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Fu R, Zhang S, Cai C, Wang X, Jiang Y, Zhuang X, Zhang J, Ji X, Yang C. Association between the intake of potentially risky beverages and the occurrence of endometrial polyps: a case-control study. Front Nutr 2025; 12:1538405. [PMID: 39968393 PMCID: PMC11832405 DOI: 10.3389/fnut.2025.1538405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 01/16/2025] [Indexed: 02/20/2025] Open
Abstract
Background This case-control study aimed to examine the association between the frequency of potentially risky beverage consumption, levels of anxiety, and the prevalence of endometrial polyps. Methods A total of 418 participants were enrolled in the study, comprising 206 cases and 212 controls. The case group consisted of patients who visited the gynecological clinic at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and were diagnosed with endometrial polyps (Eps) based on international diagnostic criteria. The control group consisted of women of childbearing age who visited the gynecological clinic with similar clinical symptoms but did not have EPs. Basic information, consumption of potentially risky beverages (PRB), and anxiety levels for both groups were collected through a questionnaire survey. Finally, the relationship between the frequency of PRB consumption, anxiety levels, and the prevalence of EPs was evaluated. Results In this study, we identified a significant positive association between the consumption of PRB and the prevalence of EPs. PRB intake was categorized into three groups based on the cumulative total score: 5-8 for the Low potentially risky beverages (LPRB) intake group, 9-12 for the medium potentially risky beverages (MPRB) intake group, and 13-21 for the high potentially risky beverages (HPRB) intake group. The results revealed that PRB consumption frequency was significantly associated with EPs (OR: 2.348, 95% CI: 1.153-4.78), with higher PRB intake correlating with an increased risk of EPs (p-value: 0.014). However, no significant difference was observed between the LPRB, MPRB, HPRB intake frequency groups and the different levels of anxiety (p-value: 0.793). Conclusion Increased consumption of PRB was clearly associated with a greater risk of EPs, and over half of the participants exhibited varying degrees of anxiety. These findings suggest that the risk of EPs can be mitigated by controlling beverage intake and highlight the need for increased attention to women's mental health. Clinical trial registration NCT06295510.
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Affiliation(s)
- Rui Fu
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shipeng Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chang Cai
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaocui Wang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yanjie Jiang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiulian Zhuang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiating Zhang
- Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, Liaoning, China
| | - Xiaoli Ji
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chengcheng Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Zhou L, Guo Q, Wang J, Zhou Z, Zhang Y. Association between cumulative intake of sugar-sweetened and artificially sweetened beverages and progression of coronary calcification: Insights from the CARDIA study. Nutr Metab Cardiovasc Dis 2024; 34:2807-2816. [PMID: 39443280 DOI: 10.1016/j.numecd.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 09/04/2024] [Accepted: 09/12/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND AND AIMS This study investigates the relationship between the cumulative intake of artificially sweetened beverages (ASBs) and sugar-sweetened beverages (SSBs) during young adulthood and the progression of coronary artery calcium (CAC) by midlife, using data from the Coronary Artery Risk Development in Young Adults study. METHODS AND RESULTS We included 2,466 participants with CAC measurement via computed tomography at the 15th, 20th, and 25th year follow-ups. Dietary intake was assessed using the CARDIA Diet History at baseline and years 7. Cumulative average beverage intake was calculated and categorized. Multivariable Cox regression models adjusted for demographic, lifestyle, and cardiovascular risk factors assessed associations between beverages consumption and CAC progression. Among the included participants, 1107 (44.9 %) were male, 1439 (58.4 %) were white, and the average age was 40.4 years with a standard deviation of 3.5 years. Over a 9.2±1.8-year follow-up, CAC progression was recorded in 715 participants. Higher cumulative ASBs intake was associated with increased CAC progression risk, with hazard ratios (95%CI, P-value) for low and high ASBs consumption being 1.35 (1.14, 1.60; P < 0.001) and 1.54 (1.15, 2.07; P < 0.001) compared to non-consumers. Participants consuming >2 servings/day of SSBs had a 37 % higher CAC progression risk (HR 1.37, 95 % CI 1.14-1.64, P < 0.001). However, no significant association was found between SSB consumption and CAC progression after adjusting for confounders. CONCLUSIONS Prolonged consumption of beverages, especially ASBs, in young adults is linked to an increased risk of CAC progression.
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Affiliation(s)
- Lingqu Zhou
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qi Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Junjie Wang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Zirui Zhou
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yinyin Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Wang X, Zhao J, Xu J, Li B, Liu X, Xie G, Duan X, Liu D. Noncaloric monosaccharides induce excessive sprouting angiogenesis in zebrafish via foxo1a-marcksl1a signal. eLife 2024; 13:RP95427. [PMID: 39365738 PMCID: PMC11452176 DOI: 10.7554/elife.95427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2024] Open
Abstract
Artificially sweetened beverages containing noncaloric monosaccharides were suggested as healthier alternatives to sugar-sweetened beverages. Nevertheless, the potential detrimental effects of these noncaloric monosaccharides on blood vessel function remain inadequately understood. We have established a zebrafish model that exhibits significant excessive angiogenesis induced by high glucose, resembling the hyperangiogenic characteristics observed in proliferative diabetic retinopathy (PDR). Utilizing this model, we observed that glucose and noncaloric monosaccharides could induce excessive formation of blood vessels, especially intersegmental vessels (ISVs). The excessively branched vessels were observed to be formed by ectopic activation of quiescent endothelial cells (ECs) into tip cells. Single-cell transcriptomic sequencing analysis of the ECs in the embryos exposed to high glucose revealed an augmented ratio of capillary ECs, proliferating ECs, and a series of upregulated proangiogenic genes. Further analysis and experiments validated that reduced foxo1a mediated the excessive angiogenesis induced by monosaccharides via upregulating the expression of marcksl1a. This study has provided new evidence showing the negative effects of noncaloric monosaccharides on the vascular system and the underlying mechanisms.
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Affiliation(s)
- Xiaoning Wang
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
| | - Jinxiang Zhao
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
- Suqian First HospitalSuqianChina
| | - Jiehuan Xu
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
| | - Bowen Li
- Medical School, Nantong UniversityNantongChina
| | - Xia Liu
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
| | - Gangcai Xie
- Medical School, Nantong UniversityNantongChina
| | - Xuchu Duan
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
| | - Dong Liu
- Affiliated Hospital of Nantong University, Nantong Laboratory of Development and Diseases, School of Life Science; Co-innovation Center of Neuroregeneration, Nantong UniversityNantongChina
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Sun T, Yang J, Lei F, Huang X, Liu W, Zhang X, Lin L, Sun L, Xie X, Zhang XJ, Cai J, She ZG, Xu C, Li H. Artificial sweeteners and risk of incident cardiovascular disease and mortality: evidence from UK Biobank. Cardiovasc Diabetol 2024; 23:233. [PMID: 38965574 PMCID: PMC11225337 DOI: 10.1186/s12933-024-02333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Artificial sweeteners are widely popular worldwide as substitutes for sugar or caloric sweeteners, but there are still several important unknowns and controversies regarding their associations with cardiovascular disease (CVD). We aimed to extensively assess the association and subgroup variability between artificial sweeteners and CVD and CVD mortality in the UK Biobank cohort, and further investigate the modification effects of genetic susceptibility and the mediation role of type 2 diabetes mellitus (T2DM). METHODS This study included 133,285 participants in the UK Biobank who were free of CVD and diabetes at recruitment. Artificial sweetener intake was obtained from repeated 24-hour diet recalls. Cox proportional hazard models were used to estimate HRs. Genetic predisposition was estimated using the polygenic risk score (PRS). Furthermore, time-dependent mediation was performed. RESULTS In our study, artificial sweetener intake (each teaspoon increase) was significantly associated with an increased risk of incident overall CVD (HR1.012, 95%CI: 1.008,1.017), coronary artery disease (CAD) (HR: 1.018, 95%CI: 1.001,1.035), peripheral arterial disease (PAD) (HR: 1.035, 95%CI: 1.010,1.061), and marginally significantly associated with heart failure (HF) risk (HR: 1.018, 95%CI: 0.999,1.038). In stratified analyses, non-whites were at greater risk of incident overall CVD from artificial sweetener. People with no obesity (BMI < 30 kg/m2) also tended to be at greater risk of incident CVD from artificial sweetener, although the obesity interaction is not significant. Meanwhile, the CVD risk associated with artificial sweeteners is independent of genetic susceptibility, and no significant interaction exists between genetic susceptibility and artificial sweeteners in terms of either additive or multiplicative effects. Furthermore, our study revealed that the relationship between artificial sweetener intake and overall CVD is significantly mediated, in large part, by prior T2DM (proportion of indirect effect: 70.0%). In specific CVD subtypes (CAD, PAD, and HF), the proportion of indirect effects ranges from 68.2 to 79.9%. CONCLUSIONS Our findings suggest significant or marginally significant associations between artificial sweeteners and CVD and its subtypes (CAD, PAD, and HF). The associations are independent of genetic predisposition and are mediated primarily by T2DM. Therefore, the large-scale application of artificial sweeteners should be prudent, and the responses of individuals with different characteristics to artificial sweeteners should be better characterized to guide consumers' artificial sweeteners consumption behavior.
