To estimate the effect of increased sugar-sweetened beverage (SSB) consumption on future adult obesity prevalence in South Africa in the absence of preventive measures.

A model was constructed to simulate the effect of a 2·4 % annual increase in SSB consumption on obesity prevalence. The model computed the change in energy intake assuming a compounding increase in SSB consumption. The population distribution of BMI by age and sex was modelled by fitting measured data from the 2012 South African National Income Dynamics Survey to the log-normal distribution and shifting the mean values.

Over the past decade the prevalence of obesity and related non-communicable diseases has increased in South Africa, as have the sales and availability of SSB. Soft drink sales in South Africa are projected to grow between 2012 and 2017 at an annual compounded growth rate of 2·4 % in the absence of preventive measures to curb consumption.

A 2·4 % annual growth in SSB sales alongside population growth and ageing will result in an additional 1 287 000 obese adults in South Africa by 2017, 22 % of which will be due to increased SSB consumption.

In order to meet the South African target of reducing the number of people who are obese and/or overweight by 10 % by 2020, the country cannot afford to delay implementing effective population-wide interventions. In the face of plans to increase growth of SSB, the country will soon face even greater challenges in overcoming obesity and related non-communicable diseases.

To examine the consumption of plain water among children in France and compare total water intakes with guidelines issued by the European Food Safety Authority (EFSA).

Nationally representative data were used to assess food, beverage and water consumption by sex, age group (4–8 years, 9–13 years), income-to-poverty ratio, eating occasion and location. Beverages were classified into nine groups: water (tap or bottled), milk, 100 % fruit juice, sodas, fruit drinks, hot beverages, sports drinks and flavoured waters. Total water volume in relation to energy intake (litres/kcal) was also examined.

INCA 2 study (Étude Individuelle Nationale des Consommations Alimentaires 2006–2007).

French children (n 835) aged 4–13 years.

Total water intakes were accounted for by plain water (34 %), beverages (26 %) and food moisture (40 %). Plain water could be tap (18 %) or bottled (16 %). Older children drank more plain water than did younger children and boys drank more plain water than did girls. No socio-economic gradient for plain water consumption was observed. About 90 % of children did not meet the EFSA water intake recommendations. The daily water shortfall ranged from 367 to 594 ml/d. Water-to-energy ratio was 0·75–0·77 litres/1000 kcal (4184 kJ). Children drank milk at breakfast and plain water during lunch and dinner. Caloric beverages provided 10 % of dietary energy; consumption patterns varied by eating location.

Total water intakes among young children in France were below EFSA-recommended levels. Analyses of beverage consumption patterns by eating occasion and location can help identify ways to increase water consumption among children.

To study the quantity and quality of water intake from beverages among pre-schoolers and investigate associations with gender and socio-economic status (SES).

Kindergarten-based cross-sectional survey within the large-scale European ToyBox-study. A standardized protocol was used and parents/caregivers filled in sociodemographic data and a semi-quantitative FFQ.

Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).

European pre-schoolers (aged 3·5–5·5 years) and their parents/caregivers (n 7051).

Mean water intake was 1051 ml/d; plain water, 547 ml/d; plain milk, 241 ml/d; other fruit juice, 104 ml/d; pure fruit juice, 59 ml/d; soft drinks, 55 ml/d; tea, 45 ml/d; sugared and chocolate milk, 37 ml/d; smoothies, 15 ml/d; and light soft drinks, 6 ml/d. Boys had a higher water intake than girls due to a higher consumption of plain water, but more importantly to the consumption of beverages of less quality. Lower-SES pre-schoolers scored better on quantity than high-SES pre-schoolers, but as a consequence of consumption of sugared beverages. Nevertheless, the associations differed by country.

The water intake from beverages did not meet the European Food Safety Authority standard of 1280 ml/d; especially in Western European countries water intake from beverages was low. The most important water sources were plain water, milk and fruit juices. Interventions aiming at a proper and sufficient water intake should focus on both quantity and quality. Messages about water and water sources should be clear for everyone and interventions should be sufficiently tailored.

Excessive free sugars consumption has a possible role in health issues, diet quality and obesity development. The present cross-sectional study aimed to identify the major food sources of free sugars in Greek children’s diet and investigate possible associations of dietary patterns with free sugars intake.

