AUTHOR]

Background: The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a cost- and time-efficient self-report screening instrument to estimate dietary intake of saturated fat and free sugar. To date, only the English version has been psychometrically evaluated. We assessed the psychometric characteristics of the German version of the DFS in individuals with normal weight, overweight, and obesity. Method: Sixty-five adult participants completed a German translation of the DFS and a validated food frequency questionnaire (FFQ). We correlated participants’ percentage of energy intake from saturated fat and free sugar from the FFQ with the DFS scores. To establish test-retest reliability, participants completed the DFS a second time. To investigate convergent validity, we correlated participants’ DFS scores with self-reported eating behavior and sensitivity to reward. Results: DFS scores correlated with percentage of energy from free sugar (rs = 0.443) and saturated fatty acids (rs =0.258) but not with non-target nutrients. The correlation between DFS scores and percentage energy from free sugar was not moderated by body mass index (BMI), whereas the correlation with percentage energy from saturated fat slightly decreased with BMI. Intra-class correlation as an indicator of test-retest reliability was 0.801. DFS scores correlated significantly with restraint of eating behavior (rs = –0.380) and feelings of hunger (rs = 0.275). Correlations of the DFS score with disinhibited eating and sensitivity to rewards failed to be significant. Conclusion: Our data indicate that the German version of the DFS might be a psychometrically sound self-report instrument to estimate saturated fat and free sugar intake of German adults.

Resumen: Introducción: El consumo de azúcares libres se ha relacionado con el exceso de peso, recomendando la OMS una ingesta

The aim of the present study was to evaluate the effects of three biostimulant products (Nomoren (N), Twin Antistress (TW), x-Stress (XS) and control treatment (C: no biostimulants added)) on the nutritional value, chemical composition and bioactive properties of greenhouse tomato fruit grown under full (W+: 100% of field capacity) and deficit irrigation (W–: 70% of field capacity) conditions. Fat content was the highest for the fully irrigated plants that received no biostimulants (CW+), while proteins and carbohydrates and energetic value were the highest in the XSW+ treatment. The content of the main detected sugars (fructose, glucose and trehalose) varied depending on the irrigation and biostimulant treatment. The highest amounts of individual and total organic acids and tocopherols were recorded in fully irrigated plants treated with Twin Antistress (TW), whereas the lowest overall values were observed under deficit irrigation for plants that received the XS treatment. The most abundant fatty acids were palmitic (27.5–36.0%) and linoleic acid (27.4–35.4%), followed by oleic (9.2–21.2%), linolenic (5.4–13.1%) and stearic acid (5.3–6.8%). Moreover, the highest values of β-carotene and lycopene were recorded for the CW- and NW+ treatments, respectively. The TWW+ showed the highest antioxidant activity for both assays tested (TBARS and OxHLIA). Most of the tested extracts showed lower antibacterial activity against the tested bacteria compared to the positive controls. On the other hand, CW+, XSW+ and XSW- treatments showed higher antifungal activity (MIC values) than positive controls. In conclusion, each biostimulant product had a different effect on the determined characteristics depending on the level of irrigation. Therefore, more research is needed to better identify the mechanisms of action and the physiological processes, after which the tested biostimulants may be used to standardize the application of such products in tomato cultivation.

Determining the extent to which added sugars intake contribute to non-communicable disease in various populations is challenging because it is difficult to accurately measure intakes. Biomarkers may provide a reliable and easily measured method of assessing intakes. In a predominantly Māori population we compared various sugars intake estimates derived from a 36 item sugar-specific food frequency questionnaire (FFQ) with biomarkers of sugars intake; urinary sugars excretion in random spot collections (n = 153) and carbon stable isotope ratios (n = 36) in red blood cells (RBCs, δ13CRBC) and in the alanine fraction of the RBCs (δ13Calanine). Estimated 24 h urinary sucrose+fructose excretion was statistically significantly correlated with intakes of total sugars (r = 0.23), sucrose (r = 0.26) and added sugars from sugar-sweetened beverages (SSBs; r = 0.26). δ13Calanine was correlated with added sugars (r = 0.40). In log linear multiple regression models adjusted with HbA1C and eGFR δ13Calanine predicted added sugars intakes (r2 = 0.29) and estimated 24 h urinary sucrose+fructose excretion predicted intakes of total sugars (r2 = 0.14), sucrose (r2 = 0.17), added sugars (r2 = 0.17) and sugars from SSBs (r2 = 0.14). These biomarkers have potential for improving assessment of sugars intake in New Zealand populations enabling monitoring of the effectiveness of sugar reduction strategies designed to reduce risk of NCDs. However, further validation is required to confirm these preliminary findings.

