Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013-2018.

BACKGROUND: Differences in nutrient intakes by urbanization level in the Unites States is not well understood. OBJECTIVE: Describe, by urbanization level: 1) intake of protein, fiber, percent of energy from added sugars (AS) and saturated fat (SF), calcium, iron, potassium, sodium, and vitamin D; 2) the percent of the population meeting nutrient recommendations. METHODS: Twenty-four-hour dietary recalls from 23,107 participants aged 2 y and over from the 2013-2018 National Health and Nutrition Examination Surveys were analyzed. Usual intakes were estimated, and linear regression models adjusted for age, sex, race and Hispanic origin, and whether family income met the 130% threshold examined intake differences by urbanization levels-large urban areas (LUA), small to medium metro areas (SMMA), and rural areas (RA). RESULTS: A small percentage of the population met the nutrient recommendations, except for protein (92.8%) and iron (70.5%). A higher percentage of the population met recommendations than SMMA and RA for fiber (11.8% compared with 8.1% and 5.3%, P < 0.001), AS (40.2% compared with 33.4% and 31.3%, P < 0.001), SF (26.8% compared with 18.2% and 20.1%, P < 0.001), and potassium (31.5% compared with 25.5% and 22.0%, P < 0.001). Mean protein intake were also higher in LUA than RA (80.0 g compared with 77.7 g, P = 0.003) and fiber intake higher in LUA than SMMA (16.5 g compared with 15.9 g, P = 0.01) and RA (16.5 g compared with 15.2 g, P = 0.001). In addition, contributions to energy intake were lower in LUA than SMMA for AS (11.3% compared with 12.0%, P < 0.001) and SF (11.5% compared with 11.7%, P < 0.001), and for LUA than RA for AS (11.3% compared with 12.9%, P < 0.001) and SF (11.5% compared with 11.8%, P < 0.001). CONCLUSIONS: RA had some markers of poorer diet quality-lower protein and fiber intake and higher AS intake-compared with LUA, and these differences persisted in adjusted regression models. These results may inform public health efforts to address health disparities by urbanization levels in the Unites States.

Associations of free sugars from solid and liquid sources with cardiovascular disease: a retrospective cohort analysis.

BACKGROUND: The World Health Organization recommends a 10% total energy (TE%) limit for free sugars (i.e., added sugars and naturally occurring sugars in fruit juice, honey, and syrups) based on evidence linking higher intakes with overweight and dental caries. Evidence for cardiovascular disease (CVD) is limited. Impacts may differ by sex, age group, and solid vs. liquid sources; liquids may stimulate more adverse CVD profiles (due to their rapid absorption in the body along along with triggering less satiety). We examined associations of consuming total free sugars ≥ 10 TE% with CVD within four sex and age-defined groups. Given roughly equal free sugar intakes from solid and liquid sources, we also evaluated source-specific associations of free sugars ≥ 5 TE% thresholds. METHODS: In this retrospective cohort study, we estimated free sugars from 24-h dietary recall (Canadian Community Health Survey, 2004-2005) in relationship to nonfatal and fatal CVD (Discharge Abstract and Canadian Mortality Databases, 2004-2017; International Disease Classification-10 codes for ischemic heart disease and stroke) through multivariable Cox proportional hazards models adjusted for overweight/obesity, health behaviours, dietary factors, and food insecurity. We conducted analyses in separate models for men 55 to 75 years, women 55 to 75 years, men 35 to 55 years, and women 35 to 55 years. We dichotomized total free sugars at 10 TE% and source-specific free sugars at 5 TE%. RESULTS: Men 55 to 75 years of age had 34% higher CVD hazards with intakes of free sugars from solid sources ≥ 5 TE% vs. below (adjusted HR 1.34, 95% CI 1.05- 1.70). The other three age and sex-specific groups did not demonstrate conclusive associations with CVD. CONCLUSIONS: Our findings suggest that from a CVD prevention standpoint in men 55 to 75 years of age, there may be benefits from consuming less than 5 TE% as free sugars from solid sources.