Anthropometric measurements and information on dietary and physical activity habits were obtained. Energy and free sugars intake coming from foods were estimated and principal components analysis was applied to identify dietary patterns.

The GRECO (Greek Childhood Obesity) study.

Nationwide sample of 3089 children (aged 10–12 years).

Adopting WHO criteria, 44·2 % of participants were categorized as having free sugars intake above 10 % of total energy intake. Mean contribution of free sugars to energy intake was 11·2 %, and the major food sources of free sugars differed from those of other childhood populations. Free sugars intake was not associated with overweight/obesity. Multiple linear regression analysis revealed that two lifestyle and dietary patterns, characterized by higher consumption of sweets, fast foods, fries, sugared drinks, frequently ordering/eating outside home and having meals in front of a screen (pattern 1) and higher consumption of whole fruits, 100 % fruit juices, vegetables, legumes and honey/jam (pattern 2), were positively associated with free sugars intake.

A large proportion of children exceeded the recommended cut-off and free sugars intake was associated with lifestyle patterns rather than single foods. Public health programmes aiming to reduce free sugars consumption should be tailored on promoting the correct dietary habits of specific childhood populations.

To fully understand the sugar-sweetened beverage (SSB) consumption status among Chinese young children and to explore its association with weight gain.

In this cross-sectional study, data on sociodemographic characteristics, SSB intake and weight/height were collected by means of face-to-face interviews. The intake of SSB among young Chinese children in relation to their age, different characteristics and types of SSB consumed is described, and the association between SSB intake and BMI-for-age Z-score and overweight is explored.

Seven large cities and two villages in China.

Nine hundred and forty-six healthy children, aged 3–7 years.

The proportion of SSB intake among Chinese young children was 80·5 %; 3·4 % were daily consumers, 34·0 % (31·4 %) consumed at least once per week (month). The per capita and per consumer SSB intake was 63·1 9 (sd 100·8) and 78·4 (sd 106·9) ml/d. Children from rural areas consumed twice, or even triple, the amount of SSB as those from urban areas (P<0·001) and great disparities existed between the types of SSB consumed by urban and rural children. An association was found between increased SSB intake and higher BMI-for-age Z-score (P<0·05) after adjusting for potential confounders; there was also an association between SSB intake and increased risk of being overweight or obese.

The consumption status of SSB in Chinese young children is of concern. There was a positive association between SSB intake and weight gain. Measures should be taken to improve the present situation of SSB consumption among Chinese young children.

To estimate reporting bias of WebCAAFE, a web-based questionnaire for the assessment of food intake (recall of frequency of intake of thirty-two food items the day before) and physical activity in schoolchildren.

Cross-sectional study. Self-reported food intake on WebCAAFE was compared with direct observation of school meals in five public schools. Additional data included school grade, sex, BMI, socio-economic status and access to Internet at home. Poisson regression was used to calculate the reporting bias (WebCAAFE v. direct observation) and the sample size necessary to detect a statistically significant difference between WebCAAFE reports and at least 75 % compliance with the recommendations for a healthy diet.

Intentional sample of five elementary public schools in Florianopolis, Brazil.

Schoolchildren (n 629) from 2nd to 5th grades.

Moderate bias magnitude was found for most food groups of interest. Frequency of consumption was not related to the bias. Sample sizes necessary to detect the compliance with dietary recommendations varied between four and seventy-four individuals for the different groups investigated.

After adjusting for moderate bias, WebCAAFE may be used as a food questionnaire for evaluation of schoolchildren’s food compliance on a group level, even with a relatively small sample size.

To evaluate the reliability and validity of the FFQ administered to participants in the follow-up of the Melbourne Collaborative Cohort Study (MCCS), and to provide calibration coefficients.

A random sample stratified by country of birth, age, sex and BMI was selected from MCCS participants. Participants completed two FFQ and three 24 h recalls over 1 year. Reliability was evaluated by intraclass correlation coefficients (ICC). Validity coefficients (VC) were estimated from structural equation models and calibration coefficients obtained from regression calibration models.

Adults born in Australia, Greece or Italy.

Nine hundred and sixty-five participants consented to the study; of these, 459 participants were included in the reliability analyses and 615 in the validity and calibration analyses.

