Sugar Intake among Preschool-Aged Children in the Guelph Family Health Study: Associations with Sociodemographic Characteristics.

BACKGROUND: It is crucial to develop strategies targeted to promote healthy eating patterns in vulnerable populations, especially young children from diverse sociodemographic groups. Thus, the study objective was to investigate the associations between child age, child sex, child ethnicity, parent number of years living in Canada, annual household income, parent education and parent marital status with total, free and added sugar intakes in young children. METHODS: This cross-sectional study was a secondary analysis of data gathered in the Guelph Family Health Study. The study included 267 children (129M; 138F) from 210 families aged 1.5 to 5 years. Parents completed questionnaires for children on sociodemographic characteristics and an online 24-hour diet recall. The associations between sociodemographic characteristics and sugar intakes were determined using generalized estimating equations applied to linear regression models. RESULTS: The mean age of the children was 3.5 ± 1.2 years (mean ± std dev.). As children's age increased, there was a greater intake of free and added sugar (ß^ = 8.6, p = 0.01, 95% CI = 2.4 to 14.7 and ß^ = 6.5, p = 0.03, 95% CI = 0.8 to 12.2, respectively). Those children who identified as white had a higher total sugar intake than children of other ethnicities (ß^ = 31.0, p = 0.01, 95% CI = 7.2 to 54.7). Additionally, higher annual household income was associated with lower was free sugar intake in children (ß^ = -2.4, p = 0.02, 95% CI = -4.5 to -0.4). CONCLUSIONS: This study underscores the significant influence of multiple sociodemographic characteristics on sugar intake in young children, providing valuable insights for public health policy and nutrition interventions. Moreover, this study highlights the need for early behaviour interventions focusing on reducing sugar intake in young children, while considering sociodemographic factors.

Free sugar intake from snacks and beverages in Canadian preschool- and toddler-aged children: a cross-sectional study.

BACKGROUND: Excess consumption of free sugar (FS) increases the risk of dental caries and unhealthy weight gain. However, the contribution of snacks and beverages to young children's FS intake is not well understood. The purpose of this study was to determine FS intake from snacks and beverages among preschool-aged Canadian children. METHODS: This cross-sectional study examined baseline data from 267 children 1.5 to 5 y enrolled in the Guelph Family Health Study. Dietary assessment was completed over a 24-h period using ASA24-Canada-2016 to, 1) estimate the proportion of children whose FS intake from snacks and beverages consumed exceeded 5% total energy intake (TE) and 10% TE, and 2) identify the top snack and beverage sources of FS. RESULTS: FS contributed 10.6 ± 6.9% TE (mean ± SD). 30 and 8% of children consumed ≥ 5% TE and ≥ 10% TE from snack FS, respectively. Furthermore, 17 and 7% of children consumed ≥ 5% TE and ≥ 10% TE from beverages FS, respectively. Snacks and beverages accounted for 49 ± 30.9% of FS energy. Top snack sources of FS (% children, children's %TE from FS) were bakery products (55%, 2.4%), candy and sweet condiments (21%, 3.0%), and sugar-containing beverages (20%, 4.1%). Top sugar-containing beverage sources of FS (48%, 5.3%) were 100% fruit juice (22%, 4.6%) and flavored milk (11%, 3.1%). CONCLUSIONS: Snacks and beverages contributed nearly half of FS intake among a sample of young children in Canada. Thus, long-term monitoring of snacking behavior and consumption of FS is warranted. These findings may help inform nutritional strategies and public policies to improve diet quality and FS intake in preschool-aged children. TRIAL REGISTRATION: The Clinical Trial Registry number is NCT02939261 from clinicaltrials.gov. Date of Registration: October 20, 2016.

Non-Nutritive Sweetener Intake Is Low in Preschool-Aged Children in the Guelph Family Health Pilot Study.

There is limited research on the intake of non-nutritive sweeteners (NNS) among preschool-aged children. Canada's Food Guide suggests limiting intake of NNS for all population groups and Health Canada recommends that young children (<2 years) avoid consuming beverages containing NNS. The aim of this study was to investigate the frequency and type of non-nutritive sweetener (NNS) intake in preschool-aged children participating in the Guelph Family Health Study pilots. Parents (n = 78 families) completed 3-day food records (n = 112 children; n = 55 females, n = 57 males; 3.6 years ± 1.3). Nineteen children (17%) reported consumption of foods or beverages containing NNS. Food sources with NNS included: freezies, oral nutritional supplements, flavored water, carbonated drinks, sugar free jam and protein powder. The majority of NNS contained in these foods were identified as stevia leaf extract, acesulfame K, sucralose, monk fruit extract and aspartame. Future research should continue to study NNS intake patterns longitudinally in children and examine the association of NNS intake with diet quality and health outcomes.

Dietary sugar intake among preschool-aged children: a cross-sectional study.

BACKGROUND: Excessive intake of sugar in young children is a public health concern. Our study objectives were to examine intakes of total, free and added sugar among preschool-aged children and to investigate their associations with body weight, body mass index Z-scores, percent fat mass and waist circumference. METHODS: The cross-sectional cohort study included preschool-aged children between 1.5 and 5 years of age, enrolled in pilot studies of the Guelph Family Health Study, Guelph, Ontario, from 2014 to 2016. Daily intake of total sugar was determined using a food processor software; daily intakes of free and added sugar, and food sources were determined through manual inspection of 3-day food records. Anthropometric measures were completed by trained research staff. We used linear regression models with generalized estimating equations to estimate associations between sugar intakes and anthropometric measures. RESULTS: We included 109 children (55 girls and 54 boys) in 77 families. Mean daily intakes were 86 (standard deviation [SD] 26) g for total sugar, 31 (SD 15) g for free sugar and 26 (SD 13) g for added sugar. Of participants, 80% (n = 87) had intakes of free sugar greater than 5% of their daily energy intake. The most frequent food sources of free and added sugar were bakery products. A weak inverse association between free sugar intake (kcal/1000 kcal) and waist circumference (cm) (ß = -0.02, 95% confidence interval -0.04 to -0.0009) was found, but no significant associations were noted between sugar intake and other anthropometric measures. INTERPRETATION: Most of the preschool-aged children in this study had free sugar intakes greater than current recommendations; overall, their total, free and added sugar intakes were not associated with the anthropometric measures. This study can be used to inform policy development for sugar intake in young children and apprise early intervention programs.

Identifying the top research priorities in postmastectomy breast cancer reconstruction: a James Lind Alliance priority setting partnership.

BACKGROUND: Major improvements in breast cancer treatment in the last decade include advancements in postmastectomy breast reconstruction (PMBR). Unfortunately, the studies in PMBR are primarily researcher or industry led with minimal input from patients and caregivers. The aim of this study is to use the James Lind Alliance (JLA) approach to bring together the patients, caregivers and clinicians in a priority setting partnership to identify the most important unanswered research questions in PMBR. METHODS: The JLA priority setting methodology involved four key stages: gathering research questions on PMBR from patients, caregivers and clinicians; checking these research questions against existing evidence; interim prioritisation and a final consensus meeting to determine the top 10 unanswered research questions using the modified nominal group methodology. RESULTS: In stage 1, 3168 research questions were submitted from 713 respondents across Canada, of which 73% of the participants were patients or caregivers. Stage 2 confirmed that there were a total of 48 unique unanswered questions. In stage three, 488 individuals completed the interim prioritisation survey and the top 25 questions were taken to a final consensus meeting. In the final stage, the top 10 unanswered research questions were determined. They cover a breadth of topics including personalised surgical treatment, safety of implants and newer techniques, access to PMBR, breast cancer recurrence and rehabilitation. INTERPRETATION: Identification of the top 10 unanswered research questions is an important first step to generating relevant and impactful research that will ultimately improve the PMBR experience for patients with breast cancer.

Validation of a self-administered version of the Mediterranean diet scale (MDS) for cardiac rehabilitation patients in Canada.

The Mediterranean dietary pattern has been linked with lower incidence of cardiovascular disease and the Mediterranean diet scale (MDS) has been created to incorporate and test the inherent characteristics of this dietary pattern. This study aimed to psychometrically validate a self-administered version of the MDS in cardiac rehabilitation (CR) patients in Canada. To establish content validity, the scale was reviewed by an expert interdisciplinary panel. A final version of the tool was tested in 150 CR patients. Cronbach's alpha was 0.69. All ICC coefficients met the minimum recommended standard. Factor analysis revealed four factors, all internally consistent. Criterion validity was supported by significant differences in total scores by duration in CR. Construct validity was supported by agreements between the self-administered MDS and original MDS in all items and with the 3-day food record in 8 of 13 items. In conclusion, the self-administered version of the MDS demonstrated good reliability and validity.

Dental caries, gingivitis, periodontitis: a review

Microbial populations colonizing the teeth and periodontal tissues are a major source of pathogens responsible for oral and dental infections including dental caries, gingivitis, periodontitis etc. Dental caries is a multifactor and infectious disease resulting dueto interaction of three different aspects like dietary sugar, susceptible tooth enamel and oral microbial colonization. Plaques from caries active sites have significantly higher proportion of Streptococcus mutans (principle acid producer) with pH levels of 5.0 or lower. Dental decay occurs when normal demineralization remineralization is disturbed. On the other hand the most common form of gingivitis is chronic or long standing plaque induced gingivitis while acute necrotizing ulcerative gingivitis is most aggressive, developing gingivitis is associated with increasing numbers of Actinomyces israeliwhereas gingivitis with bleeding is associated with A. viscosus and pigmented Bacteroides. Periodontitis is defined as loss of alveolar support to the tooth and can be differentiated microbiologically and clinically into adult, localised juvenile and pre-pubertal periodontitis. Various species of Bacteroides, Actinomyces, Fusobacterium etc. have been isolated from cases of active periodontitis. Thus wherever possible both aerobic and anaerobic culture should be performed and appropriate antibiotic therapy should be prescribed instead of empirical treatment.

Antibiotic susceptibility of bacterial isolates in gingivitis and periodontitis.

The present study was conducted to isolate aerobic as well as anaerobic microbes from patients of gingivitis and adult periodontitis and to study the susceptibility patterns of these isolates to different antibiotics. In our study all the samples belonging to the control as well as the study groups yielded microbes. Aerobes and facultative anaerobes were isolated from 100 percent and 96 percent cases of normal gingiva and orodental infections respectively. Anaerobes were isolated from 80 percent of the normal gingival samples and 97 percent of the cases of orodental infections. Metronidazole was found to be the best for the anaerobes while the aerobes and facultative anaerobes showed good susceptibility to cefazolin and cefotaxime.