Trends in Added Sugars Intake and Sources Among US Children, Adolescents, and Teens Using NHANES 2001-2018.

BACKGROUND: Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens. OBJECTIVES: The present study provides a comprehensive time-trends analysis of added sugars intakes and contributing sources in the diets of US children, adolescents, and teens (2-18 years) from 2001-2018, focusing on variations according to sociodemographic factors (age, sex, race and ethnicity, income), food assistance, and health-related factors (physical activity level, body weight status). METHODS: Data from 9 consecutive 2-year cycles of the NHANES were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001-2018 for the overall age group (2-18 years) and for 2 age subgroups (2-8 and 9-18 years). Trends were also examined on subsamples stratified by sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White), income (household poverty income ratio), food assistance, physical activity level, and body weight status. RESULTS: From 2001-2018, added sugars intakes decreased significantly (P < 0.01), from 15.6% to 12.6% kcal among children (2-8 years) and from 18.4% to 14.3% kcal among adolescents and teens (9-18 years), mainly due to significant declines in added sugars from sweetened beverages, which remained the top source. Declines in added sugars intakes were observed for all strata, albeit to varying degrees. CONCLUSIONS: Declines in added sugars intakes were observed among children, adolescents, and teens from 2001-2018, regardless of sociodemographic factors, food assistance, physical activity level, or body weight status, but variations in the magnitudes of decline suggest persistent disparities related to race and ethnicity and to income. Despite these declines, intakes remain above the DGA recommendation; thus, continued monitoring is warranted.

Sugar intake above international recommendations and oral disease burden: A population-based study.

OBJECTIVE: To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents. METHODS: This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling. RESULTS: Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators. CONCLUSION: Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.

Sugars measured enzymatically in a fasting overnight urine sample are not sensitive biomarkers of dietary added sugar intake in postmenopausal women.

BACKGROUND: Restricting dietary sugar is a leading recommendation, but limited biomarkers assessing intake exist. Although 24-h urinary sucrose (U-Suc) and urinary fructose (U-Fruc) excretion has been used with mixed success, collection is burdensome. AIM: This study aimed to test the sensitivity of an enzymatic assay of U-Suc and U-Fruc to detect changing added sugar intake using low-burden overnight urine samples in 30 postmenopausal women. METHODS: Women consumed usual dietary intake during day 1 and usual intake plus a sugar sweetened beverage during day 2. Weighed, photographed food records assessed intake. Enzymatic assay measured U-Suc and U-Fruc from fasting overnight samples; liquid chromatography mass spectrometry (LC-MS) validated U-Suc findings. RESULTS: Dietary added sugars increased significantly during day 2 (p < 0.001), but urinary sugars were not significantly increased. Enzymatic assay detected urinary sugars in 75% (U-Suc) and 35% (U-Fruc) of samples. Dietary sucrose was not associated with U-Suc, however dietary fructose was significantly associated with U-Fruc [ß = 0.031; p < 0.05] among women with detectable urinary sugars. Participants with detectable U-Fruc consumed more energy from added sugars [12.6% kcal day 1; 21.5% kcal day 2] than participants with undetectable U-Fruc [9.3% kcal day 1; 17.4% kcal day 2], p < 0.05. Using LC-MS, U-Suc predicted sucrose and added sugar intake [ß = 0.017, ß = 0.013 respectively; both p < 0.05]. CONCLUSIONS: Urinary sugars measured enzymatically from overnight urine samples were not sensitive biomarkers of changing added sugar intake in postmenopausal women. However, urinary fructose measured by enzymatic assay or LC-MS may differentiate low versus high added sugar consumers.

Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers.