The FFQ showed good repeatability for twenty-three nutrients with ICC ranging from 0·66 to 0·80 for absolute nutrient intakes for Australian-born and from 0·51 to 0·74 for Greek/Italian-born. For Australian-born, VC ranged from 0·46 (monounsaturated fat) to 0·83 (Ca) for nutrient densities, comparing well with other studies. For Greek/Italian-born, VC were between 0·21 (Na) and 0·64 (riboflavin). Calibration coefficients for nutrient densities ranged from 0·39 (retinol) to 0·74 (Mg) for Australian-born and from 0·18 (Zn) to 0·54 (riboflavin) for Greek/Italian-born.

The FFQ used in the MCCS follow-up study is suitable for estimating energy-adjusted nutrients for Australian-born participants. However, its performance for estimating intakes is poorer for southern European migrants and alternative dietary assessment methods ought to be considered if dietary data are to be measured in similar demographic groups.

To evaluate how well respondents perceive digital images of food portions commonly consumed in Greece.

The picture series was defined on the basis of usual dietary intakes assessed in earlier large-scale studies in Greece. The evaluation included 2218 pre-weighed actual portions shown to participants, who were subsequently asked to link each portion to a food picture. Mean differences between picture numbers selected and portions actually shown were compared using the Wilcoxon paired signed-rank test. The effect of personal characteristics on participants’ selections was evaluated through unpaired t tests (sex and school years) or through Tukey–Kramer pairwise comparisons (age and food groups).

Testing of participants’ perception of digital food images used in the Greek national nutrition survey.

Individuals (n 103, 61 % females) aged 12 years and over, selected on the basis of the target population of the Greek nutrition survey using convenience sampling.

Individuals selected the correct or adjacent image in about 90 % of the assessments and tended to overestimate small and underestimate large quantities. Photographs of Greek traditional pies and meat-based pastry dishes led participants to perceive the amounts in the photos larger than they actually were. Adolescents were more prone to underestimating food quantities through the pictures.

The digital food atlas appears generally suitable to be used for the estimation of average food intakes in large-scale dietary surveys in Greece. However, individuals who consistently consume only small or only large food portions may have biased perceptions in relation to others.

The present study aimed to evaluate the precision, ease of use and likelihood of future use of portion size estimation aids (PSEA).

A range of PSEA were used to estimate the serving sizes of a range of commonly eaten foods and rated for ease of use and likelihood of future usage.

For each food, participants selected their preferred PSEA from a range of options including: quantities and measures; reference objects; measuring; and indicators on food packets. These PSEA were used to serve out various foods (e.g. liquid, amorphous, and composite dishes). Ease of use and likelihood of future use were noted. The foods were weighed to determine the precision of each PSEA.

Males and females aged 18–64 years (n 120).

The quantities and measures were the most precise PSEA (lowest range of weights for estimated portion sizes). However, participants preferred household measures (e.g. 200 ml disposable cup) – deemed easy to use (median rating of 5), likely to use again in future (all scored either 4 or 5 on a scale from 1=‘not very likely’ to 5=‘very likely to use again’) and precise (narrow range of weights for estimated portion sizes). The majority indicated they would most likely use the PSEA preparing a meal (94 %), particularly dinner (86 %) in the home (89 %; all P<0·001) for amorphous grain foods.

Household measures may be precise, easy to use and acceptable aids for estimating the appropriate portion size of amorphous grain foods.

To evaluate the impact on food purchasing behaviour of the ‘Change4Life Smart Swaps’ campaign to encourage families to make small changes to lower-fat or lower-sugar versions of commonly eaten foods and drinks.

Quasi-experimental study comparing the proportion of swaps made by an intervention group (267 families who had signed up to the ‘Smart Swaps’ campaign promoted through various media, including television and radio advertising in early 2014) and a comparison group (135 families resident in Wales, signed up for ‘Change4Life’ materials, but not directly exposed to the ‘Smart Swaps’ campaign). During weeks 1, 2 and 3 of the campaign participants were asked to record their purchases of dairy products, carbonated drinks and breakfast cereals, using a mobile phone app questionnaire, when making a purchase within the category.

England and Wales.

Families registered with ‘Change4Life’.