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Affiliation(s)
- Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, 430060, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan Yang
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, 430060, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, 430060, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Linsu Sun
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China
| | - Xinlan Xie
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China
| | - Xiao-Jing Zhang
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, 430060, Wuhan, China.
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China.
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China.
- Institute of Model Animal, Wuhan University, Wuhan, China.
| | - Chengsheng Xu
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, 430060, Wuhan, China.
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Medical University, Ganzhou, China.
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China.
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Ding P, Yue W, Wang X, Zhang Y, Liu Y, Guo X. Effects of sugary drinks, coffee, tea and fruit juice on incidence rate, mortality and cardiovascular complications of type2 diabetes patients: a systematic review and meta-analysis. J Diabetes Metab Disord 2024; 23:1113-1123. [PMID: 38932853 PMCID: PMC11196440 DOI: 10.1007/s40200-024-01396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/05/2024] [Indexed: 06/28/2024]
Abstract
Aims Despite more and more studies indicate that beverages play an important role in type 2 diabetes mellitus(T2DM), the efficacy of intaking different beverages for T2DM has not been clearly stated in one article. The meta-analysis was performed, which aims to assess the effects of beverages on mortality and cardiovascular complications in patients with type 2 diabetes and the incidence of T2DM. Method PubMed, Embase, Web of Science and Cochrane Library databases were search up to March, 2023 to identify relevant studies, including studies researching beverage consumption, the incidence and mortality of T2DM and incidence of cardiovascular disease, a kind of complication of T2DM. The way to explore the source of heterogeneity is performing subgroup analyses and sensitivity analyses. Funnel plots and Egger's regression test were performed to assess publication bias. The Hazard ratio (HR) and 95% confidence intervals (95% CIs) were used to analysis the results. Fifteen observational studies were included in our meta-analysis. Results Fifteen eligible articles were included sugar-sweetened beverages(SSB) consumption increased the mortality and incidence of T2DM ( Hazard ratio (HR), 1.20; 95% confidence interval (CI), 1.05-1.38; P = 0.01 and HR, 1.15; 95% CI,1.06-1.24; P = 0.001), respectively. Artificially-sweetened beverages (ASB) consumption was not associated with the mortality and incidence of T2DM (HR,0.96;95%CI, 0.86-1.07; P = 0.464 and HR, 1.15; 95% CI,1.05-1.26; P = 0.003), respectively. Fruit juice consumption increased the incidence of T2DM (HR,1.08;95%CI,1.02-1.14, P = 0.296).Tea or coffee consumption can reduce the incidence of T2DM (HR, 0.89; 95%CI,0.81-0.98; P = 0.016). Tea or coffee consumption was associated with a lower risk of mortality of T2DM (HR,0.84; 95% Cl, 0.75-0.94; P = 0.002 and HR,0.75; 95% CI, 0.65-0.87; P < 0.001), respectively. Additionally, beverage consumption was not associated with cardiovascular disease in T2DM patients (HR,1.03; 95% Cl, 0.82-1.30, P > 0.05). Conclusions High consumption of SSBs led to a higher risk and mortality of T2DM, while high consumption of coffee or tea showed significant associations with a lower risk of the incidence and mortality of T2DM. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01396-5.
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Affiliation(s)
- Ping Ding
- Department of Critical Care Medicine, No. 988 hospital of The PLA Joint Logistic Support Force (PLAJLSF), Zhengzhou, 450000 China
| | - Wei Yue
- Department of Critical Care Medicine, No. 988 hospital of The PLA Joint Logistic Support Force (PLAJLSF), Zhengzhou, 450000 China
| | - Xu Wang
- School of Clinical Medicine, Zhengzhou University, Zhengzhou, 450000 China
| | - Yuqing Zhang
- School of Clinical Medicine, Zhengzhou University, Zhengzhou, 450000 China
| | - Yuxiang Liu
- School of Clinical Medicine, Zhengzhou University, Zhengzhou, 450000 China
| | - Xiaofeng Guo
- Department of Critical Care Medicine, No. 988 hospital of The PLA Joint Logistic Support Force (PLAJLSF), Zhengzhou, 450000 China
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Mohd Hanim MFB, Md Sabri BA, Yusof N. Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis. Public Health Nurs 2024; 41:139-150. [PMID: 37953703 DOI: 10.1111/phn.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography. METHODS This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo. RESULTS Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries. CONCLUSION The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.
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Affiliation(s)
- Muhammad Faiz Bin Mohd Hanim
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Oral Health Program, Ministry of Health, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
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Henn M, Glenn AJ, Willett WC, Martínez-González MA, Sun Q, Hu FB. Changes in Coffee Intake, Added Sugar and Long-Term Weight Gain - Results from Three Large Prospective US Cohort Studies. Am J Clin Nutr 2023; 118:1164-1171. [PMID: 37783371 PMCID: PMC10739774 DOI: 10.1016/j.ajcnut.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Consumption of both caffeinated and decaffeinated coffee has been reported to attenuate long-term weight gain. Whether the association between coffee consumption and weight gain depends on the addition of sugar, cream, or coffee whitener remains unclear. OBJECTIVE We aimed to study the associations between changes in coffee consumption, caffeine intake, and weight changes by considering the addition of sugar, cream, or a nondairy coffee whitener. METHODS We used 3 large prospective cohorts - the Nurses' Health Study (1986 - 2010), Nurses' Health Study II (1991 - 2015) and Health Professional Follow-up Study (1991 - 2014). We applied multivariable linear regression models with robust variance estimators to assess the association of changes in coffee habits within each 4-y interval with concurrent weight changes. Results across the 3 cohorts were pooled using inverse-variance weights. RESULTS After multivariable adjustment, each 1 cup per day increment in unsweetened caffeinated coffee was associated with a reduction in 4-y weight gain of -0.12 kg (95 % CI: -0.18, -0.05 kg) and of -0.12 kg (95 % CI: -0.16, -0.08 kg) for unsweetened decaffeinated coffee. The habits of adding cream or nondairy coffee whitener were not significantly linked to weight changes. Adding a teaspoon of sugar was associated with a 4-y weight gain of +0.09 kg (0.07, 0.12 kg). Stratified analyses suggested stronger magnitude of the observed associations with younger age and higher baseline BMI. Neither caffeine nor coffee modified the association of adding sugar to any food or beverage with weight changes. CONCLUSIONS An increase in intake of unsweetened caffeinated and decaffeinated coffee was inversely associated with weight gain. The addition of sugar to coffee counteracted coffee's benefit for possible weight management. To the contrary, adding cream or coffee whitener was not associated with greater weight gain.
