Parental Attitudes Linked to Infant Sugar-Sweetened Beverage Consumption

MedicalResearch.com Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Jennifer Woo Baidal, MD, MPH
Assistant Professor of Pediatrics
Director of Pediatric Weight Management,
Division of Pediatric Gastroenterology, Hepatology, and Nutrition,
Columbia University Medical Center &
New York-Presbyterian Morgan Stanley Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Childhood obesity prevalence is historically high, with most incident obesity among children occurring before age 5 years. Racial/ethnic and socioeconomic disparities in childhood obesity are already apparent by the first years of life. Latino/Hispanic children in low-income families are at-risk for obesity. Thus, understanding potentially effective ways to prevent childhood obesity, particularly in vulnerable populations, should focus on early life.

Sugar-sweetened beverage (SSB) consumption is a modifiable risk factor for obesity and is linked to other adverse health outcomes. Maternal SSB consumption in pregnancy and infant sugar-sweetened beverage consumption in the first year of life are linked to later childhood obesity.

We sought to describe beverage consumption in a modern cross-sectional cohort of 394 low-income, Latino families, and to examine the relationship of parental attitudes toward sugar-sweetened beverages with parental and infant SSB consumption.

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Not All Calories Affect Health Equally

MedicalResearch.com Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Kimber L. Stanhope, Ph.D., M.S., R.D.
Research Nutritional Biologist
Department of Molecular Biosciences: SVM
University of California, Davis 

MedicalResearch.com:? What are the main findings of this study?

Response: Sugar-sweetened beverages increase risk factors for cardiometabolic disease compared with calorically-equal amounts of starch.

We are not the first group of experts to reach this conclusion. The Nutrition and Chronic Diseases Expert Group reached a similar conclusion last year (Micha, 2017). Yet very different conclusions/opinions are being still being published by other researchers. (Latest example: Archer E., In Defense of Sugar: A Critique of Diet-Centrism. Progress in Cardiovascular Disease, May 1, 2018).

These conflicting conclusions confuse the public and undermine the implementation of public health policies, such as soda taxes and warning labels, that could help to slow the epidemics of obesity and cardiometabolic disease. We hope that the careful review of the evidence and the discussion of issues that can lead to conflicting opinions in nutrition research in this paper will help to clarify this issue.

Consumption of polyunsaturated (n-6) fats, such as those found in some vegetable oils, seeds, and nuts, lowers disease risk when compared with equal amounts of saturated fats.

It is important to note however, that the effects of saturated fat can vary depending on the type of food. Dairy foods such as cheese and yogurts, which can be high in saturated fats, have been associated with reduced cardiometabolic risk.

The non-caloric sweetener aspartame does not promote weight gain in adults.

Aspartame is the most extensively studied of the non-caloric sweeteners. None of the dietary intervention studies that have investigated the effects of aspartame consumption have shown it promotes body weight gain.

This includes studies in which the adult research participants consumed aspartame for 6 months, 1 year or 3 years.

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Diet Soda and Excess Sugar During Pregnancy May Depress Child’s Cognition

MedicalResearch.com Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Juliana F. W. Cohen, ScM, ScD

Department of Health Sciences
Merrimack College
North Andover MA 01845.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sugar consumption among Americans is above recommended limits and this excess intake may have important health implications.

This study examined the associations of pregnancy and offspring sugar consumption, as well as sugar-sweetened beverages, other beverages (diet soda, juice), and fruit consumption with child cognition.

This study found that when pregnant women or their children consumed greater quantities of sugar, as well as when women consumed diet soda during pregnancy, this was associated with poorer childhood cognition.  However, children’s fruit consumption was associated with higher cognitive scores.

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Small Intestinal Microbiome Adjusts To Dietary Fats and Sugar

MedicalResearch.com Interview with:

Eugene B. Chang, MD Martin Boyer Professor of Medicine Knapp Center for Biomedical Discovery University of Chicago Chicago, IL  60637

Dr. Chang

Eugene B. Chang, MD
Martin Boyer Professor of Medicine
Knapp Center for Biomedical Discovery
University of Chicago
Chicago, IL  60637 and

Kristina Martinez-Guryn, Ph.D., R.D. Assistant Professor  Biomedical Sciences Program Midwestern University Downers Grove, IL.