BACKGROUND: Formulas often contain high amounts of added sugars, though little research has studied their connection to obesity. OBJECTIVES: This study assessed the contribution of added sugars from formulas during complementary feeding on total added sugar intakes, and the association between these sugars and upward weight-for-age percentile (WFA%) crossing (i.e., participants crossing a higher threshold percentile were considered to have an upward crossing). METHODS: Data from three 24-hour dietary recalls for infants (n = 97; 9-12 months) and toddlers (n = 44; 13-15 months) were obtained in this cross-sectional analysis. Foods and beverages with added sugars were divided into 17 categories. Pearson's correlations were used to test relations between added sugar intake and upward WFA% crossing, followed by multivariable regressions when significant. ANOVA compared intakes of all, milk-based, and table foods between primarily formula-fed compared with breastfed participants. Multivariable regressions were used to test effects of added sugars and protein from all foods compared with added sugars and protein from milk-based sources on upward WFA% crossing. RESULTS: Added sugars from formulas comprised 66% and 7% of added sugars consumed daily by infants and toddlers, respectively. A significant association was observed between upward WFA% crossing and added sugars from milk-based sources after controlling for gestational age, sex, age, introduction to solid foods, mean energy intakes, and maternal pre-pregnancy BMI and education (ß = 0.003; 95% CI, 0.000-0.007; P = 0.046). Primarily formula-fed participants consumed nearly twice the energy from added sugars (P = 0.003) and gained weight faster (upward WFA% crossing = 1.1 ± 1.2 compared with 0.3 ± 0.6, respectively; P < 0.001) than their breastfed counterparts. CONCLUSIONS: Added sugars in formulas predict rapid weight gain in infants and toddlers. Educating mothers on lower-sugar options may enhance childhood obesity prevention.

Knowledge and acceptance of interventions aimed at reducing sugar intake in Portugal.

OBJECTIVE: Governments worldwide have been implementing interventions aimed at improving citizens' dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population. DESIGN: Online survey to assess which interventions are the most salient and receive greater public support. SETTING: Portugal. PARTICIPANTS: 1010 (76·7 % female, MAge 36·33, sd 13·22). RESULTS: Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex). CONCLUSION: By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.

Development and validation of the Dental Nutrition Knowledge Competency Scale for low-income women.

OBJECTIVE: To develop and validate a Dental Nutrition Knowledge Competency Scale to assess dental health-related nutrition knowledge of low-income women. DESIGN: This is a cross-sectional study. A literature search for foods/dietary practices related to dental caries was conducted and the items were incorporated into an initial questionnaire. A panel of ten nutrition experts evaluated it for its content, readability and relevance, and a focus group of six low-income women determined its readability and comprehension. Then the questionnaire was administered to 150 low-income women. Construct validity was evaluated by item difficulty, item discrimination and factor analysis. Internal consistency reliability was tested via Cronbach's α. In a sub-sample of forty women, test-retest reliability was established. Paired-sample t tests were conducted to examine differences between test scores at the two time points, 2 weeks apart. SETTINGS: Community centres in low-income housing in Central Texas, USA. PARTICIPANTS: A total of 150 low-income women, aged 18-50 years; annual household income <250 % of the federal poverty level. RESULTS: Item difficulty and discrimination analysis resulted in elimination of eight questions. Factor analysis identified twenty-four items that loaded on three factors related to knowledge. These included foods/dietary practices that affect dental caries, added sugars in foods and on food labels, and recommended frequency of oral hygiene practices. The subscales and the completed scale exhibited good internal consistency (mean 0·7 (sd 0·97)) and test-retest reliability (mean 0·8 (sd 0·013)). CONCLUSIONS: The Dental Nutrition Knowledge Competency Scale is a validated and reliable instrument to assess nutrition knowledge related to dental health in low-income women.

Title: efficacy of a food parenting intervention for mothers with low income to reduce preschooler's solid fat and added sugar intakes: a randomized controlled trial.