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Affiliation(s)
- Matthias Henn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; University of Navarra-IdiSNA (Instituto de Investigacion Sanitaria de Navarra), Department of Preventive Medicine and Public Health, Pamplona, Spain
| | - Andrea J Glenn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Miguel A Martínez-González
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; University of Navarra-IdiSNA (Instituto de Investigacion Sanitaria de Navarra), Department of Preventive Medicine and Public Health, Pamplona, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
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Wong ND, Sattar N. Cardiovascular risk in diabetes mellitus: epidemiology, assessment and prevention. Nat Rev Cardiol 2023; 20:685-695. [PMID: 37193856 DOI: 10.1038/s41569-023-00877-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/18/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Secular changes in CVD outcomes have occurred over the past few decades, mainly due to a decline in the incidence of ischaemic heart disease. The onset of T2DM at a young age (<40 years), leading to a greater number of life-years lost, has also become increasingly common. Researchers are now looking beyond established risk factors in patients with T2DM towards the role of ectopic fat and, potentially, haemodynamic abnormalities in mediating important outcomes (such as heart failure). T2DM confers a wide spectrum of risk and is not necessarily a CVD risk equivalent, indicating the importance of risk assessment strategies (such as global risk scoring, consideration of risk-enhancing factors and assessment of subclinical atherosclerosis) to inform treatment. Data from epidemiological studies and clinical trials demonstrate that successful control of multiple risk factors can reduce the risk of CVD events by ≥50%; however, only ≤20% of patients achieve targets for risk factor reduction (plasma lipid levels, blood pressure, glycaemic control, body weight and non-smoking status). Improvements in composite risk factor control with lifestyle management (including a greater emphasis on weight loss interventions) and evidence-based generic and novel pharmacological therapies are therefore needed when the risk of CVD is high.
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Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA.
| | - Naveed Sattar
- Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
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Yi J, Song G, Lin Z, Peng Y, Wu J. Validity and Reproducibility of Food Group-Based Food Frequency Questionnaires in Assessing Sugar-Sweetened Beverage Consumption Habits among Chinese Middle-School Students. Nutrients 2023; 15:3928. [PMID: 37764712 PMCID: PMC10537416 DOI: 10.3390/nu15183928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Assessing the intake of sugar-sweetened beverages (SSBs) is crucial for reducing obesity; however, a simple but relatively accurate method for determining added sugar consumption among school adolescents is lacking. The aim of this study was to evaluate the reproducibility and validity of a food group-based food frequency questionnaire (FG-FFQ) for SSBs in assessing SSB consumption and added sugar among middle-school students. A total of 242 school students completed the FG-FFQs twice and four discontinuous 24-h dietary records (24HDR) over a three-month period. A weighted average approach was used to obtain the average sugar content in the sugary drink food group (FG). Correlation coefficient, weighted kappa statistic, misclassification analysis, and Bland-Altman plot were used to evaluate the validity and reproducibility of the FG-FFQ. Linear regression was utilized to obtain the calibration formulas. The average content of added sugar in sugary drink FG was 8.1 g/100 mL. SSB consumption frequency, consumption amount, and added sugar had correlation coefficients of 0.81, 0.87, and 0.87, respectively, in the validity analysis (p < 0.05). The majority of scatter plots were covered by 95% confidence intervals in the Bland-Altman bias analysis. The intra-class correlation coefficient of SSB consumption frequency and Spearman correlation coefficient of SSB consumption amount and added sugar were 0.74, 0.81, and 0.90, respectively, in the reproducibility analysis (p < 0.05). Results produced by the FG-FFQ calibration formula were more comparable to 24HDR. The FG-FFQ for SSB consumption showed acceptable validity and reproducibility, making it a viable instrument for epidemiological studies on sugary drinks in adolescents.
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Affiliation(s)
- Junyao Yi
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (J.Y.); (G.S.)
| | - Guoye Song
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (J.Y.); (G.S.)
| | - Zhenghao Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
| | - Yuting Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
| | - Jieshu Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
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Dumith SC, Martins OPL, Moreira MKV, Paulitsch RG, Simões MO, Marmitt LP, Silva PEA, Silva MP. Is the increment of diabetes mellitus in Brazil associated with the consumption of artificially sweetened beverages? A time trend analysis with 757,386 adults from 2006 to 2020. Public Health 2023; 221:66-72. [PMID: 37421755 DOI: 10.1016/j.puhe.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To describe trends in the prevalence of diabetes mellitus (DM) in Brazil and to analyze its association with the consumption of artificially sweetened beverages among individuals aged 18 years or older. STUDY DESIGN This was a repeated cross-sectional study. METHODS Annual data from VIGITEL surveys (2006-2020) were used, which included adults from all Brazilian state capitals. The outcome was the prevalence of DM (type 1 and type 2). The main exposure variable was consuming beverages like soft drinks and artificial juices, either in its 'diet, light, or zero' form. Covariates included sex, age, sociodemographic characteristics, smoking, alcohol consumption, physical activity, fruit consumption, and obesity. The temporal trend in the indicators and the etiological fraction (population attributable risk [PAR]) were calculated. Analyses were performed using Poisson regression. The association between DM and consumption of beverages was tested, excluding the year 2020 due to the pandemic; restricting the analysis to the final three years (2018-2020). RESULTS Overall, 757,386 subjects were included. The prevalence of DM increased from 5.5% to 8.2%, with an annual growth of 0.17 percentage points (95% CI 0.11-0.24). Among those who consumed diet/light/zero beverages, the annual percentage change of DM was four times greater. The PAR corresponding to the consumption of diet/light/zero beverages on the occurrence of DM was 17%. CONCLUSIONS An increasing prevalence of DM was observed, while diet/light/zero beverages consumption remains stable. A substantial reduction in the annual percentage change of DM could be observed if people stopped consuming diet/light soda/juice.
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Affiliation(s)
- S C Dumith
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - O P L Martins
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M K V Moreira
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, CEP: 96020-220, Brazil
| | - R G Paulitsch
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M O Simões
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Universidade Vale do Rio Doce, Governador Valadares, MG, CEP: 35020-220, Brazil
| | - L P Marmitt
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Biosciences and Health, Universidade do Oeste de Santa Catarina, Joaçaba, SC, CEP: 89600-000, Brazil.
| | - P E A Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil
| | - M P Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
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11
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Ma L, Hu Y, Alperet DJ, Liu G, Malik V, Manson JE, Rimm EB, Hu FB, Sun Q. Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study. BMJ 2023; 381:e073406. [PMID: 37076174 PMCID: PMC10114037 DOI: 10.1136/bmj-2022-073406] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate the intake of specific types of beverages in relation to mortality and cardiovascular disease (CVD) outcomes among adults with type 2 diabetes. DESIGN Prospective cohort study. SETTING Health professionals in the United States. PARTICIPANTS 15 486 men and women with a diagnosis of type 2 diabetes at baseline and during follow-up (Nurses' Health Study: 1980-2018; and Health Professionals Follow-Up Study: 1986-2018). Beverage consumption was assessed using a validated food frequency questionnaire and updated every two to four years. MAIN OUTCOME MEASURES The main outcome was all cause mortality. Secondary outcomes were CVD incidence and mortality. RESULTS During an average of 18.5 years of follow-up, 3447 (22.3%) participants with incident CVD and 7638 (49.3%) deaths were documented. After multivariable adjustment, when comparing the categories of lowest intake of beverages with the highest intake, the pooled hazard ratios for all cause mortality were 1.20 (95% confidence interval 1.04 to 1.37) for sugar sweetened beverages (SSBs), 0.96 (0.86 to 1.07) for artificially sweetened beverages (ASBs), 0.98 (0.90 to 1.06) for fruit juice, 0.74 (0.63 to 0.86) for coffee, 0.79 (0.71 to 0.89) for tea, 0.77 (0.70 to 0.85) for plain water, 0.88 (0.80 to 0.96) for low fat milk, and 1.20 (0.99 to 1.44) for full fat milk. Similar associations were observed between the individual beverages and CVD incidence and mortality. In particular, SSB intake was associated with a higher risk of incident CVD (hazard ratio 1.25, 95% confidence interval 1.03 to 1.51) and CVD mortality (1.29, 1.02 to 1.63), whereas significant inverse associations were observed between intake of coffee and low fat milk and CVD incidence. Additionally, compared with those who did not change their consumption of coffee in the period after a diabetes diagnosis, a lower all cause mortality was observed in those who increased their consumption of coffee. A similar pattern of association with all cause mortality was also observed for tea, and low fat milk. Replacing SSBs with ABSs was significantly associated with lower all cause mortality and CVD mortality, and replacing SSBs, ASBs, fruit juice, or full fat milk with coffee, tea, or plain water was consistently associated with lower all cause mortality. CONCLUSIONS Individual beverages showed divergent associations with all cause mortality and CVD outcomes among adults with type 2 diabetes. Higher intake of SSBs was associated with higher all cause mortality and CVD incidence and mortality, whereas intakes of coffee, tea, plain water, and low fat milk were inversely associated with all cause mortality. These findings emphasize the potential role of healthy choices of beverages in managing the risk of CVD and premature death overall in adults with type 2 diabetes.
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Affiliation(s)
- Le Ma
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education of China, Xi'an, China
| | - Yang Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Derrick J Alperet
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Vasanti Malik
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Sun
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Li B, Yan N, Jiang H, Cui M, Wu M, Wang L, Mi B, Li Z, Shi J, Fan Y, Azalati MM, Li C, Chen F, Ma M, Wang D, Ma L. Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis. Front Nutr 2023; 10:1019534. [PMID: 37006931 PMCID: PMC10050372 DOI: 10.3389/fnut.2023.1019534] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionSugar-sweetened beverage (SSB) intake is associated with an increased risk of cardiometabolic diseases. However, evidence regarding associations of artificially sweetened beverages (ASBs) and fruit juices with cardiometabolic diseases is mixed. In this study, we aimed to investigate the association between the SSB, ASB and fruit juice consumption with the incidence of cardiometabolic conditions and mortality.MethodsRelevant prospective studies were identified by searching PubMed, Web of Science, Embase, and Cochrane Library until December 2022 without language restrictions. The pooled relative risk (RR) and 95% confidence intervals (CIs) were estimated for the association of SSBs, ASBs, and fruit juices with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and mortality by using random-effect models.ResultsA total of 72 articles were included in this meta-analysis study. Significantly positive associations were observed between the consumption of individual beverages and T2D risk (RR: 1.27; 95% CI: 1.17, 1.38 for SSBs; RR: 1.32; 95% CI: 1.11, 1.56 for ASBs; and RR:0.98; 95% CI: 0.93, 1.03 for fruit juices). Moreover, our findings showed that intakes of SSBs and ASBs were significantly associated with risk of hypertension, stroke, and all-cause mortality (RR ranging from 1.08 to 1.54; all p < 0.05). A dose-response meta-analysis showed monotonic associations between SSB intake and hypertension, T2D, coronary heart disease (CHD), stroke and mortality, and the linear association was only significant between ASB consumption and hypertension risk. Higher SSB and ASB consumptions were associated with a greater risk of developing cardiometabolic diseases and mortality. Fruit juice intake was associated with a higher risk of T2D.ConclusionTherefore, our findings suggest that neither ASBs nor fruit juices could be considered as healthier beverages alternative to SSBs for achieving improved health.Systematic Review Registration: [PROSPERO], identifier [No. CRD42022307003].
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Affiliation(s)
- Baoyu Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Ni Yan
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Hong Jiang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Meng Cui
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Min Wu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Lina Wang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Baibing Mi
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Zhaofang Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jia Shi
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yahui Fan
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | | | - Chao Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Fangyao Chen
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Mao Ma
- The First Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
| | - Le Ma
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education of China, Xi’an, China
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
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An HJ, Kim Y, Seo YG. Relationship between Coffee, Tea, and Carbonated Beverages and Cardiovascular Risk Factors. Nutrients 2023; 15:934. [PMID: 36839290 PMCID: PMC9966641 DOI: 10.3390/nu15040934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
We aimed to analyze the relationship between coffee, tea, and carbonated beverages and cardiovascular risk factors. We used data from the fourth to eighth Korea National Health and Nutrition Examination Surveys (2007-2016, 2019-2020). We categorized the frequency of intake into three groups (<1 time/week, 1 time/week to <1 time/day, and ≥1 time/day). Subsequently, logistic regression analyses by sex were performed to assess cardiovascular risk factors (hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DL), or metabolic syndrome (MetS)) according to the frequency of coffee, tea, and carbonated beverage intake. For HTN, coffee intake showed an inverse relationship and tea intake showed a direct relationship. For DM, coffee intake showed an inverse relationship, and tea and carbonated beverage intake showed a direct relationship. For DL, coffee intake showed an inverse relationship, whereas tea intake demonstrated a direct relationship. In addition, carbonated beverage intake showed a direct relationship with MetS. Coffee intake showed an inverse relationship with HTN, DM, and DL. However, tea intake showed a direct relationship with HTN, DM, and DL, whereas carbonated beverage intake showed a direct relationship with DM and MetS.
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Affiliation(s)
| | | | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Gyeonggi-do, Republic of Korea
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Gillespie KM, Kemps E, White MJ, Bartlett SE. The Impact of Free Sugar on Human Health-A Narrative Review. Nutrients 2023; 15:889. [PMID: 36839247 PMCID: PMC9966020 DOI: 10.3390/nu15040889] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.
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Affiliation(s)
- Kerri M. Gillespie
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Eva Kemps
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA 5042, Australia
| | - Melanie J. White
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Selena E. Bartlett
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
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Association between Sugar-Sweetened Beverage Consumption and the Risk of the Metabolic Syndrome: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15020430. [PMID: 36678301 PMCID: PMC9912256 DOI: 10.3390/nu15020430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: The increasing occurrence of the metabolic syndrome (MetS) is largely related to harmful food habits. Among them, the consumption of sugar-sweetened beverages (SSBs) is noteworthy. However, to our knowledge, there are not enough high-quality methodological studies summarizing the association between the intake of SSBs and the MetS. Therefore, the aim of this study is to examine the existing published results on this association among adults by synthesizing the existing evidence. (2) Methods: Systematic review and meta-analysis of observational studies following the PRISMA guidelines. Relevant information was extracted and presented following the PRISMA recommendations. PubMed and SCOPUS databases were searched for studies published until June 2022 that assessed the association between SSB consumption (including soft drinks, bottled fruit juices, energy drinks, and milkshakes) and the occurrence of MetS. Random effect models were used to estimate pooled odds ratios (ORs) with their 95% coefficient interval, and I2 was used to assess heterogeneity. (3) Results: A total of 14 publications from 6 different countries were included in this meta-analysis (9 cross-sectional and 5 cohort studies). For the cross-sectional studies, which included 62,693 adults, the pooled OR for the risk of MetS was 1.35 (95% CI 1.15, 1.58; I2 57%) when the highest versus the lowest categories of SSB consumption were compared. For the cohort studies, which included 28,932 adults, the pooled OR was 1.18 (95% CI 1.06, 1.32; I2 70%). (4) Conclusions: The consumption of SSBs was positively associated with an increased risk of MetS. The published literature supports public health strategies and the need to reduce the consumption of SSBs to prevent MetS.
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16
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Bayram HM, Ozturkcan A. Intake and risk assessment of nine priority food additives in Turkish adults. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2022.104710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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LaRose JG, Reading JM, Lanoye A, Brown KL. Recruitment and retention of emerging adults in lifestyle interventions: Findings from the REACH trial. Contemp Clin Trials 2022; 121:106904. [PMID: 36055582 PMCID: PMC10430794 DOI: 10.1016/j.cct.2022.106904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Emerging adulthood (EA) is a critical time to promote cardiometabolic health, but EAs are underrepresented in lifestyle intervention trials. Knowledge gaps exist regarding how best to recruit and retain sociodemographically diverse EAs. Our goal was to begin to address these gaps using data from the Richmond Emerging Adults Choosing Health (REACH) Trial. METHODS REACH was a comparative efficacy trial for EAs, age 18-25, with a body mass index of 25-45 kg/m2. Enrollment goals were: N = 381, ≥40% underrepresented race/ethnicity, ≥30% men, ≥85% retention at 6 months. We translated formative work into a recruitment and retention plan, examined yield for recruitment and retention overall, and by gender and race/ethnicity, as well as cost data. Descriptive statistics and chi square tests were used. RESULTS Enrollment benchmarks were met overall (N = 382) and for participants from underrepresented race/ethnic backgrounds (58.0%), but not men (17.3%). The most common recruitment sources were email (26.9%), radio (22.2%), and online radio (15.4%); this pattern largely held true across gender and race/ethnic groups, though word of mouth and participant referral together accounted for nearly a quarter of enrolled men. Costs averaged $155 per randomized participant. Retention was 89% at 3-months, 84% at 6-months (primary endpoint) and 80% at 12-months (follow-up), with no significant differences by gender or race/ethnicity (all p's > 0.05). Retention did not differ by recruitment method (p = .69). CONCLUSIONS Grounding our approach in formative data and embracing participants as partners in research contributed to the recruitment and retention of sociodemographically diverse EAs. Additional efforts are needed to enroll EA men.
