Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task

The idea of using 'fat taxes’ to curb obesity rates has been raised by many. In particular, the idea of taxing sugar-sweetened beverages (SSBs) has received considerable attention in the United States and has recently been discussed by President Obama. Rather less attention has been given to the alternative of 'thin subsidies’, that is, subsidies for the consumption of foods or beverages likely to be associated with reduced incidence of obesity. This commentary examines the case for a subsidy for artificially sweetened beverages (ASBs) or 'diet soft drinks’. In this commentary, we outline the evidence on the relationship between health outcomes, most notably obesity, and the consumption of SSBs and ASBs. In the light of the evidence we consider the economic effects of taxing SSBs, and the way in which those effects would be modified by the adoption of the alternative 'thin subsidy’ based on subsidising ASBs.

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Consumption of Sugar-Sweetened or Artificially Sweetened Beverages and Semen Quality in Young Men: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020682 ◽

2022 ◽

Vol 19 (2) ◽

pp. 682

Author(s):

Maiken Meldgaard ◽

Nis Brix ◽

Anne Gaml-Sørensen ◽

Andreas Ernst ◽

Cecilia Høst Ramlau-Hansen ◽

...

Keyword(s):

Negative Binomial ◽

Semen Quality ◽

Young Men ◽

Cross Sectional Study ◽

Male Participant ◽

Negative Binomial Regression Model ◽

Sectional Study ◽

Cross Sectional ◽

Sweetened Beverages ◽

Artificially Sweetened Beverages

Background: Existing literature suggests that frequent consumption of sugar-sweetened drinks may be associated with lower semen quality. Studies performed in mice suggest a dose-response relationship between intake of saccharin or aspartame, two artificial sweeteners, and sperm and testis function. Methods: A cross-sectional study based on data from The Fetal Programming of Semen Quality (FEPOS) Cohort, including 1047 young men (mean age = 19 years) was performed. Each male participant completed an online questionnaire on health, health behavior and diet, and provided a semen sample. The associations between consumption of sugar-sweetened or artificially sweetened beverages (moderate ≥ 3 days/week; infrequent < 3 days/week) and semen quality were analyzed using a multivariable, negative, binomial regression model. Results: Sugar-sweetened or artificially sweetened beverage consumption was not strongly associated with either semen volume, sperm concentration, total sperm count or total motility in young men. The proportion of morphologically normal sperm was 11% lower (0.89 (95% CI 0.76, 1.04)) for moderate (≥3 days/week) consumption of artificially sweetened beverages relative to infrequent (<3 days/week). Conclusion: Consumption of sugar-sweetened or artificially sweetened beverages, at the levels present in this study had limited effect on the measured markers of semen quality in young men.

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Front-of-pack warning labels are preferred by parents with low education level in four Latin American countries

World Nutrition ◽

10.26596/wn.201910411-26 ◽

2019 ◽

Vol 10 (4) ◽

pp. 11-26

Author(s):

Sofia Rincon Gallardo Patino ◽

Ángela Carriedo ◽

Lizbeth Tolentino-Mayo ◽

Jacqueline Araneda ◽

Lorena Allemandi ◽

...

Keyword(s):