BACKGROUND: Few interventions have shown efficacy to influence key energy balance behaviors during the preschool years. OBJECTIVE: A randomized controlled trial (RCT) was used to evaluate the efficacy of Food, Fun, and Families (FFF), a 12 week authoritative food parenting intervention for mothers with low-income levels, to reduce preschool-aged children's intake of calories from solid fat and added sugar (SoFAS). METHODS: Mothers were randomly assigned to receive FFF (n = 59) or to a delayed treatment control (n = 60). The primary outcome was children's daily energy intake from SoFAS at the end of the 12 week intervention, controlling for baseline levels, assessed by 24-h dietary recalls. Secondary outcomes included children's daily energy intake, children's BMI z-scores, and meal observations of maternal food parenting practices targeted in FFF (e.g. providing guided choices). RESULTS: Participating mothers were predominantly African American (91%), with 39% educated beyond high school and 66% unemployed. Baseline demographics and child SoFAS intakes did not differ by group. Lost to follow-up was 13% and did not differ between groups. At post-intervention, FFF children consumed ~ 94 kcal or 23% less daily energy from SoFAS than children in the control group, adjusting for baseline levels (307.8 (95%CI = 274.1, 341.5) kcal vs. 401.9 (95%CI = 369.8, 433.9) kcal, FFF vs. control; p < 0.001). FFF mothers also displayed a greater number of authoritative parenting practices when observed post-intervention with their child at a buffet-style meal (Wilcoxon z = - 2.54, p = 0.012). Neither child total daily energy intake nor BMI z-scores differed between groups post-intervention. CONCLUSIONS: Findings demonstrate the initial efficacy of an authoritative food parenting intervention for families with low-income to reduce SoFAS intake in early childhood. Additional research is needed to evaluate longer-term effects on diet and growth. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov : #NCT03646201.

Top food sources of percentage of energy, nutrients to limit and total gram amount consumed among US adolescents: National Health and Nutrition Examination Survey 2011-2014.

OBJECTIVE: To identify most commonly consumed foods by adolescents contributing to percentage of total energy, added sugars, SFA, Na and total gram intake per day. DESIGN: Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. SETTING: NHANES is a cross-sectional study nationally representative of the US population.ParticipantsOne 24 h dietary recall was used to assess dietary intake of 3156 adolescents aged 10-19 years. What We Eat in America food category classification system was used for all foods consumed. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were sample-weighted and ranked based on percentage contribution to intake of total amount. RESULTS: Three-highest ranked food subgroup sources of total energy consumed were: sugar-sweetened beverages (SSB; 7·8 %); sweet bakery products (6·9 %); mixed dishes - pizza (6·6 %). Highest ranked food sources of total gram amount consumed were: plain water (33·1 %); SSB (15·8 %); milk (7·2 %). Three highest ranked food sources of total Na were: mixed dishes - pizza (8·7 %); mixed dishes - Mexican (6·7 %); cured meats/poultry (6·6 %). Three highest ranked food sources of SFA were: mixed dishes - pizza (9·1 %); sweet bakery products (8·3 %); mixed dishes - Mexican (7·9 %). Three highest ranked food sources of added sugars were: SSB (42·1 %); sweet bakery products (12·1 %); coffee and tea (7·6 %). CONCLUSIONS: Identifying current food sources of percentage energy, nutrients to limit and total gram amount consumed among US adolescents is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Concentrated sugars and incidence of prostate cancer in a prospective cohort.

The association between consumption of added or concentrated sugars and prostate cancer risk is unclear. We examined the association between concentrated sugars in beverages and desserts and prostate cancer risk among 22 720 men in the usual-care arm of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, enrolled during 1993-2001. After a median follow-up of 9 years, 1996 men were diagnosed with prostate cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HR) for prostate cancer risk and 95 % CI, adjusting for potential confounding factors. Increased consumption of sugars from sugar-sweetened beverages was associated with increased risk of prostate cancer for men in the highest quartile of sugar consumption (HR: 1·21; 95 % CI 1·06, 1·39), and there was a linear trend (P<0·01). There were no linear associations between prostate cancer risk and consumption of sugars from fruit juices or dessert foods. In conclusion, in this prospective substudy within the PLCO trial, consumption of sugars from sugar-sweetened beverages was associated with increased risk of prostate cancer among men receiving standard medical care. Our study suggests that limiting intake of sugars from beverages may be important in the prevention of prostate cancer.

Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project.

The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.

Patterns of added sugars intake by eating occasion among a nationally representative sample of Australians.

PURPOSE: To examine the eating occasion (EO) where most added sugars (AS) were consumed using a nationally representative dataset. METHODS: Plausible dietary data from the Australian Health Survey respondents (n = 8202), collected by a multiple-pass 24-h recall, were analyzed. EO was self-reported during the recall. AS content of the foods reported was estimated using a previously published method. Proportion of daily AS consumed (%ASdaily) and the main food sources, at each EO, were calculated. Differences between children/adolescents and adults were tested by one-way ANOVA. Further stratification by age group and sex was performed. RESULTS: The majority of the %ASdaily came from non-main meal occasions (NMMOs; 48.3 %, 95 % CI 47.5-49.0 %), followed by breakfast/brunch (20.6 %, 95 % CI 20.1-21.1 %). Children and adolescents consumed more %ASdaily during NMMOs compared with adults (52 vs. 47 %; p < 0.001), while girls/women consumed more %ASdaily during NMMO compared with boys (54 vs. 49 %; p = 0.002) and men (50 vs. 45 %; p < 0.001). Sugar-sweetened beverages were the top contributors to AS at lunch, dinner and NMMOs, while sugar and sweet spreads were the top contributor at breakfast/brunch. Other top contributors at NMMOs included "other foods," ice cream and cakes and biscuits, pastries and batter-based products. CONCLUSION: Australians consumed nearly half of %ASdaily during NMMOs, most of which came from high-sugar energy-dense nutrient-poor foods. While the common perception that most AS come from snacks holds true, our results suggest that main meals are also important intervention targets.

Ultra-processed foods and added sugars in the Chilean diet (2010).

OBJECTIVE: To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet. DESIGN: Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification). SETTING: Chile. SUBJECTS: A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario). RESULTS: Ultra-processed foods represented 28·6 (se 0·5) % of total energy intake and 58·6 (se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 (se 0·3) to 19·7 (se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2-19 years (OR=3·9; 95 % CI 2·7, 5·9). CONCLUSIONS: In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.

Clearing the fog: a review of the effects of dietary omega-3 fatty acids and added sugars on chemotherapy-induced cognitive deficits.

Cancer treatments such as chemotherapy have been an important part of extending survival in women diagnosed with breast cancer. However, chemotherapy can cause potentially toxic side effects in the brain that impair memory, verbal fluency, and processing speed in up to 30% of women treated. Women report that post-chemotherapy cognitive deficits negatively impact quality of life and may last up to ten years after treatment. Mechanisms underlying these cognitive impairments are not fully understood, but emerging evidence suggests that chemotherapy induces structural changes in the brain, produces neuroinflammation, and reduces adult hippocampal neurogenesis. Dietary approaches that modify inflammation and neurogenesis are promising strategies for reducing chemotherapy-induced cognitive deficits in breast cancer survivors. In this review, we describe the cognitive and neuronal side effects associated with commonly used chemotherapy treatments for breast cancer, and we focus on the often opposing actions of omega-3 fatty acids and added sugars on cognitive function, neuroinflammation, and adult hippocampal neurogenesis. Omega-3 fatty acids administered concurrently with doxorubicin chemotherapy have been shown to prevent depressive-like behaviors and reduce neuroinflammation, oxidative stress, and neural apoptosis in rodent models. In contrast, diets high in added sugars may interact with n-3 FAs to diminish their anti-inflammatory activity or act independently to increase neuroinflammation, reduce adult hippocampal neurogenesis, and promote cognitive deficits. We propose that a diet rich in long-chain, marine-derived omega-3 fatty acids and low in added sugars may be an ideal pattern for preventing or alleviating neuroinflammation and oxidative stress, thereby protecting neurons from the toxic effects of chemotherapy. Research testing this hypothesis could lead to the identification of modifiable dietary choices to reduce the long-term impact of chemotherapy on the cognitive functions that are important to quality of life in breast cancer survivors.