In weeks 2 and 3 a significantly higher percentage of the intervention group had made ‘smart swaps’ than the comparison group. After week 3, 58 % of participants had swapped to a lower-fat dairy product compared with 26 % of the comparison group (P<0·001), 32 % of the intervention group had purchased a lower-sugar drink compared with 19 % of the comparison group (P=0·01), and 24 % had made a change to a lower-sugar cereal compared with 12 % of the comparison group (P=0·009).

In the short term a national campaign to change purchase habits towards healthier products may have some merit but the sustainability of change requires further investigation.

Children may influence household spending through ‘pester power’. The present study examined pestering through parent–child food shopping behaviours in relation to children’s diet and weight status.

Cross-sectional and prospective analyses drawn from the IDEFICS study, a cohort study of parents and their children. Children’s height and weight were measured and their recent diets were reported by parental proxy based on the Children’s Eating Habits Questionnaire-FFQ at baseline and 2-year follow-up. Parents also completed questionnaires at both time points about pestering, including whether the child goes grocery shopping with them, asks for items seen on television and is bought requested food items.

Participants were recruited from eight European countries for the IDEFICS study (non-nationally representative sample).

Study participants were children aged 2–9 years at enrolment and their parents. A total of 13 217 parent–child dyads were included at baseline. Two years later, 7820 of the children were re-examined.

Most parents (63 %) at baseline reported ‘sometimes’ acquiescing to their children’s requests to purchase specific foods. Pestering was modestly associated with weight and diet. At baseline, children whose parents ‘often’ complied consumed more high-sugar and high-fat foods. Children who ‘often’ asked for items seen on television were likely to become overweight after 2 years (OR=1·31), whereas ‘never’ asking protected against overweight (OR=0·72).

Pestering was modestly related to diet and weight in cross-sectional, but not longitudinal analyses. Asking for items seen on television had the most robust relationships across child outcomes and over time.

Restaurants are playing an increasingly important role in children’s dietary intake. Interventions to promote healthy ordering in restaurants have primarily targeted adults. Much remains unknown about how to influence ordering for and by children. Using an ecological lens, the present study sought to identify sources of influence on ordering behaviour for and by children in restaurants.

A mixed-methods study was conducted using unobtrusive observations of dining parties with children and post-order interviews. Observational data included: child’s gender, person ordering for the child and server interactions with the dining party. Interview data included: child’s age, restaurant visit frequency, timing of child’s decision making, and factors influencing decision making.

Ten independent, table-service restaurants in San Diego, CA, USA participated.

Complete observational and interview data were obtained from 102 dining parties with 150 children (aged 3–14 years).

Taste preferences, family influences and menus impacted ordering. However, most children knew what they intended to order before arriving at the restaurant, especially if they dined there at least monthly. Furthermore, about one-third of children shared their meals with others and all shared meals were ordered from adult (v. children’s) menus. Parents placed most orders, although parental involvement in ordering was less frequent with older children. Servers interacted frequently with children but generally did not recommend menu items or prompt use of the children’s menu.

Interventions to promote healthy ordering should consider the multiple sources of influence that are operating when ordering for and by children in restaurants.

To combat childhood obesity, researchers have focused on parental feeding practices that promote child health. The current study investigated how parenting style relates to twelve parental feeding practices.

Data on parenting style and parental feeding practices were obtained for a correlational study from users of Amazon’s Mechanical Turk, an online survey system.

USA.

Mothers of children aged 7–11 years (n 193).

Parenting style related differentially to eleven out of the twelve measured practices. Authoritative mothers displayed more feeding practices that promote child health and fewer practices that impede child health. Authoritarian and permissive mothers displayed more unhealthy practices than authoritative mothers, but differed from each other on the practices they employed.

Parenting style may relate to more aspects of feeding than previously realized. The inclusion of numerous healthy feeding practices along with unhealthy practices in the current study provides suggestions for the application of healthy feeding behaviours. Instruction on feeding behaviours and parenting style should be a focus of future educational programmes.

Little is known about whether siblings have similar or different eating behaviours or whether parents tailor their feeding practices to different siblings. The main objectives of the present study were to examine similarities and differences in child eating behaviours and parental feeding practices with siblings and to determine whether child eating behaviours and parental feeding practices differ depending on sibling concordant (i.e. both siblings overweight or healthy weight) or discordant (i.e. one sibling overweight and one sibling healthy weight) weight status.