Latin America ◽

Latin American ◽

Overweight And Obesity ◽

Policy Implications ◽

Warning Labels ◽

Nutrition Label ◽

Nutrition Labels ◽

Low Education ◽

Education Levels ◽

Latin American Countries

Background: Overweight and obesity rates in Latin America are much higher than the global prevalence. Front-of-pack (FOP) nutrition label systems are gaining momentum in Latin America and being implemented as a strategy to tackle obesity among children and adults. This study investigates the usage and preference of three FOP nutrition labels among Argentinian, Chilean, Costa Rican, and Mexican adult parents. Methods: From March to May 2016, a questionnaire was administered to 966 parents of elementary school aged children in Argentina (89), Chile (304), Costa Rica (258) and Mexico (315). Guideline Daily Amounts (GDA), traffic light (TL), and warning label FOP systems were compared and analyzed. Statistical analysis was conducted using frequencies and proportions. Median differences tests, ANOVAs and logistic regression models were performed. A thematic analysis of qualitative data was conducted using a deductive process. Results: Parents with low education levels and poor health conditions (i.e., overweight) preferred the FOP warning labels over the GDA and TL systems. The GDA FOP nutrition labels were preferred by parents with higher education levels. Overall, the TL system was preferred with no significant differences across countries. Conclusion: FOP warning labels are preferred by parents with vulnerable conditions (i.e., low education levels and overweight) across four Latin American countries. An easily understandable, readable and acceptable label may facilitate usage by vulnerable groups to make healthy food purchases. These results have important policy implications by providing evidence to government policymakers to enact legislation to implement or enhance existing FOP nutrition label policies as a viable strategy to reduce obesity risk.

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Abstract MP49: Sugar Sweetened and Artificially Sweetened Beverages and risk of Mortality in US adults

Circulation ◽

10.1161/circ.129.suppl_1.mp49 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Vasanti S Malik ◽

An Pan ◽

Lawrence de Koning ◽

Eva Schernhammer ◽

Walter C Willett ◽

...

Keyword(s):

Proportional Hazards ◽

Total Mortality ◽

Cox Proportional Hazards ◽

Health Study ◽

Sweetened Beverages ◽

Risk Of Mortality ◽

Regular Consumption ◽

Increased Risk ◽

Artificially Sweetened Beverages ◽

Cvd Mortality

Background: Sugar sweetened beverages (SSBs) are the single largest source of calories and added sugars in the US diet and regular consumption has been associated with weight gain and risk of chronic diseases. Artificially sweetened beverages (ASBs) are often suggested as alternatives to SSB but little is known about their long-term health effects. Whether consumption of SSBs or ASBs is associated with risk of mortality is unknown. Methods: We prospectively followed 38,602 men from the Health Professional’s Follow-up study (1986-2010) and 82,592 women from the Nurses’ Health study (1980-2010) who were free from cardiovascular disease (CVD) and cancer at baseline. Diet was assessed using validated food frequency questionnaires every 4 years and Cox Proportional Hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: We documented 27,691 deaths (6,631 CVD and 10,447 cancer deaths) during 3.14 million person-years. After adjusting for major dietary and lifestyle risk factors, and BMI, baseline diabetes, hypertension and hypercholesterolemia, consumption of SSBs was associated with an increased risk of total mortality, which was mainly driven by CVD mortality among individuals consuming at least 2 servings per day; pooled HRs (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.95 (0.91, 0.98), 0.96 (0.93, 0.99), 1.02 (0.96, 1.08), and 1.18 (1.04, 1.33), respectively (P-trend= 0.0001) for total mortality, and 1.00, 0.97 (0.90, 1.02), 0.96 (0.90, 1.02), 1.04 (0.93, 1.16) and 1.28 (1.09, 1.51), respectively (P-trend=0.007) for CVD mortality. In contrast, ASBs were not associated with mortality; pooled HR’s (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.92 (0.89, 0.95), 0.91 (0.86, 0.97), 0.91 (0.86, 0.95) and 0.99 (0.85, 1.15), respectively (P-trend=0.50) for total mortality and 1.00, 0.86 (0.80, 0.92), 0.87 (0.81, 0.94), 0.96 (0.88, 1.06) and 0.96 (0.74, 1.25), respectively (P-trend=0.99) for CVD mortality. No associations were observed with cancer mortality for either SSBs or ASBs in multi-variable adjusted models. Conclusion: Regular consumption of SSBs is associated with an increased risk of total and CVD mortality, providing additional support for recommendations and policies to limit intake of these beverages.