A review of total & added sugar intakes and dietary sources in Europe.

Public health policies, including in Europe, are considering measures and recommendations to limit the intake of added or free sugars. For such policies to be efficient and monitored, a precise knowledge of the current situation regarding sugar intake in Europe is needed. This review summarizes published or re-analyzed data from 11 representative surveys in Belgium, France, Denmark, Hungary, Ireland, Italy, Norway, The Netherlands, Spain and the UK. Relative intakes were higher in children than in adults: total sugars ranged between 15 and 21% of energy intake in adults and between 16 and 26% in children. Added sugars (or non-milk extrinsic sugars (NMES), in the UK) contributed 7 to 11% of total energy intake in adults and represented a higher proportion of children's energy intake (11 to 17%). Educational level did not significantly affect intakes of total or added sugars in France and the Netherlands. Sweet products (e.g. confectionery, chocolates, cakes and biscuits, sugar, and jam) were major contributors to total sugars intake in all countries, genders and age groups, followed by fruits, beverages and dairy products. Fruits contributed more and beverages contributed less to adults' total sugars intakes than to children's. Added sugars were provided mostly by sweet products (36 to 61% in adults and 40 to 50% in children), followed by beverages (12 to 31% in adults and 20 to 34% in children, fruit juices excluded), then by dairy products (4 to 15% in adults and 6 to 18% in children). Caution is needed, however, as survey methodologies differ on important items such as dietary data collection, food composition tables or estimation of added sugars. Cross-country comparisons are thus not meaningful and overall information might thus not be robust enough to provide a solid basis for implementation of policy measures. Data nevertheless confirm that intakes of total and added sugars are high in the European countries considered, especially in children, and point to sweet products and beverages as the major contributors to added sugar intakes.

Similarities and interactions between the ageing process and high chronic intake of added sugars.

In our societies, the proportions of elderly people and of obese individuals are increasing. Both factors are associated with high health-related costs. During obesity, many authors suggest that it is a high chronic intake of added sugars (HCIAS) that triggers the shift towards pathology. However, the majority of studies were performed in young subjects and only a few were interested in the interaction with the ageing process. Our purpose was to discuss the metabolic effects of HCIAS, compare with the effects of ageing, and evaluate how deleterious the combined action of HCIAS and ageing could be. This effect of HCIAS seems mediated by fructose, targeting the liver first, which may lead to all subsequent metabolic alterations. The first basic alterations induced by fructose are increased oxidative stress, protein glycation, inflammation, dyslipidaemia and insulin resistance. These alterations are also present during the ageing process, and are closely related to each other, one leading to the other. These basic alterations are also involved in more complex syndromes, which are also favoured by HCIAS, and present during ageing. These include non-alcoholic fatty liver disease, hypertension, neurodegenerative diseases, sarcopenia and osteoporosis. Cumulative effects of ageing and HCIAS have been seldom tested and may not always be strictly additive. Data also suggest that some of the metabolic alterations that are more prevalent during ageing could be related more with nutritional habits than to intrinsic ageing. In conclusion, it is clear that HCIAS interacts with the ageing process, accelerates the accumulation of metabolic alterations, and that it should be avoided.

Savoring Sweet: Sugars in Infant and Toddler Feeding.