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Affiliation(s)
| | - Jean M Reading
- Virginia Commonwealth University School of Medicine, USA
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, USA; VCU Massey Cancer Center, USA
| | - Kristal Lyn Brown
- Virginia Commonwealth University School of Medicine, USA; The Johns Hopkins University School of Medicine, USA
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18
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Luo Y, He L, Ma T, Li J, Bai Y, Cheng X, Zhang G. Associations between consumption of three types of beverages and risk of cardiometabolic multimorbidity in UK Biobank participants: a prospective cohort study. BMC Med 2022; 20:273. [PMID: 35978398 PMCID: PMC9386995 DOI: 10.1186/s12916-022-02456-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although the association between beverages and a single cardiometabolic disease has been well studied, their role in disease progression from the single cardiometabolic disease state to cardiometabolic multimorbidity (CMM) state remains unclear. This study examined the associations between three types of beverages: sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and pure fruit/vegetable juices, and the incidence of CMM in patients with a single cardiometabolic disease. METHODS Our analysis included 37,994 participants from the UK Biobank who completed at least one dietary questionnaire and were diagnosed with only one cardiometabolic disease at the time of recruitment. Competing risk models were used to examine the association between the three types of beverages and incidence of CMM. We conducted analysis both in patients with any single cardiometabolic disease and in patients with specific cardiometabolic disease. RESULTS During a median follow-up of 9.1 years (interquartile range [IQR] 9.0-9.8), a total of 6399 participants developed CMM. The consumption of SSBs and ASBs (>1 serving per day) was associated with a higher risk of CMM (SSBs: hazard ratio [HR] 1.19, 95% confidence interval [95% CI] 1.08-1.31; ASBs: HR 1.15, 95% CI 1.04-1.27). Intake of pure fruit/vegetable juices was inversely associated with the incidence of CMM (0-1 serving per day: HR 0.90, 95% CI 0.85-0.94; >1 serving per day: HR 0.90, 95% CI 0.81-0.99). However, the association of the high-level consumption of pure fruit/vegetable juices (>1 serving per day) was not statistically significant after correcting for multiple testing. In the analysis of patients with specific cardiometabolic diseases, positive associations were observed in patients with hypertension for SSBs consumption, while inverse associations persisted in patients with cardiovascular disease (coronary heart disease or stroke) and in hypertensive patients for pure fruit/vegetable juice consumption. CONCLUSIONS Consuming >1 serving of SSBs and ASBs per day was associated with a higher risk of CMM in patients with a single cardiometabolic disease. In contrast, intake of pure fruit/vegetable juices was inversely associated with the risk of CMM. Our findings highlight the need to limit the use of SSBs and ASBs in patients with a single cardiometabolic disease.
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Affiliation(s)
- Yi Luo
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.,Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Guogang Zhang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China. .,Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.
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19
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Santos LP, Gigante DP, Delpino FM, Maciel AP, Bielemann RM. Sugar sweetened beverages intake and risk of obesity and cardiometabolic diseases in longitudinal studies: A systematic review and meta-analysis with 1.5 million individuals. Clin Nutr ESPEN 2022; 51:128-142. [DOI: 10.1016/j.clnesp.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
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20
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Liu D, Li ZH, Shen D, Zhang PD, Song WQ, Zhang WT, Huang QM, Chen PL, Zhang XR, Mao C. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study. Ann Intern Med 2022; 175:909-917. [PMID: 35635846 DOI: 10.7326/m21-2977] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous observational studies have suggested an association between coffee intake and reduced risk for death, but these studies did not distinguish between coffee consumed with sugar or artificial sweeteners and coffee consumed without. OBJECTIVE To evaluate the associations of consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee with all-cause and cause-specific mortality. DESIGN Prospective cohort study. SETTING Data were extracted from the UK Biobank. PARTICIPANTS A total of 171 616 participants (mean age, 55.6 years [SD, 7.9]) without cardiovascular disease (CVD) or cancer at baseline were eligible. Baseline demographic, lifestyle, and dietary data from the UK Biobank were used, with follow-up beginning in 2009 and ending in 2018. MEASUREMENTS Dietary consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee was self-reported. All-cause, cancer-related, and CVD-related mortality were estimated. RESULTS During a median follow-up of 7.0 years, 3177 deaths were recorded (including 1725 cancer deaths and 628 CVD deaths). Cox models with penalized splines showed U-shaped associations of unsweetened coffee, sugar-sweetened coffee, and artificially sweetened coffee with mortality. Compared with nonconsumers, consumers of various amounts of unsweetened coffee (>0 to 1.5, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/d) had lower risks for all-cause mortality after adjustment for lifestyle, sociodemographic, and clinical factors, with respective hazard ratios of 0.79 (95% CI, 0.70 to 0.90), 0.84 (CI, 0.74 to 0.95), 0.71 (CI, 0.62 to 0.82), 0.71 (CI, 0.60 to 0.84), and 0.77 (CI, 0.65 to 0.91); the respective estimates for consumption of sugar-sweetened coffee were 0.91 (CI, 0.78 to 1.07), 0.69 (CI, 0.57 to 0.84), 0.72 (CI, 0.57 to 0.91), 0.79 (CI, 0.60 to 1.06), and 1.05 (CI, 0.82 to 1.36). The association between artificially sweetened coffee and mortality was less consistent. The association of coffee drinking with mortality from cancer and CVD was largely consistent with that with all-cause mortality. U-shaped associations were also observed for instant, ground, and decaffeinated coffee. LIMITATION Exposure assessed at baseline might not capture changes in intake over time. CONCLUSION Moderate consumption of unsweetened and sugar-sweetened coffee was associated with lower risk for death. PRIMARY FUNDING SOURCE National Natural Science Foundation of China, Young Elite Scientist Sponsorship Program by CAST, and Project Supported by Guangdong Basic and Applied Basic Research Foundation.
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Affiliation(s)
- Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, and Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China (D.L.)
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Wei-Qi Song
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Wen-Ting Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Qing-Mei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (Z.L., D.S., P.Z., W.S., W.Z., Q.H., P.C., X.Z.)
| | - Chen Mao
- Department of Epidemiology, School of Public Health, and Department of Laboratory Medicine, Microbiome Medicine Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China (C.M.)
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21
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Santoso P, Maliza R, Octavian R, Rita RS. Dietary fiber of jicama ( Pachyrhizus erosus L) tuber exerts hepatoprotective effect against high-sugar drinks in mice. JOURNAL OF HERBMED PHARMACOLOGY 2022. [DOI: 10.34172/jhp.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Jicama (Pachyrhizus erosus, family Fabaceae) is a potent medicinal plant. Although extensive studies report the health benefits of jicama extract, few studies have investigated the efficacy of its dietary fiber in preventing metabolic diseases, including liver disease. The present study aimed to elucidate whether dietary fiber obtained from the jicama tuber counteracts the development of liver disease induced by high-sugar drinks. Methods: Twenty-four adult male mice (DDY strain; 2 months old with bodyweight 22-25 g) were randomized into three groups: normal drink (ND), fed with tap water and standard chow; high-sucrose drink (HSD), fed with a high-sucrose drink and standard chow; and high-sucrose drink plus standard chow with 25% jicama fiber (HSD + JF 25%). After the mice were on their respective diets for ten weeks, the following parameters were measured: body weight, liver weight, malondialdehyde (MDA), histopathological alterations, blood glucose, and serum glutamate-pyruvate transaminase (SGPT). Results: Mice in the HSD + JF 25% group had significantly lower body weight (P < 0.01), liver weight (P<0.05), MDA (P<0.01), blood glucose (P<0.01), and SGPT (P<0.01) compared to those in the HSD group. They also had fewer histopathological alterations in the liver, as demonstrated by a lower proportion of degenerated cells and an overall lower histopathological score than those in the HSD group (P<0.05). Conclusion: Adding jicama fiber (25% of standard chow) mitigates the increase in blood glucose and body weight and histopathological changes in the liver induced by high-sucrose drinks, showing liver protective activity.
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Affiliation(s)
- Putra Santoso
- Biology Department, Faculty of Mathematics and Natural Sciences, Andalas University, Padang West Sumatra 25163, Indonesia
| | - Rita Maliza
- Biology Department, Faculty of Mathematics and Natural Sciences, Andalas University, Padang West Sumatra 25163, Indonesia
| | - Riski Octavian
- Biology Department, Faculty of Mathematics and Natural Sciences, Andalas University, Padang West Sumatra 25163, Indonesia
| | - Rauza Sukma Rita
- Biochemistry Department, Faculty of Medicine, Andalas University, Padang West Sumatra 25163 Indonesia
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22
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Yan RR, Chan CB, Louie JCY. Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence. Am J Clin Nutr 2022; 116:15-39. [PMID: 35380611 PMCID: PMC9307988 DOI: 10.1093/ajcn/nqac084] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/01/2022] [Indexed: 01/15/2023] Open
Abstract
Sugar is widely consumed over the world. Although the mainstream view is that high added or free sugar consumption leads to obesity and related metabolic diseases, controversies exist. This narrative review aims to highlight important findings and identify major limitations and gaps in the current body of evidence in relation to the effect of high sugar intakes on health. Previous animal studies have shown that high sucrose or fructose consumption causes insulin resistance in the liver and skeletal muscle and consequent hyperglycemia, mainly because of fructose-induced de novo hepatic lipogenesis. However, evidence from human observational studies and clinical trials has been inconsistent, where most if not all studies linking high sugar intake to obesity focused on sugar-sweetened beverages (SSBs), and studies focusing on sugars from solid foods yielded null findings. In our opinion, the substantial limitations in the current body of evidence, such as short study durations, use of supraphysiological doses of sugar or fructose alone in animal studies, and a lack of direct comparisons of the effects of solid compared with liquid sugars on health outcomes, as well as the lack of appropriate controls, seriously curtail the translatability of the findings to real-world situations. It is quite possible that "high" sugar consumption at normal dietary doses (e.g., 25% daily energy intake) per se-that is, the unique effect of sugar, especially in the solid form-may indeed not pose a health risk for individuals apart from the potential to reduce the overall dietary nutrient density, although newer evidence suggests "low" sugar intake (<5% daily energy intake) is just as likely to be associated with nutrient dilution. We argue the current public health recommendations to encourage the reduction of both solid and liquid forms of free sugar intake (e.g., sugar reformulation programs) should be revised due to the overextrapolation of results from SSBs studies.
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Affiliation(s)
- Rina Ruolin Yan
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chi Bun Chan
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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23
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Bayram HM, Ozturkcan A. Added sugars and non-nutritive sweeteners in the food supply: Are they a threat for consumers? Clin Nutr ESPEN 2022; 49:442-448. [DOI: 10.1016/j.clnesp.2022.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/26/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
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24
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Powell LM, Leider J. Impact of the Seattle Sweetened Beverage Tax on substitution to alcoholic beverages. PLoS One 2022; 17:e0262578. [PMID: 35041717 PMCID: PMC8765634 DOI: 10.1371/journal.pone.0262578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Taxes are increasingly used as a policy tool aimed at reducing consumption of sugar-sweetened beverages (SSBs), given their association with adverse health outcomes including type 2 diabetes, obesity and cardiovascular disease. However, a potential unintended consequence of such a policy could be that the tax induces substitution to alcoholic beverages. The purpose of this study is to examine the impact of the $0.0175 per ounce Seattle, Washington, Sweetened Beverage Tax (SBT) on volume sold of alcoholic beverages. METHODS A difference-in-differences estimation approach was used drawing on universal product code-level food store scanner data on beer (N = 1059) and wine (N = 2655) products one-year pre-tax (February-November, 2017) and one and two-years post-tax (February-November, 2018 and 2019) with Portland, Oregon, as the comparison site. RESULTS At two-years post-tax implementation, volume sold of beer in Seattle relative to Portland increased by 7% (ratio of incidence rate ratios [RIRR] = 1.07, 95% CI:1.00,1.15), whereas volume sold of wine decreased by 3% (RIRR = 0.97, 95% CI:0.95,1.00). Overall alcohol (both beer and wine) volume sold increased in Seattle compared to Portland by 4% (RIRR = 1.04, 95% CI:1.01,1.07) at one-year post-tax and by 5% (RIRR = 1.05, 95% CI:1.00,1.10) at two-years post-tax. The implied SSB cross-price elasticities of demand for beer and wine, respectively, were calculated to be 0.35 and -0.15. CONCLUSIONS There was evidence of substitution to beer following the implementation of the Seattle SSB tax. Continued monitoring of potential unintended outcomes related to the implementation of SSB taxes is needed in future tax evaluations.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
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25
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S60-S82. [PMID: 34964866 DOI: 10.2337/dc22-s005] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Impact of a sugar-sweetened beverage tax two-year post-tax implementation in Seattle, Washington, United States. J Public Health Policy 2021; 42:574-588. [PMID: 34732842 DOI: 10.1057/s41271-021-00308-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
This study examines longer-run impacts of the Seattle, Washington, Sweetened Beverage Tax (SBT) on beverage prices, volume sold, and cross-border shopping. We use a difference-in-differences estimation approach, drawing on universal product code-level store scanner data on taxed and untaxed beverages one-year pre-tax and two-year post-tax with Portland, Oregon, as the comparison site. Two-year post-tax, prices of taxed beverages increased by 1.04 cents per ounce (59% tax pass-through rate). Volume sold of taxed beverages fell by 22%. Declines were larger for family-size (29%) compared to individual-size (10%) beverages; particularly for soda (36% decrease for family-size compared to no change for individual-size). We found no change in volume sold of taxed beverages in Seattle's 2-mile border area, suggesting no cross-border shopping. Overall, we found a sustained impact of the Seattle SBT two-year post-tax implementation suggesting that sugar-sweetened beverage taxes may yield permanent reductions in demand for sugary beverages and associated health harms.
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Tseng TS, Lin WT, Gonzalez GV, Kao YH, Chen LS, Lin HY. Sugar intake from sweetened beverages and diabetes: A narrative review. World J Diabetes 2021; 12:1530-1538. [PMID: 34630905 PMCID: PMC8472506 DOI: 10.4239/wjd.v12.i9.1530] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the fastest growing public health concerns around the world. Sugar-sweetened beverage (SSB) consumption has been proven to be associated with adverse health consequences in the diabetic population. Reducing SSB consumption, body weight control, healthy diets, and increased physical activity have been suggested as strategies to improve diabetes prevention and management. This literature review provides an overview of: (1) The association between SSB consumption and the risk of T2DM; (2) Types of SSB consumption and T2DM; (3) The effect of obesity and inflammation on the association between SSB consumption and risk of T2DM; and (4) SSB consumption in T2DM patients. There is still work to be done to determine how SSB consumption is related to T2DM, but the current research on identifying the association between SSB consumption and T2DM is promising, with the most promising studies confirming the connection between SSBs, T2DM risk, and diabetes management. Future studies should explore more effective SSB related diabetes prevention and management interventions.
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Affiliation(s)
- Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Wei-Ting Lin
- Department of Global Community Health and Behavioral Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, United States
| | - Gabrielle V Gonzalez
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Yu-Hsiang Kao
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
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28
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Wang CW, Chen DR. Associations of sugar-sweetened beverage knowledge, self-efficacy, and perceived benefits and barriers with sugar-sweetened beverage consumption in adolescents: A structural equation modeling approach. Appetite 2021; 168:105663. [PMID: 34455023 DOI: 10.1016/j.appet.2021.105663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022]
Abstract
This study was performed to investigate the predictors of sugar-sweetened beverage (SSB) consumption in adolescents, including knowledge of SSBs, self-efficacy, and perceived benefits and barriers, using the structural equation modeling approach. This cross-sectional study was conducted from March to June 2019 in New Taipei City, Taiwan. The participants were 633 adolescents from 23 classes at three junior high schools in New Taipei City. A structured self-administered questionnaire was developed for data collection. The overall model predicted SSB consumption well, suggesting that SSB consumption was associated with self-efficacy and perceived barriers and benefits. Self-efficacy was the strongest predictor of SSB consumption. Both perceived barriers and self-efficacy sequentially and fully mediated the effect of knowledge on SSB consumption. This study confirms that self-efficacy is associated with SSB intake in both male and female adolescents. However, knowledge of SSBs was not associated with SSB consumption. Relying on nutritional education alone may not be adequate to change SSB consumption. The results suggest that future health promotion programs should improve self-efficacy to decrease SSB consumption in adolescents.