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Letter by Khan et al Regarding Article, “Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative”

Stroke ◽

10.1161/strokeaha.119.025571 ◽

2019 ◽

Vol 50 (6) ◽

Author(s):

Tauseef A. Khan ◽

Vasanti S. Malik ◽

John L. Sievenpiper

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Women's Health ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

Sweetened Beverages ◽

All Cause Mortality ◽

Artificially Sweetened Beverages ◽

The Women’S Health Initiative

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Sugary drinks, artificially sweetened beverages and cardiovascular disease in NutriNet-Santé cohort

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.573 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Chazelas ◽

C Debras ◽

L Fezeu ◽

C Julia ◽

S Hercberg ◽

...

Keyword(s):

Cardiovascular Disease ◽

Prospective Cohort ◽

Body Weight Gain ◽

Metabolic Effects ◽

Current Debate ◽

National Health Insurance System ◽

Sweetened Beverages ◽

Sugary Drinks ◽

Incident Cases ◽

Artificially Sweetened Beverages

Abstract Introduction Sugary drinks consumption has increased worldwide in recent years and evidence demonstrating their detrimental impact on cardio-metabolic health is accumulating. Artificially sweetened beverages (ASB) are marketed as a healthier alternative, but their cardio-metabolic impact is being debated in the scientific community. This study aimed to investigate the relationships between the consumption of ASB, sugary drinks and the risk of first incident cardiovascular disease (CVD) in a large prospective cohort. Methods The French NutriNet-Santé cohort was launched in 2009. Every 6 months participants are asked to fill 3 validated web-based 24-hour dietary records. All major health events reported by participants were validated based on their medical records by a committee of physicians. Data were also linked to national health insurance system and to the French national cause of specific mortality registry. For each type of beverage, 3 categories were defined as follows: non-consumers, low consumers and high consumers (separated by sex-specific median among consumers). Multi-adjusted Cox proportional hazard models with age as the primary time scale were performed. Results A total of 104,761 participants were included. During follow-up (2009-2019), 1,379 first incident cases of CVD occurred. Compared to non-consumers, higher consumers of sugary drinks had a higher risk of overall CVD (HR = 1.21, 95% CI 1.04 to 1.40, Ptrend=0.009). Higher consumers of ASB had also a significantly higher risk of CVD (HR = 1.30, 95% CI 1.00 to 1.71, Ptrend =0.04). Conclusions Both sugary drinks and ASB were similarly associated with CVD risk. The health effects of non-nutritive sweeteners is currently being debated based on contrasted epidemiological results. Mechanistic data suggests metabolic effects through gut microbiota perturbation and body weight gain. To imply a causal link, they need replication in other large-scale prospective cohort as well as further mechanistic investigations. Key messages Higher consumption of sugary drinks and ASB was associated with higher risk of CVD, suggesting that ASB might not be a healthy substitute for sugary drinks when considering cardiovascular health. These data provide additional arguments to feed the current debate on taxes, labeling and regulation of sugary and artificially sweetened beverages.

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Consumption of Sugar-Sweetened Beverages and Artificially Sweetened Beverages with Mortality: The National Health and Nutrition Examination Survey and a Meta-Analysis

Current Developments in Nutrition ◽

10.1093/cdn/nzaa049_069 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 676-676

Author(s):

Yan-Bo Zhang ◽

Yi-Wen Jiang ◽

An Pan

Keyword(s):