During the first years of life, the sweetness of sugars has a capacity to hinder or to help in laying a strong nutritional foundation for food preferences that often extend over a lifetime. Aside from supplying 4 g/kcal of energy, sugars are non-nutritive. However, sugars have a powerful attribute, sweetness, which strongly influences human food preference. A child's first relationship with sweet taste begins even before birth and continues to evolve throughout complementary feeding. The sweetness of breastmilk encourages consumption and soothes the neonate. Conversely, inappropriate introduction of non-milk solids and beverages that are sweet at 0-4 months of age raises the newborn's risk for later obesity and may discourage the acceptance of other bitter or sour foods. Although cereals, fruits, 100% fruit juices, and some grains have naturally occurring sugars that impart sweet flavor notes, there is no clear role for added sugars between 6 and 12 months of age. Yet, 60% of infants are introduced to foods and beverages containing added sugars, threatening diet quality. Pairing foods with naturally occurring sugars, such as fruits, with foods that tend to be resisted initially, such as vegetables, can mask bitterness and promote acceptance. Utilizing the infants' extraordinary capacity for sensory-motor exploration is another strategy to expose them repeatedly to challenging tastes and flavors. The transitional year, as breast milk and infant formula are withdrawn, is a time when nutritional needs are high and diet quality often precarious. Rapid growth, along with brain and cognitive development, demand high-quality nutrition. Snacks are necessary both for energy and valuable nutrients. However, the selection of snack foods often exposes toddlers to items that offer concentrated energy with low nutrient value. Recent trends suggest a rapid fall in added sugars among infants and toddlers. Parenting practices that use small amounts of sugars to promote nutrient-rich foods from all 5 food groups can enhance rather than hinder their child's emerging dietary pattern.

Simplifying mental math: Changing how added sugars are displayed on the nutrition facts label can improve consumer understanding.

BACKGROUND: Proposed variations to Nutrition Facts Labels (NFL) have included the display of added sugars (AS) content, but its impact on consumer understanding is poorly understood. OBJECTIVE: To examine the degree to which different formats for displaying AS influence consumer understanding, perceptions, and purchase intentions. DESIGN: Randomized-controlled online experiment. PARTICIPANTS: A sample of 2509 U.S adults. INTERVENTION: Participants were randomized to 1 of 8 conditions and viewed 10 food or beverage images with either: (1) no label (control); (2) the current NFL (without AS); (3) the proposed NFL without AS; or the proposed NFL with AS in (4) grams, (5) grams and teaspoons, (6) grams and percent Daily Value (%DV), (7) grams with high/medium/low text, or (8) grams with high/medium/low text and %DV. MAIN OUTCOME MEASURES & STATISTICAL ANALYSIS: ANCOVAs compared scores on quizzes that assessed the accuracy of judgments about AS, overall nutrition understanding and purchase intentions. RESULTS: Presenting AS in grams plus high/medium/low text with and without %DV led to the highest AS understanding scores (85% and 83% correct, respectively) compared to 70% correct when AS was not on the label or was displayed in grams only (74% correct). Displaying AS in teaspoons did not significantly improve understanding beyond grams alone. Consumers were best able to determine which of two products was healthier when AS was presented as %DV (68% correct) versus displayed in grams alone (60% correct), but %DV did not differ from high/medium/low text or teaspoons. None of the labels influenced purchase intentions relative to no label. CONCLUSION: Displaying AS on the NFL in grams with high/medium/low text, %DV, or the combination of the two, improved consumer understanding more than presenting it in grams or teaspoons.

Evaluation of different methods to handle misreporting in obesity research: evidence from the Canadian national nutrition survey.

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16,187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under- and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regression-generalised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95% CI 0·979, 0·998) and obesity (OR 0·989; 95% CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95% CI 0·487, 0·923) and obesity (OR 0·709; 95% CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95% CI 1·019, 1·055) and obesity (OR 1·109; 95% CI 1·082, 1·137) was observed (P<0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P<0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic.