Generating Community Measures of Food Purchasing Activities Using Store-Level Electronic Grocery Transaction Records: An Ecological Study in Montreal, Canada

Objective: Geographic measurement of diets is generally not available at areas smaller than a national or provincial (state) scale, as existing nutrition surveys cannot achieve sample sizes needed for an acceptable statistical precision for small geographic units such as city subdivisions. Design: Using geocoded Nielsen grocery transaction data collected from supermarket, supercentre and pharmacy chains combined with a gravity model that transforms store-level sales into area-level purchasing, we developed small-area public health indicators of food purchasing for neighbourhood districts. We generated the area-level indicators measuring per-resident purchasing quantity for soda, diet-soda, flavoured (sugar-added) yogurt, and plain yogurt purchasing. We then provided an illustrative public health application of these indicators as covariates for an ecological spatial regression model to estimate spatially correlated small-area risk of type 2 diabetes mellitus (T2D) obtained from the public health administrative data. Setting: Greater Montreal, Canada in 2012 Participants: Neighbourhood districts (n=193). Results: The indicator of flavoured yogurt had a positive association with neighbourhood-level risk of T2D (1.08, 95% Credible Interval [CI]: 1.02-1.14), while that of plain yogurt had a negative association (0.93, 95% CI: 0.89-0.96). The indicator of soda had an inconclusive association, and that of diet soda was excluded due to collinearity with soda. The addition of the indicators also improved model fit of the T2D spatial regression (Watanabe-Akaike information criterion = 1,765 with the indicators, 1,772 without). Conclusion: Store-level grocery sales data can be used to reveal micro-scale geographic disparities and trends of food selections that would be masked by traditional survey-based estimation.

Abstract MP54: Retail Soda Purchases Decrease And Water Purchases Increase After Six Years Of A Healthy Beverage Campaign

Introduction: Sugary drink consumption is a major risk factor for excess weight gain. In 2013, Howard County, MD launched a multi-component campaign to decrease sugary drink consumption. A previously published difference-in-differences (DID) analysis of supermarket retail beverage sales from 2012 (baseline) to 2015 documented a significant decrease in regular soda and fruit drinks sales in intervention stores compared to matched control stores. The present study extends this evaluation through 2018. Hypothesis: Sugary drink sales will continue to decrease and sales of non-sugary drinks will increase through 2018. Methods: Prior to the intervention, a retail sales tracking company identified a sample of supermarkets (N=15) in Howard County (Intervention stores) and assessed 52-weeks of top brand sales for each beverage category. These data were used to identify a set of matched Control stores (N=17) in an adjacent state. DID analyses were used to compare the weekly volume sales of each product (brand and package size) within each beverage category in the Intervention and Control stores from baseline (2012) to Year 6 (2018). Models were adjusted for relevant variables, including average price/ounce; average competitor price/ounce; and weekly local temperature. Results: DID analyses identified a significantly larger net decrease in average weekly volume sales of regular soda, fruit drinks, and 100% juice in the Intervention stores compared to the Control stores over six years (p < .001). See Figure for regular soda sales. After 2015, intervention stores also exhibited significant increases in sales of plain bottled water (p < .0001) and carbonated water (p < .001). In contrast, sports drinks, diet soda, and flavored waters did not consistently differ between conditions. Conclusion: A locally implemented, multi-component campaign reduced regular soda and fruit drink sales over six years. Additional efforts to reduce sales of sports drinks are warranted.

Acute diet soda consumption alters brain responses to food cues in humans: A randomized, controlled, cross-over pilot study

Background: Diet soda consumption has frequently been linked to obesity and its comorbidities in epidemiological studies. Whether this link is causal and a potential mechanism remains to be determined. Aim/Methods: This randomized, cross-over, controlled pilot study sought to determine whether there may be changes in reward-related brain activations to visual food cues after acute consumption of diet soda versus regular soda or carbonated water using functional magnetic resonance imaging. Results: Diet soda as compared to carbonated water consumption increased activation of reward-related caudate to highly versus less desirable food cues. Diet soda as compared to regular soda increased reward-related insula and decreased activation of cognitive control-related dorsolateral prefrontal cortex to food cues versus non-food cues. No changes in ratings of hunger an hour after beverage consumption were observed. Conclusions: These results may suggest a potential mechanism for diet soda to increase food palatability through activation of the reward system and suppression of inhibitory control that remains to be confirmed by future studies.

Longer-Term Impacts of Sugar-Sweetened Beverage Taxes on Fast-Food Beverage Prices: Evidence from Oakland, California, Two-Years Post-Tax

Objective: To evaluate the effect of a sugar-sweetened beverage (SSB) tax implemented in Oakland, California, in July 2017, on prices of beverages sold in fast-food restaurants 2-years post-tax. Design: Using a difference-in-differences (DID) approach, we analyzed beverage price data collected from fast-food restaurants 1-month pre-tax and 2-years post-tax in Oakland (intervention site) and Sacramento, California (comparison site). Separate linear regression models were used to estimate the impact of the tax on prices of bottled regular soda, bottled diet soda, bottled unsweetened beverages, and fountain drinks. Setting: Oakland and Sacramento, California, United States. Participants: Chain and non-chain fast-food restaurants (n 85). Results: DID estimates indicate that in fast-food restaurants, on average, the price of bottled regular soda increased by 1.44 cents/oz (95% CI 0.50, 2.73) (tax pass-through rate of 144%) and the price of bottled diet soda increased by 1.17 cents/oz (95% CI 0.07, 2.13). No statistically significant differences were found between bottled regular and diet soda price increases. Price effects for unsweetened beverages and fountain drinks were not statistically significant. Further, the estimated price change for fountain drinks was nearly zero. Conclusions: Findings suggest that the effectiveness of SSB taxes in discouraging SSB consumption may be limited in fast-food restaurants in Oakland, California because there were similar price increases in taxed and untaxed bottled soda and no changes in fountain drink prices.

Changes in Non-Nutritive Sweetener Consumption Patterns in Response to a Sugar-Sweetened Beverage Reduction Intervention

Data are lacking on whether non-nutritive sweeteners (NNS) can be used as a strategy to support decreases in sugar-sweetened beverage (SSB) consumption. The purpose of this secondary analysis of a 6-month SSB-reduction intervention was to explore changes in NNS consumption patterns in Talking Health participants within the SIPsmartER (n = 101) intervention. Additionally, participant characteristics were compared for three SSB-NNS change groups (decrease SSB/increase NNS; decrease SSB/no increase in NNS; increase/no change in SSB/regardless of NNS). There was a significant increase in aspartame and total NNS intake for participants (mean daily mg increases of 37.2 ± 13.9 and 63.7 ± 18.5, respectively). With the exception of sex, no differences in participant characteristics were found between the three SSB-NNS change groups. Furthermore, no significant changes in weight or body mass index (BMI) were demonstrated between SSB-NNS change groups over time. Diet soda was the most commonly consumed source of NNS; however, other dietary sources of NNS also contributed to intake. At 6 months, intake of sucralose and saccharin were primarily from dietary sources other than diet sodas (94% and 100%, respectively). These findings suggest that NNS may be a feasible strategy to help reduce SSB consumption. This study supports the need to consistently quantify and identify NNS intake, beyond using diet soda intake as a proxy for NNS intake and grouping all NNS types into one variable, to more accurately address the potential health effects of NNS.

An In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption

The need to reduce sugar-sweetened beverage (SSB) consumption is widely accepted, but whether artificially sweetened beverages (ASBs) are a recommended alternative is a growing policy issue because of emerging evidence of potential health effects associated with excess consumption. This study aimed to establish the extent of the Australian population’s knowledge of the risks associated with consuming SSBs (e.g., soda) and ASBs (e.g., diet soda), which is essential for identifying which facets of knowledge to target with public health interventions. A national computer-assisted telephone survey of 3430 Australian adults was conducted in 2017. The survey included a range of measures to test associations between SSB and ASB knowledge and beliefs, demographic characteristics, and soda and diet soda consumption. Participants had an overall awareness that there were health risks associated with SSB and ASB consumption, but they lacked more detailed knowledge of health effects and nutritional composition of these drinks. These knowledge gaps are concerning given that SSBs and ASBs are consumed in large quantities in Australia. Public health interventions targeting consumers’ limited knowledge and perceptions of health risks associated with excess sugar, calorie intake and artificial sweeteners are essential in reducing the health burden of obesity.

Higher Sugar-Sweetened Beverage Retail Prices After Excise Taxes in Oakland and San Francisco

Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California. Methods. We collected pretax (April–May 2017) and posttax (April–May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales. Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities. Conclusions. Within 4 to 10 months of implementation, Oakland’s and San Francisco’s SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.

Trends in Consumption of Sweet, Unsweetened and Alcoholic Beverages in Mexican Adults: 2006 to 2016

Objectives In the context of the introduction of the SSB tax in Mexico in 2014, we aimed to estimate national trends in the consumption of sweetened, unsweetened and alcoholic beverages in Mexican adults: 2006–2016. Methods We analyzed data from the FFQ-questionnaire of the National Surveys of Nutrition and Health 2006, 2012 and 2016. Beverages were classified as: plain water, regular soda, diet soda, sweetened or unsweetened dairy (i.e., atole, milk, latte), sweetened or unsweetened non-dairy (i.e., tea, industrialized flavour water, coffee), yogurt, juice and fruit beverages, and alcoholic beverages. Intake was collected as servings per day of 240 ml, except for yogurt set at 230 ml. Due to seasonal differences in FFQ administration, we adjusted the data from 2016 with a seasonal variation coefficient estimated using the correlation between the average montlhy sales in liters/per capita of the last 11 years. Analyzes were performed in Stata 14. Trends were assessed using multilevel linear regression models adjusted by survey design (module svy in stata), age, sex and the average temperature in the participant's municipality of residence. Results We analyzed dietary information of 29,952 Mexican adults. Consumption of plain water increased from 3.7 (4.79) servings/day in 2006 to 3.75 (1.49, P &lt; 0.05) in 2012, and to 4.85 (3.34, P &lt; 0.05) in 2016. The intake or regular soda increased from 0.76 (1.63) servings/day in 2006 to 0.86 (0.58, P &lt; 0.05) in 2012 and to 0.98 (1.27, P &lt; 0.05) in 2016. Juice and fruit beverages, decreased from 0.84 (1.71) in 2006 to 0.60 (0.51) in 2012, and increased to 1.01 (1.35, P &lt; 0.05) servings/day in 2016. Alcoholic beverages intake increased from 0.15 (0.78) in 2006, to 0.19 (0.29, P &lt; 0.05) in 2012 to 0.36 (1.01, P &lt; 0.05) in 2016. In contrast, the intakes of diet soda (0.02), dairy (0.32) and unsweetened non-dairy beverages (0.06) were not significantly different between 2012–2016, but lower than in 2006 (0.04,0.37,0.20, respectively, P &lt; 0.05). Conclusions In Mexican adults the estimated intake of water, regular soda, juice and alcoholic beverages kept increasing from 2006–2016, while the intakes of diet soda, dairy and unsweetened non-dairy beverages tended to decrease over this time-frame. A possible effect of the SSB tax on the replacement of soft drinks with water, juice and alcoholic beverages should be studied further. Funding Sources Fulbright-Comexus.

Associations of Maternal Non-Nutritive Sweetener Intake During Pregnancy with Childhood BMI Trajectory

Objectives To examine the extent to which non-nutritive sweetener (NNS; e.g., aspartame) intake during pregnancy is associated with offspring BMI z-score trajectory from birth to 15 years. Methods We included 1683 mother-child pairs from Project Viva, a prospective pre-birth-cohort recruited in 1999–2002 in Massachusetts. The main exposure was maternal NNS intake assessed in the 1st and 2nd trimesters of pregnancy using a food frequency questionnaire. We defined NNS as servings/day of diet soda + NutraSweet (aspartame packets) averaged across 1st and 2nd trimesters. We used linear regression models to examine associations of maternal NSS intake with offspring BMI z-score at each in-person research visit (birth, 6 months, 3 years, 7 years, and 12 years). We also used mixed-effects models to examine associations with BMI z-score trajectory from birth to 15 years, including both research and clinical measures of BMI for 1570 participants with ≥3 BMI z-score values. We adjusted all models for maternal pre-pregnancy BMI, age, race/ethnicity, education, parity, and pregnancy smoking status. Results 70% of mothers were white and mean (SD) pre-pregnancy BMI was 24.6 (5.2) kg/m2. Mean (SD; IQR) intake of NNS was 0.23 (0.55; 0.22) servings/day. While maternal NNS intake (per servings/day) was not associated with BMI z-score at birth (β −0.03 units; 95% CI −0.14, 0.08), NNS was associated with higher BMI z-score at 6 months (β 0.17; 0.06, 0.28), 3 years (β 0.13; 0.03, 0.24), 7 years (β 0.16; 0.04, 0.29) and 12 years (β 0.16; 0.01, 0.31). Based on the BMI z-score trajectory, the associations of NNS intake (Q4 vs. Q1) with BMI z-score became stronger with increasing age from 3–14 years (pinteraction with age: &lt;0.01); e.g., 3 years (β 0.13; 0.02, 0.23), 7 years (β 0.24; 0.11, 0.37) and 12 years (β 0.38; 0.20, 0.57). Conclusions Our findings showed higher maternal NNS intake during pregnancy was associated with higher BMI z-score from childhood to early adolescence, and the associations strengthened with increasing age. Funding Sources US National Institutes of Health (R01 HD034568, UH3 OD023286).