National Health ◽

Cardiovascular Mortality ◽

Heart Diseases ◽

Meta Analysis ◽

Nutrition Examination Survey ◽

Sugar Sweetened Beverages ◽

Sweetened Beverages ◽

Health And Nutrition ◽

All Cause Mortality ◽

Artificially Sweetened Beverages

Abstract Objectives We aimed to investigate the associations of dietary intakes of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) with mortality. Methods Adults without cancer aged 20 years or older from the National Health and Nutrition Examination Survey 1999–2014 were followed up to December 31, 2015. Beverage intake was assessed by 24-hour dietary recall interviews (a single recall in 5109 participants and an average of two recalls in 19,914 participants). Multivariable Cox proportional hazards models were used to evaluate the associations of SSB and ASB intake with all-cause and cause-specific mortality. Pubmed, Embase, Web of Science, Cochrane, ProQuest, ClinicalTrials.gov, and International Clinical Trials Registry Platform were searched for related cohort studies. Random-effects models were used to pool the estimates, and dose-response analyses were conducted using the 2-stage generalized least-squares trend program. Results After a median follow-up of 6.8 years, 2365 deaths were identified in 25,023 participants. Each additional serving of daily SSB intake was associated with an HR (95% CI) of 1.06 (1.02–1.11), 1.13 (1.03–1.24), and 1.06 (1.00–1.11) for mortality from all-cause, heart diseases, and other causes. Each additional serving of daily ASB intake was associated with an HR (95% CI) of 0.96 (0.92–1.00), 0.90 (0.82–0.98), and 0.97 (0.92–1.02) for mortality from all-cause, heart diseases, and other causes. No significant associations were found with cancer mortality. We identified 23,631 citations and included 12 studies (including 13 cohorts) in meta-analyses. It was shown that each additional serving of daily SSB intake was associated with an HR (95% CI) of 1.08 (1.05–1.11, ten cohorts with 388,548 participants) for all-cause mortality and 1.10 (1.06–1.14, five cohorts with 255,584 participants) for cardiovascular mortality. No significant association was found between ASB intake and mortality in the meta-analysis. Conclusions Higher SSB intake was associated with a higher risk of all-cause mortality and cardiovascular mortality, while the association between ASB intake and mortality needed further investigation. Funding Sources National Key Research and Development Program of China, National Nature Science Foundation of China, and Hubei Province Science Fund for Distinguished Young Scholars.

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Gut microbiota composition in relation to intake of added sugar, sugar-sweetened beverages and artificially sweetened beverages in the Malmö Offspring Study

European Journal of Nutrition ◽

10.1007/s00394-020-02392-0 ◽

2020 ◽

Author(s):

Stina Ramne ◽

Louise Brunkwall ◽

Ulrika Ericson ◽

Nicola Gray ◽

Gunter G. C. Kuhnle ◽

...

Keyword(s):

Gut Microbiota ◽

Negative Binomial ◽

Metagenomic Sequencing ◽

Microbiota Composition ◽

Multiple Testing Correction ◽

Sugar Sweetened Beverages ◽

Added Sugar ◽

Sweetened Beverages ◽

Gut Microbiota Composition ◽

Artificially Sweetened Beverages

Abstract Purpose It has been suggested that a high intake of sugar or sweeteners may result in an unfavorable microbiota composition; however, evidence is lacking. Hence, in this exploratory epidemiological study, we aim to examine if intake of added sugar, sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) associate with the gut microbiota composition. Methods Participants (18–70 years) in the Malmö Offspring Study have provided blood, urine, and fecal samples and completed both web-based 4 day food records and short food frequency questionnaires. The gut microbiota was assessed by 16S rRNA sequencing, processed in QIIME and matched to Greengenes (v.13.8), giving 64 included genera after filtering. Intake of added sugar (n = 1371) (also supported by the overnight urinary sugar biomarker in a subgroup n = 577), SSBs (n = 1086) and ASBs (n = 1085) were examined as exposures in negative binomial regressions. Results Various genera nominally associated with intake of added sugar, SSBs, and ASBs. Only the negative association between SSB intake and Lachnobacterium remained significant after multiple testing correction. A positive association between SSB intake and the Firmicutes:Bacteroidetes ratio was also observed. Conclusion In this wide population, the cross-sectional associations between added sugar and sweet beverage intake and the gut microbiota are modest, but the results suggest that SSB intake is associated negatively with the genus Lachnobacterium and positively with the Firmicutes:Bacteroidetes ratio. Larger studies, preferably using metagenomic sequencing, are needed to further evaluate if a link exists between intake of sugars and sweeteners and the human gut microbiota.

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