The influence of free sugar intake on nutrient intake remains unclear in Japanese children and adolescents with relatively low free sugar intake. This cross-sectional study aimed to investigate the relationship between free sugar and selected nutrient intakes using data from the 2016 National Health and Nutrition Survey, Japan, based on the WHO recommendations (<5 % or <10 % of energy (%E)) for free sugar intake. A 1-d weighed dietary record was assessed in Japanese children and adolescents (aged 1–19 years; n 2919). Mean intakes for selected nutrients and food groups were compared according to free sugar intake categories (<2·5 %E, 2·5 to <5 %E, 5 to <10 %E and ≥10 %E) with adjustment for sex, age and weight status. Inverse associations were observed between intakes of free sugars and twenty-one of twenty-four micronutrients assessed, except for vitamins A and C and Ca. Significantly reduced intakes were identified for twenty-two and fourteen micronutrients in the ≥10 %E and 5 to <0 %E categories, respectively, compared with the lower categories. Mean micronutrient intakes at the <2·5 %E category did not differ from those at the 2·5 to <5 %E category. Free sugar intake had positive associations with intakes of sugars and jams, confectioneries, fruit and vegetable juices, and soft drinks and negative associations with intakes of pulses and nuts and vegetables. This study showed that nutrient dilution was associated with higher free sugar intake among Japanese children and adolescents. The findings suggest that the WHO recommendations might help prevent nutrient dilution in Japanese children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented.Objective: The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada.Methods: Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates.Results: In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models.Conclusions: Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: there is currently great concern about the sugar content of food and beverages as excessive consumption is associated with a higher prevalence of chronic non-communicable diseases. In addition, there is a great deal of confusion both in published scientific data and in media reports about various concepts such as free sugars, intrinsic or endogenous sugars, and sugars added to food, as well as the type of monosaccharides and disaccharides that are part of them. The term "free sugars" refers to public health aspects whereas the term "added sugars" relates to the nutritional information included in the labelling covered by Regulation 1169/2011 as applicable to food information provided to the consumer. Material and methods: an analysis of the legislation in force in the European Union and Spain, as well as in the United States and Mexico, together with the position statements of the World Health Organization (WHO), the European Food Safety Authority (EFSA), and the Spanish Agency for Food Safety and Nutrition (AESAN), as well as their Scientific Committees on the definition and declaration of total sugars, free sugars, and added sugars. Results: added sugars are declared on the label in countries such as the United States and Mexico. In the case of the United States, there is a proposal to modify the percentage they should contribute to the diet from 10 % to 6 %. In the case of the European Union, only the reference intake for carbohydrates is established: 45-65 %, as has already been done by the Scientific Committee of AESAN. Only in the case of the ANIBES study is there an approximate figure for the consumption of added sugars by the Spanish population: 7.3 %. Conclusions: reference intakes for added sugars should be established and declared in the information provided on food product labels in order to work with reliable data in the food composition tables, and to assess their real intake by the Spanish population, and thus implement public health measures to reduce their intake in all food products containing them. [ABSTRACT FROM AUTHOR]

Background: Oral hygiene behaviours as well as dietary habits before bed can affect children's dental health resulting in higher prevalence of dental disease. Dental disease can affect children's health, development and even school performance. If left untreated, dental disease can progress and it can lead to extractions under general anaesthetic causing further distress for children and families. Consistent and appropriate oral hygiene behaviours and dietary habits can prevent dental diseases from occurring in the first place. Objective: This cross-sectional study examines the relationship between oral hygiene behaviours, dietary habits around bedtime and children's dental health. Methods: A total of 185 parents with children between the ages of 3 and 7 years from deprived areas participated in the study. Data on bedtime routine activities were collected using an automated text-survey system. Children's dental health status was established through examination of dental charts and dmft (decayed, missed, filled teeth) scores. Results: In total, 52.4% of parents reported that their children's teeth were brushed every night. The majority of children (58.9%) had dmft scores over zero. In total, 51 (46.7% of children with dmft score over 0 and 27.5% of all children) children had active decay. The mean dmft score for those experiencing decay was 2.96 (SD = 2.22) with an overall mean dmft score of 1.75 (SD = 2.24). There were significant correlations between frequency of tooth brushing, frequency of snacks/drinks before bed and dmft scores (r = -0.584, p 0.001 and r = 0.547, p = 0.001 respectively). Finally, higher brushing frequency was associated with a lower likelihood of a dmft score greater than 0 (Exp(B) = 0.9). Conclusions: Despite families implementing oral hygiene behaviours as part of their bedtime routines those behaviours varied in their consistency. Results of this study highlight the need for additional studies that consider bedtime routine-related activities and especially the combined effects of oral hygiene practices and dietary habits due to their potentially important relationship with children's dental health. [ABSTRACT FROM AUTHOR]

(1) Background: High sugar intake is prevalent among children and is associated with nonalcoholic fatty liver disease (NAFLD). The purpose of this study is to determine if a high intake of free sugars and sugary beverages (SB) in childhood is associated with NAFLD in adulthood; (2) Methods: At 24 years, 3095 participants were assessed for severe hepatic steatosis (controlled attenuation parameter >280 dB/m) and had dietary data collected via a food frequency questionnaire at age three years. Multiple logistic regression models adjusted for total energy intake, potential confounders, and a mediator (offspring body mass index (BMI) at 24 years); (3) Results: Per quintile increase of free sugar intake association with severe hepatic steatosis at 24 years after adjusting for total energy was odds ratio (OR):1.07 (95% CL: 0.99–1.17). Comparing the lowest vs. the highest free sugar consumers, the association was OR:1.28 (95% CL: 0.88–1.85) and 1.14 (0.72, 1.82) after full adjustment. The OR for high SB consumption (>2/day) compared to <1/day was 1.23 (95% CL: 0.82–1.84) and OR: 0.98 (95% CL: 0.60–1.60) after full adjustment; (4) Conclusions: High free sugar and SB intake at three years were positively but weakly associated with severe hepatic steatosis at 24 years. These associations were completely attenuated after adjusting for confounders and 24-year BMI. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess changes in the basic quality parameters induced by controlled lactic fermentation of fruiting bodies of the button mushroom (Agaricus bisporus). Lactiplantibacillus plantarum 299v with documented probiotic properties and L. plantarum EK3, i.e., an isolate obtained from spontaneously fermented button mushrooms, were used as starter strains. The fruiting bodies of fresh, blanched, and fermented mushrooms were analyzed at different stages of the lactic fermentation process. The content of free sugars (high-performance liquid chromatography with charged aerosol detector method; HPLC-CAD) and organic acids (high-performance liquid chromatography with diode array detector method; HPLC-DAD) was determined both in the mushroom fruiting bodies and in the brine. Five free sugars (ribose, trehalose, sucrose, glucose, and fructose), mannitol, and six organic acids (lactic, malic, succinic, citric, acetic, and fumaric acids) were detected in the samples. Lactic acid dominated in the final products. The starter cultures exhibited varying degrees of utilization of available mushroom sugars and sucrose used as an additional substrate. Sucrose was utilized at a higher rate and in greater amounts by the L. plantarum EK3 isolate. This starter culture was characterized by a significantly higher final amount of produced lactic acid, a lower pH value, and higher numbers of LAB (lactic acid bacteria). These important quality parameters largely determine the stability of fermented products. Based on the analysis results and the high scores in the organoleptic evaluation of the fermented mushrooms, the L. plantarum EK3 isolate can be recommended as an appropriate starter culture for lactic fermentation of mushroom fruiting bodies.

Summary: Background: A product package can be a powerful marketing tool to persuade and attract consumers at the point‐of‐sale. Evidence shows that most advertised products have low nutritional quality. Currently, Mexico has incorporated advertising regulations on food and beverage packaging. Objectives: To analyze the advertising strategies used to target children on packaging and to assess the nutritional quality of sugar‐sweetened beverages available in the Mexican market. Methods: Photographs of 2380 beverages available in retail stores in Mexico City from January to March 2017 were analyzed. Beverages were classified as displaying child‐directed strategies or nondirected strategies. Nutrition quality was evaluated using the Pan American Health Organization nutrient profile model. Results: The use of characters was the most frequent strategy among beverages with child‐directed strategies (82.0%). The evaluation of nutrition quality found that 88.0% (P <.001) of sugar‐sweetened beverages with child‐directed strategies were excessive in free sugars and 56.9% (P <.001) contained other sweeteners. Beverages with more than two advertising strategies have the highest proportion of excessive free sugars (93.4%, 95% CI 82.8‐98.6). Conclusions: The use of characters and other visual strategies were frequently used in the packaging of sugar‐sweetened beverages with child‐directed strategies. In addition, these beverages are excessive in free sugars and contain a large number of products with other sweeteners. [ABSTRACT FROM AUTHOR]

Refractive index detector is usually used in the analysis of sugars in mushrooms, which is characterized by poor sensitivity, reproducibility, and susceptibility to interference from co-eluting sample components. In the current study, identification and determination of free sugars in mushroom samples by high-performance liquid chromatography coupled to corona charged aerosol detector (HPLC-CAD) were presented for the first time. The best chromatographic separation was performed on a Shodex Asahipak NH2P-50 4E 5 μm and mobile phase composed of 75% acetonitrile and 25% water with flow rate was 1 mL/min. The developed method offers good linearity in concentration range 0.001–0.01 or 0.01–0.2 mg/mL for tested compounds with R2 > 0.99. Limit of detection (LOD) for analytes was in the range of 7.1–120.2 ng on column. HPLC-CAD method showed very good reproducibility (RSD < 5.1%). Fructose, mannitol, and glucose were detected in all examined mushroom samples. For white Agaricus bisporus, mannitol was the most abundant sugar (7.575 mg/g dw), whereas trehalose for Pleurotus ostreatus (3.426 mg/g dw). The developed method was successfully applied for quantification of free sugars and mannitol in mushrooms. The optimized method proved to be sensitive, reproducible, and accurate. [ABSTRACT FROM AUTHOR]

To understand the effects of saccharides on our metabolism and health, we need a clear understanding of what they are, how they differ, and why some types are deemed “less healthy” and others “better for health.” There are various ways to look at this topic. Firstly, saccharides can be classified according to their degree of polymerization (DP). This classification is useful when qualitative or quantitative analysis and calculation of intakes are required or for food-labeling definitions. However, it does not account for the fact that saccharides with a similar DP can differ in molecular composition, which will influence digestion, absorption, and metabolism. Secondly, another approach widely used in the biomedical and nutritional sciences is therefore a physiological classification, which addresses the rate and degree of digestibility and absorption, the glycemic response, and the metabolic fate. The individual health status also plays a role in this respect. An active, lean person will have a metabolic response that differs from an inactive person with overweight and insulin resistance. However, this approach will not give a complete answer either because the characteristics of the matrix/meal in which these carbohydrates (CHOs) are present will also influence the responses of our body. Thirdly, one can also rank CHOs by comparing their functional/technological properties, such as relative sweetness, viscosity, and solubility. Understanding CHO characteristics and related physiological responses will help understand health and disease implications. Therefore, a brief outline of different carbohydrate classifications is presented. This outline will be placed in the context of potential overall effects after consumption. The answer to the question whether we should we eat less of certain sugars depends on the angle from which you look at this matter; for example, do you address this question from a single molecular characteristic point of view or from a meal quality perspective? Looking at one particular CHO characteristic will almost always lead to a different conclusion (e.g., the labeling of fructose as toxic) than evaluating from a “total perspective” (fructose has adverse effects in certain conditions). Examples are given to help understand this matter for the benefit of justified dietary/food-based recommendations.

Wood apple (Limonia acidissima L.) is an underutilized, fruit-yielding tree that is native to India and Sri Lanka. Wood apple trees are also cultivated in India, Sri Lanka, Bangladesh, Myanmar, Thailand, Malaysia, Vietnam, Kampuchea, Laos, and Indonesia for delicious fruits and medicinal purposes. The major objective of the present work was the analysis of the nutritional status of wood apple fruit pulp.The fruits are rich in total carbohydrates (24.74 ± 0.19%), total proteins (9.30 ± 0.16%), oil (0.99 ± 0.01%), fiber (3.32 ± 0.02%), and ash (2.73 ± 0.12%). Further analysis and quantification of free sugars, organic acids, and fatty acid methyl esters were carried out by using high-performance liquid chromatography (HPLC) and gas chromatographic (GC) methods. In total, five sugars and nine organic acids were detected and quantified. The predominant sugars were fructose (16.40 ± 0.23%) and glucose (14.23 ± 0.10%), whereas the predominant organic acids were D-tartaric (4.01 ± 0.03%), ascorbic (4.51 ± 0.05%), and citric acid (4.27 ± 0.04%). The oil content of fruit pulp was 0.99 ± 0.01% and GC-MS analysis revealed that, it comprise of 16 fatty acid methyl esters. The percentage of saturated fatty acids were 32.17 ± 0.35%, that includes palmitic (18.52 ± 0.12%) and stearic acids (9.02 ± 0.08%), whereas, the unsaturated fatty acids were 51.98 ± 0.94%, including oleic acid (23.89 ± 0.06%), α-linolenic acid (16.55 ± 0.26%), linoleic acid (10.02 ± 0.43%), and vaccenic acid (1.78 ± 0.23%).