Dr. Martinez-Guryn

Kristina Martinez-Guryn, Ph.D., R.D.
Assistant Professor 
Biomedical Sciences Program
Midwestern University
Downers Grove IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Martinez-Guryn: The original goal of this study was to understand why mice devoid of all microorganisms (germ free mice) are protected from diet-induced obesity. We demonstrate that these mice display severely impaired lipid absorption even when fed a high fat diet.

Dr. Chang: We found that many of the processes of dietary lipid digestion and absorption are dependent on and modulated by the gut microbiome which itself responds to dietary cues to adjust the small intestine’s ability and capacity to handle dietary lipids appropriately. This interplay is important for general health, but the findings are also relevant to conditions of overnutrition (obesity, metabolic syndrome) and undernutrition (starvation, environmental enteropathy).  In conditions of overnutrition, high fat, simple sugar, low fiber foods typical of western diets promote small intestinal microbes (which have been largely neglected by the scientific community) that promote fat digestion and absorption. This increases our capacity to assimilate dietary fats which can contribute to the overnutrition problem.  In conditions of undernutrition, these types of gut microbes are lost or minimally represented.  Thus, when nutritional repletion is started, the gut’s ability to upregulate its capacity for dietary lipid digestion and absorption is compromised.

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Sugar-Sweetened Beverages During Adolescence Linked To Dental Cavities

MedicalResearch.com Interview with:
“Caries” by COM SALUD Agencia de comunicación is licensed under CC BY 2.0Teresa A. Marshall, PhD
Professor in the Department of Preventive and Community Dentistry
University of Iowa College of Dentistry
Iowa City

MedicalResearch.com: What is the background for this study?

Response: Dental caries is a process during which oral bacteria ferment carbohydrates to produce acid. The acid demineralizes enamel and/or dentin at the tooth surface leading to white spots and eventually cavitation in the tooth. Added sugars – those not naturally present in foods or beverages, but rather added during processing – are the primary type of carbohydrate associated with caries. Sugar-sweetened beverages (SSBs; beverages with added sugars) are the food/beverage category most associated with dental caries.

Historically, fluoride has protected against caries through remineralization of the enamel. However, there has been some question as to whether fluoride’s ability to protect against caries is overwhelmed by the quantity of added sugars currently consumed.

Oral hygiene behaviors – brushing and flossing – are thought protect against caries by disrupting the oral bacteria on the tooth.

Most studies have investigated dietary factors and caries during early childhood, with less attention paid to caries during adolescence.

Our objective was to identify associations between longitudinal beverage intakes and adolescent caries experience, while also considering fluoride intake and tooth brushing behaviors.

We followed a group of children from birth through age 17 years; during this time period, we looked at their beverage intakes, fluoride intakes and brushing behaviors every 3-6 months. We calculated their average milk, 100% juice, SSB, water/water-based beverage and fluoride intakes from 6 months through 17 years, and daily tooth brushing from 1 through 17 years.

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Intake of Sugar-Sweetened Beverages By Both Partners Appears To Harm Fertility

MedicalResearch.com Interview with:

Dr-Elizabeth-Hatch

Dr. Hatch

Dr. Elizabeth E. Hatch, PhD
Professor, Epidemiology
School of Public Health
Boston University

MedicalResearch.com: What is the background for this study?  

Response: We are conducting a large, ongoing, preconception cohort study, PREgnancy STudy Online or PRESTO http://sites.bu.edu/presto/   in the U.S. and Canada of couples who are planning a pregnancy.  The overall goal of the study is to identify factors that affect fertility, measured by the time taken to conceive, and factors that affect the risk of miscarriage.  Since many women are postponing pregnancy until the later reproductive years, we would like to help find behavioral and environmental factors that might either help or harm fertility so that couples can avoid the stress and expense of infertility workups and treatment.  As part of the larger study, we looked at consumption of sugar-sweetened beverages (SSBs) by both the male and female partner, since some previous research suggested that sugar-sweetened beverages might harm semen quality and ovulation.

For this analysis, we included 3,828 women aged 21 to 45 and 1,045 of their male partners. We asked both males and females (in separate baseline questionnaires) about their usual consumption of SSBs over the last month, and we had a drop-down menu with names of individual sodas (both sugar-sweetened and diet) and energy drinks.  We also asked general questions about the frequency of fruit juice and ‘sports drink’ consumption.   In our analysis, we controlled for multiple factors that might ‘confound’ the associations, such as body mass index, education, caffeine, smoking and alcohol consumption, as well as a measure of overall diet quality.

