ABSTRACT
Scarlet fever notifications surged across the United Kingdom in spring 2014. Molecular epidemiologic investigation of Streptococcus pyogenes infections in North-West London highlighted increased emm4 and emm3 infections coincident with the upsurge. Unlike outbreaks in other countries, antimicrobial resistance was uncommon, highlighting an urgent need to better understand the drivers of scarlet fever activity.
Subject(s)
Scarlet Fever/epidemiology , Scarlet Fever/microbiology , Streptococcus pyogenes/classification , Streptococcus pyogenes/genetics , Antigens, Bacterial/genetics , Antigens, Bacterial/immunology , Genotype , History, 21st Century , Humans , London/epidemiology , Mutation , Scarlet Fever/history , Scarlet Fever/immunology , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/immunology , Superantigens/genetics , Superantigens/immunologyABSTRACT
OBJECTIVE: In the public health arena, a single component of total dietary intake, such as sugar intake, has been questioned as the health risk of obesity. This study aimed to investigate if the uptrend of obesity prevalence in the USA is associated with dietary sugar intake when other dietary intakes are controlled. METHODS: In this cross-sectional study, National Health and Nutrition Examination Surveys I (1971-1975, n = 20 195) and III (1988-1994, n = 28 663) were investigated. Multivariate predictive models were used to determine if body mass index was predicted by the daily intakes of total energy, carbohydrate (CHO), and total sugars and the percentages of energy from CHO, fat, total sugar, and added sugars. RESULTS: From 1970 through 1990, the contribution of sugars to total CHO intake decreased in the 1 to 18 y and ≥19 y subgroups, and the contribution of added sugars to the total energy intake did not change. Multivariate predictive models identified energy intake as a positive predictor, CHO as a negative predictor, and total sugar intake as a non-predictor for body mass index in the 1 to 18 y and ≥19 y age subgroups. Daily energy intake was positively predicted by CHO and fat intakes but not with total and added sugar intakes in the two age subgroups. CONCLUSION: Energy intake was the primary contributor to body mass index in all age groups in this study. The major energy sources of children and adolescents differed from those of adults. The implicated associations between energy and macronutrient intakes indicate that keeping energy balance is the primary strategy to avoid obesity.