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Affiliation(s)
- Chia-Wen Wang
- Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei, 10055, Taiwan
| | - Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei, 10055, Taiwan.
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Léger PT, Powell LM. The impact of the Oakland SSB tax on prices and volume sold: A study of intended and unintended consequences. HEALTH ECONOMICS 2021; 30:1745-1771. [PMID: 33931915 DOI: 10.1002/hec.4267] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
We examine the effects of a sugar-sweetened beverage (SSB) tax that took effect in Oakland, California in 2017. Using rich customized universal product code -level data, we estimate the effect of the SSB tax on prices and volume in the short to medium term in a difference-in-differences framework. We pay particular attention to tax-avoidance strategies that may minimize the policy's intended effect including: (i) transfers to SSBs to the nontaxed border area (i.e., cross-border shopping), (ii) a move from high-priced per ounce single serve to their cheaper multipacks or larger format counterparts (i.e., format switching), and (iii) a move from high-priced beverages to less expensive ones within a category and format (i.e., brand switching). We find that the year-over-year tax pass-through is 49%. We find that volume sold of taxed beverages fell by 14%, but 46% of this decrease is offset with an increase in the border area. We also find evidence of substitution to lower-priced taxed beverages but no evidence of switching to cheaper formats. Finally, we find important dynamic effects with respect to tax pass-through, volume sold and cross-border shopping.
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Affiliation(s)
- Pierre Thomas Léger
- Health Policy and Administration, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lisa M Powell
- Health Policy and Administration, University of Illinois Chicago, Chicago, Illinois, USA
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Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y. Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients 2021; 13:2636. [PMID: 34444794 PMCID: PMC8402166 DOI: 10.3390/nu13082636] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15-1.41, I2 = 80.8%) and 13% (95%CI: 1.03-1.25, I2 = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07-1.12, I2 = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04-1.11, I2 = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97-1.26, I2 = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91-1.25, I2 = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality.
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Affiliation(s)
- Yantong Meng
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Siqi Li
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Jabir Khan
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Zijian Dai
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Chang Li
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Xiaosong Hu
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Qun Shen
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
- Key Laboratory of Plant Protein and Grain Processing, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Yong Xue
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
- Key Laboratory of Plant Protein and Grain Processing, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
- Xinghua Industrial Research Centre for Food Science and Human Health, China Agricultural University, Xinghua 225700, China
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Ruxton CHS, Myers M. Fruit Juices: Are They Helpful or Harmful? An Evidence Review. Nutrients 2021; 13:nu13061815. [PMID: 34071760 PMCID: PMC8228760 DOI: 10.3390/nu13061815] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Dietary guidelines often deal with 100% fruit juice (FJ) inconsistently because it represents a source of free sugars. However, FJ also provides bioavailable micronutrients and plant bioactives at levels similar to those found in whole fruits. The present review weighs up the evidence from high-quality studies investigating a potential health harm for FJ against evidence from studies which indicate a potential health benefit. The findings reveal that FJ consumption, at moderate intakes consistent with the dietary guidelines for the US and some European countries (75-224 mL daily), does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycaemic control. In contrast, regular consumption of FJ-even up to 500 mL per day in short-to-medium-term studies-appears to confer a health benefit in terms of vascular function and reduced blood pressure. Emerging evidence for cognitive health benefits requires further investigation in human trials. Observational studies report associations between FJ and nutrient adequacy and suggest that FJ consumption is associated with reduced risk of stroke. In conclusion, FJ appears to offer more benefit than risk and there appears to be no justification for discouraging FJ within a balanced diet for children and adults.
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Affiliation(s)
- Carrie H. S. Ruxton
- Nutrition Communications, East Road, Cupar KY15 4HQ, UK
- Correspondence: ; Tel.: +44-7973-337757
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Leider J, Li Y, Powell LM. Pass-through of the Oakland, California, sugar-sweetened beverage tax in food stores two years post-implementation: A difference-in-differences study. PLoS One 2021; 16:e0244884. [PMID: 33395444 PMCID: PMC7781485 DOI: 10.1371/journal.pone.0244884] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Taxes on sugar-sweetened beverages (SSBs) have gained support as a policy response to adverse health effects associated with SSB consumption. On July 1, 2017, Oakland, California, implemented a one-cent/ounce tax on SSBs with ≥25 calories/12 fluid ounces. This study estimated the long-term impact of the tax on taxed and untaxed beverage prices. METHODS Data on 5,830 taxed and 5,146 untaxed beverage prices were obtained from 99 stores in Oakland and 111 stores in Sacramento (comparison site), California, in late May-June 2017 and June 2019. Linear regression difference-in-differences models were computed with store and product fixed effects, with robust standard errors clustered on store, weighted based on volume sold by beverage sweetener status, type, and size. RESULTS Taxed beverage prices increased by 0.73 cents/ounce (95% CI = 0.47,1.00) on average in supermarkets and grocery stores in Oakland relative to Sacramento and 0.74 cents/ounce (95% CI = 0.39,1.09) in pharmacies, but did not change in convenience stores (-0.09 cents/ounce, 95% CI = -0.56,0.39). Untaxed beverage prices overall increased by 0.40 cents/ounce (95% CI = 0.05,0.75) in pharmacies but did not change in other store types. Prices of taxed individual-size soda specifically increased in all store types, by 0.91-2.39 cents/ounce (p<0.05), as did prices of untaxed individual-size soda in convenience stores (0.79 cents/ounce, 95% CI = 0.01,1.56) and pharmacies (1.66 cents/ounce, 95% CI = 0.09,3.23). CONCLUSIONS Two years following SSB tax implementation, there was partial tax pass-through with differences by store type and by beverage type and size within store type.
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Affiliation(s)
- Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Yu Li
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lisa M. Powell
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S53-S72. [PMID: 33298416 DOI: 10.2337/dc21-s005] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Abstract
PURPOSE OF REVIEW We have focused on recent research relevant to effects of dietary patterns and major food groups on cardiovascular outcomes, taking into account guidelines and position statements from expert authorities, with an emphasis on important changes in recommendations, some of which remain controversial. RECENT FINDINGS Major findings include: refocusing on qualitative patterns of food consumption replacing quantitative prescriptive advice on nutrients; increasing intake of plant foods; substituting saturated fats with polyunsaturated and monounsaturated oils; reducing salt intake; regular consumption of fish with a focus on omega-3 enrichment; not restricting dairy foods, other than butter and cream, with encouragement of some fermented products; reducing cholesterol intake for those at increased cardiovascular risk and diabetes, allowing 7-eggs weekly; restricting processed meats and allowing moderate lean meat consumption; preference for fiber-rich complex carbohydrates and reduced sugar intake; maintaining healthy bodyweight; and although water is the preferred beverage, allowing moderate alcohol consumption to national guidelines and avoiding alcohol in specific cardiovascular disorders. SUMMARY The new approach that focuses on healthier patterns of food intake is more readily understood by health practitioners and translatable to consumers and patients.
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Affiliation(s)
| | | | - Trevor A Mori
- Medical School, University of Western Australia, Perth, Australia
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Powell LM, Leider J. Evaluation of Changes in Beverage Prices and Volume Sold Following the Implementation and Repeal of a Sweetened Beverage Tax in Cook County, Illinois. JAMA Netw Open 2020; 3:e2031083. [PMID: 33369659 PMCID: PMC7770557 DOI: 10.1001/jamanetworkopen.2020.31083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. OBJECTIVES To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. DESIGN, SETTING, AND PARTICIPANTS This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. EXPOSURES Implementation and repeal of the Cook County SBT. MAIN OUTCOMES AND MEASURES Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. RESULTS The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (β = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (β = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. CONCLUSIONS AND RELEVANCE This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago
- Institute for Health Research and Policy, University of Illinois Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago
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Nestel PJ, Beilin LJ, Clifton PM, Watts GF, Mori TA. Practical Guidance for Food Consumption to Prevent Cardiovascular Disease. Heart Lung Circ 2020; 30:163-179. [PMID: 33158734 DOI: 10.1016/j.hlc.2020.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
This dietary guidance, informed by best contemporary evidence, aims to assist medical practitioners and allied health professionals in advising patients for the primary and secondary prevention of cardiovascular disease (CVD). While differing in some details from other current guidelines, the core messages accord with those published in 2019 by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Atherosclerosis Society; the National Lipid Association in 2014 and the NH&MRC Australian Dietary Guidelines in 2013. These were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II) and the levels of evidence and classes of a recommendation developed using the GRADE system. Recommendations with high levels of evidence include increased consumption of plant based foods comprising mainly complex, fibre enriched carbohydrates (wholegrains, fruits and vegetables) while limiting intake of refined starches; partial replacement of saturated fats with monounsaturated or polyunsaturated fats and oils; reduced salt intake; achievement and maintenance of healthy weight; and low-to-moderate consumption of alcohol. Additional guidance but with moderate levels of evidence includes increased consumption of fish (and fish oils where indicated); reduction in sugar-sweetened beverages and added sugars; avoidance of butter and cream especially in those at increased CVD risk but encouragement of yoghurt; allow moderate consumption of lean meat but limit intake of processed meats; and limit cholesterol-rich foods such as eggs and crustaceans for those at increased CVD risk. Guidance has been formulated qualitatively on food categories of commonly eaten foods while avoiding prescriptive quantitative measures that are less readily translatable. This approach accords with current guidelines such as the American College of Cardiology/American Heart Association 2019 guidelines and is understandable and readily implemented.
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Affiliation(s)
- Paul J Nestel
- Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.
| | - Lawrence J Beilin
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gerald F Watts
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, WA, Australia
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Gao (高静伟) JW, Hao (郝卿鋆) QY, Zhang (张海峰) HF, Li (李雄志) XZ, Yuan (袁智敏) ZM, Guo (郭颖) Y, Wang (王景峰) JF, Zhang (张少玲) SL, Liu (刘品明) PM. Low-Carbohydrate Diet Score and Coronary Artery Calcium Progression: Results From the CARDIA Study. Arterioscler Thromb Vasc Biol 2020; 41:491-500. [PMID: 33115269 PMCID: PMC7752248 DOI: 10.1161/atvbaha.120.314838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Supplemental Digital Content is available in the text. To investigate whether low-carbohydrate diets (LCDs) were associated with coronary artery calcium (CAC) progression.
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Affiliation(s)
- Jing-Wei Gao (高静伟)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Yun Hao (郝卿鋆)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Feng Zhang (张海峰)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiong-Zhi Li (李雄志)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Min Yuan (袁智敏)
- Department of Clinical Nutrition (Z.-M.Y.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Guo (郭颖)
- Department of Endocrinology (Y.G., S.-L.Z.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing-Feng Wang (王景峰)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shao-Ling Zhang (张少玲)
- Department of Endocrinology (Y.G., S.-L.Z.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu (刘品明)
- Department of Cardiology (J.-W.G., Q.-Y.H., H.-F.Z., X.-Z.L., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Ebbeling CB, Feldman HA, Steltz SK, Quinn NL, Robinson LM, Ludwig DS. Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e015668. [PMID: 32696704 PMCID: PMC7792240 DOI: 10.1161/jaha.119.015668] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background A 2018 American Heart Association science advisory indicated that, pending further research, artificially sweetened beverages (ASBs) may be an appropriate initial replacement for sugar‐sweetened beverages (SSBs) during transition to unsweetened beverages (USBs). Methods and Results We randomly assigned 203 adults (121 males, 82 females; 91.6% retention), who habitually consumed SSBs, to 3 groups and delivered free SSBs, ASBs, or USBs to their homes for 12 months. Outcomes included serum triglyceride to high‐density lipoprotein cholesterol ratio (primary), body weight, and sweet taste preference (experimental assessment, 0%–18% sucrose solutions). Change in serum triglyceride to high‐density lipoprotein cholesterol ratio was not different between groups. Although overall change in weight also was not different between groups, we found effect modification (P=0.006) by central adiposity. Among participants in the highest tertile of baseline trunk fat but not other tertiles, weight gain was greater (P=0.002) for the SSB (4.4±1.0 kg, estimate±SE) compared with ASB (0.5±0.9 kg) or USB (−0.2±0.9 kg) group. Both sweetness threshold (–1.0±0.2% m/v; P=0.005) and favorite concentration (–2.3±0.4% m/v; P<0.0001) decreased in the USB group; neither changed in the SSB group. In the ASB group, sweetness threshold did not change, and favorite concentration decreased (–1.1±0.5% m/v; P=0.02). Pairwise comparison between the ASB and USB groups indicated a difference in sweetness threshold (P=0.015). Conclusions Replacing SSBs with noncaloric beverages for 12 months did not affect serum triglyceride to high‐density lipoprotein cholesterol ratio. Among individuals with central adiposity, replacing SSBs with either ASBs or USBs lowered body weight. However, USBs may have the most favorable effect on sweet taste preference. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01295671.
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Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston MA
| | - Sarah K Steltz
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
| | - Nicolle L Quinn
- Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston MA
| | | | - David S Ludwig
- New Balance Foundation Obesity Prevention Center Boston Children's Hospital Boston MA
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Qin P, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M. Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol 2020; 35:655-671. [PMID: 32529512 DOI: 10.1007/s10654-020-00655-y] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/06/2020] [Indexed: 12/20/2022]
Abstract
Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose-response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose-response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose-response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05-1.19, I2 = 67.7%) and 21% (RR = 1.21, 95% CI 1.09-1.35, I2 = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13-1.25, I2 = 82.4%) and 15% (RR = 1.15, 95% CI 1.05-1.26, I2 = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06-1.14, I2 = 58.4%) and 8% (RR = 1.08, 95% CI 1.06-1.10, I2 = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01-1.07, I2 = 58.0%) and 6% (RR = 1.06, 95% CI 1.02-1.10, I2 = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity (Pnon-linearity = 0.359), T2DM (Pnon-linearity = 0.706), hypertension (Pnon-linearity = 0.510) and all-cause mortality (Pnon-linearity = 0.259). For ASBs, we found linear associations with risk of obesity (Pnon-linearity = 0.299) and T2DM (Pnon-linearity = 0.847) and non-linear associations with hypertension (Pnon-linearity = 0.019) and all-cause mortality (Pnon-linearity = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.
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Affiliation(s)
- Pei Qin
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
| | - Quanman Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Qing Chen
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xizhuo Sun
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yu Liu
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Honghui Li
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Tieqiang Wang
- Key Lab of Epidemiology, Department of Infectious Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, People's Republic of China
| | - Xiaoliang Chen
- Key Lab of Epidemiology, Department of Infectious Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, People's Republic of China
| | - Qionggui Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
| | - Chunmei Guo
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dongdong Zhang
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Gang Tian
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dechen Liu
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Ranran Qie
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Minghui Han
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Shengbing Huang
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiaoyan Wu
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yang Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
| | - Yifei Feng
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Xingjin Yang
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China.
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Powell LM, Leider J. The impact of Seattle's Sweetened Beverage Tax on beverage prices and volume sold. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100856. [PMID: 32070906 DOI: 10.1016/j.ehb.2020.100856] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
On January 1, 2018 the city of Seattle, WA, implemented a 1.75-cent per ounce (oz) Sweetened Beverage Tax (SBT) on sugar-sweetened beverages with at least 40 calories per 12 oz. This study drew on universal product code-level store scanner data and used a pre-post intervention-comparison site difference-in-differences (DID) study design to assess the impact of the SBT on taxed beverage prices in Seattle, the volume sold of taxed beverages in Seattle and in its 2-mile border area (cross-border shopping), and the volume sold of untaxed beverages (substitution) relative to changes in its comparison site of Portland, OR. The DID results showed that, on average, in the first year post-tax implementation, prices of taxed beverages rose by 1.03 cents per oz (p < 0.001) corresponding to a 59% tax pass-through rate. Volume sold of taxed beverages fell, on average, by 22% (p < 0.001) in the first year following the implementation of the tax. Volume sold of taxed beverages fell to a greater extent for family- versus individual-size beverages (31% versus 10%) and fell to a greater extent for soda (29%) compared to all other beverage types. Moderate substitution to untaxed beverages was found - volume sold of untaxed beverages increased by 4% (p < 0.05). The results revealed no significant increases in the overall volume sold of taxed beverages in the 2-mile border area of Seattle relative to its comparison site suggesting that tax avoidance in the form of cross-border shopping did not dampen the impact of the tax.
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Affiliation(s)
- Lisa M Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
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