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Sugar-Sweetened Beverages Play Large Role In Worldwide Obesity Epidemic

MedicalResearch.com Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Maria Luger, MSc
SIPCAN
Special Institute for Preventive Cardiology And Nutrition
Spendenbegünstigte Einrichtung gem. FW 1914/19.3.2005
Vorstand: Univ.-Prof. Prim. Dr. Friedrich Hoppichler
Salzburg, Austria

MedicalResearch.com: What is the background for this study?

Response: Worldwide obesity has nearly tripled since 1975. Rising consumption of sugar-sweetened beverages (SSBs) has been a major contributor to the obesity epidemic and it increases the risk of diabetes or cardiovascular disease, as previous evidence has shown. Partly inconsistent findings from previous reviews have fueled discussions on the impact of SSBs on obesity development.

Therefore, the aim of our review was to systematically review the recent evidence in children and adults.

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Mass Media Campaign Can Reduce Consumption of Sugar-Sweetened Beverages

MedicalResearch.com Interview with:

Thomas Farley, MD, MPH Health Commissioner Department of Public Health City of Philadelphia

Dr. Thomas Farley

Thomas Farley, MD, MPH
Health Commissioner
Department of Public Health
City of Philadelphia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Messages in the mass media have been used in anti-smoking campaigns, but have not be used much for other health-related behaviors.  Sugar-sweetened beverages are major contributors to the obesity epidemic in the United States, so they are an important public health target.

In this study we evaluated a brief counter-advertising campaign in a rural area of Tennessee, Virginia, and Kentucky designed to reduce consumption of these beverages.  After the campaign, adults in the area were more wary of sugary drinks, and sales of sugary drinks fell by about 4% relative to changes in a matched comparison area.

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Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax in Mexico

MedicalResearch.com Interview with:

Shu Wen Ng, Ph.D., FTOS Research Associate Professor, Department of Nutrition Gillings School of Global Public Health Fellow, Carolina Population Center Duke-UNC Center for Behavioral Economics and Healthy Food Choice Research University of North Carolina at Chapel Hill

Dr. Shu Wen Ng

Shu Wen Ng, Ph.D., FTOS
Research Associate Professor, Department of Nutrition
Gillings School of Global Public Health
Fellow, Carolina Population Center
Duke-UNC Center for Behavioral Economics and Healthy Food Choice Research
University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Mexican government enacted a 1 peso per liter tax on sugar sweetened beverages (SSB) after studies showed that more than 70 percent of the country’s population was overweight or obese, and that in excess of 70 percent of the added sugar calories in the Mexican diet were coming from SSBs. We were interested in learning how purchases of SSBs and other beverages changed in the 2 years after the tax was implemented in Mexico. The Health Affairs study titled “In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax” found that in the two-year period spanning 2014 to 2015, the tax resulted in a 5.5 percent reduction in the first year and continued to decline, averaging 9.7 percent the second year, with lower socioeconomic households, for whom health care costs are most burdensome, lowered their purchases of sweetened beverages the most. Meanwhile, purchases of untaxed beverages such as bottled water increased 2.1 percent.

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Better-Beverage Campaign Reduced Sugary Drink Consumption

MedicalResearch.com Interview with:

Marlene B. Schwartz PhD Director, Rudd Center for Obesity & Food Policy (Principal Investigator) Professor, Department of Human Development and Family Studies University of Connecticut Hartford, CT 06103

Dr. Schwartz

Marlene B. Schwartz PhD
Director, Rudd Center for Obesity & Food Policy (Principal Investigator)
Professor, Department of Human Development and Family Studies
University of Connecticut
Hartford, CT 06103

MedicalResearch.com: What is the background for this study? 

Response: The aim of this study was to evaluate the impact of a community-wide campaign to reduce consumption of sugary beverages in Howard County, Maryland. We measured the retail sales of sugary drinks in supermarkets in the target community and a set of matched control supermarkets in another state. The campaign included multiple components over three years, including television advertising, digital marketing, direct mail, outdoor advertising, social media and earned media, creating 17 million impressions. The community partners successfully advocated for public policies to encourage healthy beverage consumption in schools, child care, health care and government settings.

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Type of Sugar, Not Just Amount, Influences Metabolic Effects

MedicalResearch.com Interview with:
Dr. Marta Alegret

Department of Pharmacology, Toxicology and Therapeutic Chemistry
Pharmacology Section
School of Pharmacy and Food Sciences
University of Barcelona

MedicalResearch.com: What is the background for this study?

Response: In humans, an excessive intake of sugars has been linked to the development of metabolic disturbances, and therefore to an increase in the risk for cardiovascular diseases. Specifically, increased consumption of simple sugars in liquid form, as beverages sweetened with high fructose corn syrup or sucrose, has been linked to obesity, insulin resistance and type 2 diabetes. However, two questions remain unresolved: what is/are the underlying molecular mechanism(s) linking these metabolic alterations to cardiovascular diseases? Are the adverse cardiovascular and metabolic effects of sugar-sweetened beverages merely the consequence of the increase in caloric intake caused by their consumption?

To answer to these questions, we performed a study in female rats, which were randomly assigned to three groups: a control group, without any supplementary sugar; a fructose-supplemented group, which received a supplement of 20% weight/volume fructose in drinking water; and a glucose-supplemented group, supplemented with 20% weight/volume glucose in drinking water.

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How Strong is the Scientific Basis of Sugar Intake Guidelines?

MedicalResearch.com Interview with:

Bradley C. Johnston, PhD Prevention Lab, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 11.9859 West, Toronto, Ontario

Dr. Bradley Johnston

Bradley C. Johnston, PhD
Prevention Lab, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute
Peter Gilgan Centre for Research and Learning
Toronto, Ontario

MedicalResearch.com: What is the background for this study?

Response: I am scientist at The Hospital for Sick Children and a professor of clinical epidemiology at the University of Toronto and McMaster University in Canada. I have a particular interest in research methodology and preventive medicine. As a research methodologist I am interested in how researchers get to their conclusions. In particular I am interested in the “uncertainty” in estimated treatment or exposure effects.

Many guidelines have methodological issues but it was suspected that the nutritional guidelines were especially problematic. Our study in Annals of Internal Medicine set out to document the issues systematically with respect to sugar intake recommendations from authoritative guidelines.

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Americans Aware of Threat of Excessive Sugar Intake, But Aren’t Doing Much About It

MedicalResearch.com Interview with:

Healthline Sugar Survey

Healthline Sugar Survey

Tracy Stickler, Editor in Chief
Healthline

Ms. Stickler discusses a Healthline survey of over 3000 Americans, regarding “their knowledge of sugar and how it affects the body to gauge their relationship about their own sugar consumption and the effects it has on them”.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our company surveyed over 3,000 Americans from across the country about their sugar consumption habits and awareness about added sugar in food.

What we learned is that while many people are aware of the threat overconsumption of sugar is to their health, they aren’t doing much about it. Why not? They don’t know how and quite often they don’t know how much sugar is contained in certain foods they eat. We have an awareness issue. Two out of 3 respondents answered incorrectly to our questions related to which food item contained more sugar.

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Some Natural Sweeteners and Fiber Can Mute Glycemic Response To High Carbohydrate Foods

MedicalResearch.com Interview with:
Margaret A. Brennan
Department of Wine, Food and Molecular Biosciences
Lincoln University
Lincoln, Canterbury, New Zealand

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been immense consumer attention recently in terms of the reduction of sugar levels in food products. Most of this attention has stemmed from a nutritional understanding that foods high in sugar and easily digested carbohydrates can increase blood glucose levels and hence potentially lead to weight gain, obesity issues, metabolic diseases (diabetes related illnesses) and even Alzheimer’s disease due to up regulation of genes responsible for amyloid like complexation.

Our research over the last 10-15 years has tried to investigate the relationship between food composition – food structure / processing – human nutrition. We have developed a deep understanding of how we can regulate the potential glycaemic index of foods by selective use of non-starch polysaccharides, natural sweeteners and texturizing agents to manipulate the rate of starch and carbohydrate digestion.

This study clearly illustrates the great potential of the use of certain natural sweeteners in producing reduced sugar consumer products which have the benefit of reducing glycaemic response in individuals. The utilisation of plant based ingredients to manipulate such a a response offers not only the industry but consumers a powerful opportunity to regulate glycaemia and hence associated metabolic orders.

The study also illustrates that sugar is important in modern foods in providing the structure and hence textural characteristics we have grown accustomed to as consumers. Again careful selection of ingredients can minimise any potential negative effects on food structure and texture that sugar reduction may have.

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More Than Half of Calories Consumed in US Come From Ultraprocessed Foods

MedicalResearch.com Interview with:
Euridice Martinez Steele 
University of São Paulo, São Paulo

MedicalResearch.com: What is the background for this study?

Response: Several leading health bodies, including the World Health Organization, the Canadian Heart and Stroke Foundation, the American Heart Association, and the US Dietary Guidelines Advisory Committee have concluded that excess added sugar intake increases the risk not only of weight gain, but also of obesity and diabetes, which are associated with a heightened risk of cardiovascular disease, and tooth decay.

All reports recommended limiting intake of added sugars. In the US, the USDGAC recommended limiting added sugars to no more than 10% of total calories.

To design and implement effective measures to reduce added sugars, their dietary sources must be clearly identified. Added sugars can be consumed either as ingredients of dishes or drinks prepared from scratch by consumers or cook, or as ingredients of food products manufactured by the food industry. According to market disappearance data from 2014, more than three quarters of the sugar and high fructose corn syrup available for human consumption in the US were used by the food industry. This suggests food products manufactured by the industry could have an important role in the excess added sugars consumption in the US. However, to assess this role, it is essential to consider the contribution of manufactured food products to both total energy intake and the energy intake from added sugars, and, more relevantly, to quantify the relationship between their consumption and the total dietary content of added sugars. To address these questions, we performed an investigation utilizing 2009-2010 National Health and Nutrition Examination Survey (NHANES).

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Consumers Balance Healthy and Hedonistic Food Choices

MedicalResearch.com Interview with:
Minakshi Trivedi, PhD
Professor of Marketing
Co-Director CRM
University at Buffalo
Jacobs Management Center
Buffalo, NY 14260

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Trivedi: Consumer health concerns have been on the rise as has the flow of nutritional information and advice from retailers, manufacturers, government agencies and the medical community regarding what and how much consumers should consume. Nevertheless, whether such concerns are reflected in their purchasing and consumption behavior is not quite as certain. With diabetes and obesity showing steady increases of incidence in the population, understanding this apparent disconnect between stated health concerns and actual food consumption becomes a critical objective for policy makers wishing to impact and improve public consumption choice behavior.

Drawing from the theory of compensatory or balancing behavior (Fishbein & Ajzen 1975), we posit that consumers also exhibit such balancing behavior across a set of products when limiting the consumption of negatively perceived attributes – that is, attributes which when present, generally contribute negatively to the valuation of a product. We study this balancing behavior in consumer consumption when limiting salt, sugar and fat content across product categories. Depending on the consumer’s individual health orientation, then, a healthy choice in some categories may compensate for a less healthy choice in another category.

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High Glycemic Index May Raise Lung Cancer Risk Especially in Never Smokers

MedicalResearch.com Interview with:

Xifeng Wu, M.D., Ph.D Professor of Epidemiology

Dr. Xifeng Wu

Xifeng Wu, M.D., Ph.D
Professor of Epidemiology and

Dr. Stephanie Claire Melkonian PhD Epidemiologist, Postdoctoral Research Fellow

Dr. Melkonian

Dr. Stephanie Claire Melkonian  PhD
Epidemiologist, Postdoctoral Research Fellow
The University of Texas MD Anderson Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Glycemic index (GI) assigns foods an indexed value to show how quickly and how much carbohydrates in the food cause blood glucose levels to rise after eating and is a measure of overall carbohydrate quality. Glycemic load (GL) is a related measure that is calculated by multiplying Glycemic index by the amount of carbohydrates in grams in that specific food and by the amount consume, then dividing by 100. Previous studies have investigated the association of GI and GL with certain types of cancer, including colorectal, stomach, and pancreatic cancer, but there has been limited research into the association with lung cancer.

We conducted a study using patients and control subjects from an ongoing case-control study of lung cancer conducted at MD Anderson. The patients were newly diagnosed and had not received treatment other than surgery. The healthy control subjects were selected from patient lists at Kelsey-Seybold Clinics, a large physician group in the Houston area. The study results encompass 1,905 cases and 2,413 controls. Using data collected from in-person interviews regarding health histories and dietary behaviors, we were able to categorize the study subjects according to their dietary Glycemic index and GL.

What we found was that individuals in the highest category of GI were at an almost 50% increased risk for developing lung cancer as compared to those in the lowest group. This association was different based on different subtypes of cancer. Most interestingly, however, among those individuals that never smoked, high Glycemic index was associated with an almost 2 fold increased risk of lung cancer. In other words, we found a more profound association between GI and lung cancer in never smokers in this study.

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Young Adults, Southeners, Drink Most Sugar-Sweetened Beverages

MedicalResearch.com Interview with:

Sohyun Park, PhD Epidemiologist Epidemiology and Surveillance Team Obesity Prevention and Control Branch Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia

Dr. Sohyun Park

Sohyun Park, PhD
Epidemiologist
Epidemiology and Surveillance Team
Obesity Prevention and Control Branch
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, Georgia 

Medical Research: What is the background for this study? What are the main findings?

Dr. Park: The 2013 BRFSS provides the most recent state data for this behavior using a short screener which showed that about 1 in 3 adults consumed sugar-sweetened beverages (SSBs) at least once per day, and SSB intake differed by state and by certain subgroups.

The main findings of the study showed the following among the 23 states and DC surveyed the prevalence of adults who consumed sugar-sweetened beverages at least once daily was:

  • Aged 18-24 years (43.3%)
  • Men (34.1%)
  • Non-Hispanic Blacks (39.9%)
  • Unemployed (34.4%)
  • Had less than a high school education (42.4%)
  • Adult sugar-sweetened beverages intake was highest in Mississippi (47.5%), followed by Louisiana (45.5%) and West Virginia (45.2%).
  • The prevalence of  sugar-sweetened beverages intake one or more times per day among younger adults (18–24 years) was 2.3 times the prevalence among the older adults (aged 55 years and older)—43.3% versus 19.1%, respectively.

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Sugar Sweetened Beverages Linked to Increase in Belly Fat

Dr. Caroline Fox, MD MPH National Heart, Lung, and Blood Institute Assistant Clinical Professor of Medicine Harvard Medical School

Dr. Fox

MedicalResearch.com Interview with:
Dr. Caroline Fox, MD MPH
National Heart, Lung, and Blood Institute
Assistant Clinical Professor of Medicine
Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Fox: There is evidence linking sugar sweetened beverages with obesity and type 2 diabetes. There is also evidence suggesting that specific adipose tissue depots may play a role in the pathogenesis of these diseases. We found that higher levels of sugar sweetened beverage (SSB) intake was associated with more visceral fat (fat in the stomach cavity) over 6 years.

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Reducing Sugar in Beverages Can Have Major Impact on Population Health

Kawther Hashem MSc RNutr (Public Health) Nutritionist and Researcher Action on Sugar Wolfson Institute of Preventive Medicine, Queen Mary, University of London London UK

Kawther Hashem

MedicalResearch.com Interview with:
Kawther Hashem MSc RNutr (Public Health)
Nutritionist and Researcher
Action on Sugar
Wolfson Institute of Preventive Medicine,
Queen Mary, University of London
London UK

Medical Research: What is the background for this study? What are the main findings?

Response: The calculations showed that a 40% reduction in free sugars added to Sugar Sweetened Beverages (SSBs) over five years would lead to an average reduction in energy intake of 38 kcal per day by the end of the fifth year. This would lead to an average reduction in body weight of 1.20kg in adults,  resulting in a reduction in overweight and obese adults by approximately half a million and 1 million respectively. This would in turn prevent between 274,000-309,000 obesity-related type 2 diabetes over the next two decades. Policies such as this will reduce cases of overweight and obesity and type 2 diabetes, this will have a major clinical impact and reduce healthcare costs.

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Low Calorie Sweeteners Not Linked To Weight Gain

Prof. Peter J. Rogers PhD School of Experimental Psychology, University of Bristol, Bristol, UK

Prof. Rogers

MedicalResearch.com Interview with:
Prof. Peter J. Rogers PhD
School of Experimental Psychology
University of Bristol, Bristol, UK

Medical Research: What is the background for this study?

Prof. Rogers: In recent years low-calorie sweeteners have been in the headlines because of concern that they may undermine rather than help with healthy weight management. That concern is based on selective reporting of studies and outright speculation. Our aim was to review the totality of evidence on this subject, which included results from human and animal (mouse and rat) studies.

Medical Research: What are the main findings?

Prof. Rogers: We found that randomised, controlled intervention trials in humans showed consistently that low-calorie sweeteners versus sugar consumption reduced energy intake and body weight, with no effect or even reduced body weight compared with consumption of water. These types of studies provide the strongest form of evidence – superior to animal and observational studies. In the animal studies, exposure to low-calorie sweeteners was mostly not representative of how people consume low-calorie sweeteners.

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Sugar Sweetened Soda Linked To Chronic Kidney Disease

Wisit Cheungpasitporn, MD Nephrology Fellow Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MNMedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD
Nephrology Fellow
Departments of Nephrology and Hypertension
Program director: Suzanne Norby, MD
Co-authors: Charat Thongprayoon, MD, Oisin A O’Corragain, MD, Peter J Edmonds, BS, Wonngarm Kittanamongkolchai, MD, Stephen B Erickson, MD
Project mentor: Stephen B. Erickson, MD Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

Medical Research: What is the background for this study?

Dr. Cheungpasitporn: High-fructose corn syrup consumption in the form of sugar-sweetened soda has dramatically increased worldwide and associated with risk factors for chronic kidney disease (CKD) including diabetes mellitus (DM) and metabolic syndrome. Recently, artificial sweeteners have become commonly used in soda marketed as ‘diet’ alternatives. Recent studies have demonstrated that diet soda consumption may also be associated with weight gain, metabolic syndrome and cardiovascular disease. The risks of CKD in individuals with sugar-sweetened or diet soda consumption, however, were conflicting. We therefore conducted a meta-analysis to assess the associations between CKD and the consumption of sugar sweetened and diet soda. The findings of our study were recently published in Nephrology (Carlton). 2014; 19(12):791-7.

Medical Research: What are the main findings?

Dr. Cheungpasitporn: Five studies (2 prospective cohort studies, 2 cross-sectional studies and a case-control study) were included in our analysis of the association between consumption of sugar-sweetened soda (≥1-2 drinks of sugary soda/day) and CKD. We found an overall 1.58-fold increase CKD risk in individuals who regularly consumed sugar-sweetened soda with the pooled risk ratio (RR) of 1.58 (95% CI 1.00–2.49). Four studies (2 prospective cohort studies, a cross-sectional studies and a case-control study) were included to assess the association between CKD and diet soda consumption (≥1-2 drinks of diet soda/day). Despite a trend of chronic kidney disease risk in individuals with diet soda consumption with the pooled RR of 1.33 (95% CI 0.82–2.15), this association was not statistically significant.

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Sugar Sweetened Beverages Linked To Overall Unhealthy Diet

Louise Brunkwall Nutritionist, MPH and Phd-student Diabetes and Cardiovascular Disease, Genetic Epidemiology Lund University, Clinical Sciences Malmö, Sweden

MedicalResearch.com Interview with:
Louise Brunkwall
Nutritionist, MPH and Phd-student
Diabetes and Cardiovascular Disease, Genetic Epidemiology
Lund University, Clinical Sciences
Malmö, Sweden

 Medical Research: What is the background for this study? What are the main findings?

Response: There has been a huge interest for sugar sweetened beverages (SSB) the last years and SSB has been associated with various diseases like type 2 diabetes and obesity, while juice for example which have approximately the same amount of energy have not. We find this very interesting and wanted to know more about who the people were that consumed a lot of these different beverages. We started of by looking at diet and found that the different beverages were associated with different dietary patterns. Sugar sweetened beverages were associated with a more unhealthy diet while juice was associated with a more healthy diet. We see the same for tea which is a beverage previously associated with a lower risk of several diseases, that it is associated with an overall very healthy diet. Therefore we draw the conclusions that beverages are a part of the overall diet which might contribute to the previous findings of associations with different diseases. This also tells us that it is of great importance to know more about the overall diet than just consumption of a single product when investigating beverages-dieases association studies.

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Measures To Reduce Sugary Drinks Gains Public Acceptance

Dr. Dragos Petrescu Department of Public Health and Primary Care CambridgeMedicalResearch.com Interview with:
Dr. Dragos Petrescu
Department of Public Health and Primary Care
Cambridge

Medical Research: What is the background for this study? What are the main findings?

Response: Consumption of sugar-sweetened beverages is a major contributor to obesity, particularly in children. Recent systematic reviews provide good evidence that reducing portion size reduces consumption. Similarly, evidence suggests that container shapes and product placement in supermarkets can influence consumption. The public acceptability of “nudging” — altering properties such as the size, the shape, and location of sugar-sweetened beverages — to improve public health is unknown. Here we compared the acceptability in UK and USA samples of government interventions to reduce consumption of sugar-sweetened beverages: three nudge interventions (limiting portion size, changing container shape, and changing shelf location) and two traditional interventions (increased taxation and an education campaign).

We found that for the majority of UK and USA samples, the education campaign and the three nudge interventions were acceptable, with education attracting most support.  By contrast, only a minority of participants supported taxation.

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Replacing Sugary Drinks With Plain Coffee Or Tea May Reduce Diabetes Risk

Dr Nita Forouhi, MRCP, PhD, FFPHM MRC Programme Leader and Consultant Public Health Physician MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge Biomedical Campus Cambridge UKMedicalResearch.com Interview with:
Dr Nita Forouhi, MRCP, PhD, FFPHM
MRC Programme Leader and Consultant Public Health Physician
MRC Epidemiology Unit
University of Cambridge School of Clinical Medicine
Cambridge Biomedical Campus
Cambridge UK

Medical Research: What is the background for this study? What are the main findings?

Dr. Forouhi: Consumption of soft drinks is known to cause obesity and may contribute to the development of type 2 diabetes. We had previously published findings from the EPIC-InterAct study in 8 European countries that habitual consumption of sugar sweetened beverages increases the risk of developing type 2 diabetes, and we now wanted to probe deeper to understand more about this relationship between sweet beverages and diabetes.

We conducted research in the large EPIC-Norfolk study which included more than 25,000 men and women aged 40–79 years living in Norfolk, UK. Study participants recorded everything that they ate and drank for 7 consecutive days covering weekdays and weekend days, with particular attention to type, amount and frequency of consumption, and whether sugar was added by the participants. During approximately 11 years of follow-up, 847 study participants were diagnosed with new-onset type 2 diabetes.

By using this detailed information on diet, we were able to study several different types of sugary beverages, including sugar-sweetened soft drinks, sweetened tea or coffee and sweetened milk drinks as well as artificially sweetened beverages (ASB) – such as diet soft drinks – and fruit juice, and to examine what would happen if plain water, unsweetened tea or coffee or artificially sweetened beverages were substituted for sugary drinks.

Our study provided three main findings:

First, there was an approximately 22% increased relative risk of developing type 2 diabetes per extra serving per day habitually of each of soft drinks, sweetened milk beverages and ASB consumed, even after accounting for a range of important factors including other lifestyle and social factors and for total energy intake. However, after further accounting for body mass index and waist girth as markers of obesity, there remained a higher risk of diabetes associated with consumption of both soft drinks and sweetened milk drinks, but the link with ASB consumption no longer remained, possibly because artificially sweetened beverages was likely to be consumed by those who were already overweight or obese.

Second, when we estimated the likely effects of replacing a habitual serving of soft drinks with a serving of water or unsweetened tea or coffee, we found that the risk of diabetes could have been cut by 14%; and by replacing a habitual serving of sweetened milk beverage with water or unsweetened tea or coffee, that reduction could have been 20%–25%.  However, consuming ASB instead of any sugar-sweetened drink was not likely to reduce the risk of diabetes, when accounting for baseline obesity and total energy intake.

Third, we found that each 5% of higher intake of energy (as a proportion of total daily energy intake) from total sweet beverages (soft drinks, sweetened tea or coffee, sweetened milk beverages, fruit juice) was associated with a 18% higher risk of diabetes. We estimated that if study participants had reduced the energy they obtained from sweet beverages to below 10%, 5% or 2% of total daily energy, 3%, 7% or 15% respectively of new-onset type 2 diabetes cases could have been potentially avoided.

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