Cross-sectional, mixed-methods study.

In-home visits were conducted by research staff. Surveys were conducted with parents and anthropometry was collected on parents and siblings.

Children (n 88) aged 6–12 years (mean age 9 (sd 2) years), their parents (mean age 34 (sd 7) years) and near-age siblings (mean age 9 (sd 4) years) from diverse racial/ethnic and low-income households participated.

Results indicated that siblings with higher BMI engaged in higher levels of emotional eating compared with siblings with lower BMI. Additionally, results indicated that when families had sibling dyads discordant on weight status, the sibling who was overweight had higher food enjoyment and lower levels of food satiety. Additionally, within siblings with discordant weight status, parents were more likely to use restrictive feeding practices with the overweight sibling and pressure-to-eat and encouragement-to-eat feeding practices with the healthy-weight sibling.

Family-based childhood obesity interventions may need to assess for sibling weight status when researching the home environment and intervene with parents to avoid using restriction or pressure-to-eat feeding practices when siblings are discordant on weight status.

To examine the association between added sugar intake and metabolic syndrome among adolescents.

Dietary, serum biomarker, anthropometric and physical activity data from the US National Health and Nutrition Examination Survey cycles between 2005 and 2012 were analysed using multivariate logistic regression models. Added sugar intake in grams per day was estimated from two 24 h standardized dietary recalls and then separated into quintiles from lowest to highest consumption. Multivariate logistic regression analyses were adjusted for physical activity, age, BMI Z-score and energy intake, and their interactions with race were included.

Nationally representative sample, USA.

US adolescents aged 12–19 years (n 1623).

Added sugar was significantly associated with metabolic syndrome. The adjusted prevalence odds ratios for having metabolic syndrome comparing adolescents in the third, fourth and fifth quintiles v. those in the lowest quintile of added sugar were 5·3 (95 % CI 1·4, 20·6), 9·9 (95 % CI 1·9, 50·9) and 8·7 (95 % CI 1·4, 54·9), respectively.

Our findings suggest that higher added sugar intake, independent of total energy intake, physical activity or BMI Z-score, is associated with increased prevalence of metabolic syndrome in US adolescents. Further studies are needed to determine if reducing intake of added sugar may help US adolescents prevent or reverse metabolic syndrome.

The prevalence of asthma is rising, presenting serious public health challenges. Recent data suggest that sugar-sweetened beverage (SSB) consumption plays a role in asthma aetiology. The purpose of the present study was to determine whether SSB consumption is linked to post-exercise airway narrowing (predictor of asthma development) across puberty.

Participants completed pulmonary function tests, physical activity and dietary habit questionnaires, and an exercise test to exhaustion.

Community in Manhattan, Kansas, USA.

We recruited ten boys and ten girls from an original cohort of forty participants tested in our laboratory approximately 5 years prior. Participants were aged 9·7 (sd 0·9) years at baseline and 14·7 (sd 0·9) years at follow-up.

Pre-puberty, boys consumed 6·8 (sd 4·8) servings/week and girls consumed 6·9 (sd 3·7) servings/week, while post-puberty boys consumed 11·5 (sd 5·3) servings/week and girls consumed 7·7 (sd 4·3) servings/week. Using Pearson correlation, SSB consumption was not significantly related to post-exercise airway narrowing at pre-puberty (r=−0·35, P=0·130). In linear regression analyses, SSB consumption was significantly related to post-exercise airway narrowing post-puberty before (standardized β=−0·60, P=0·005) but not after (standardized β=−0·33, P=0·211) adjustment for confounders. Change in SSB consumption from pre- to post-puberty was significantly associated with post-exercise airway narrowing post-puberty (r=−0·61, P=0·010) and change in post-exercise airway narrowing from pre- to post-puberty (r=−0·45, P=0·048) when assessed via Pearson correlations.

These findings suggest a possible link between SSB consumption and asthma development during maturation. Reduced SSB intake may be a possible public health avenue for blunting rising asthma prevalence.

To study diet quality among pre-schoolers using the Diet Quality Index (DQI) and to investigate differences according to gender, socio-economic status (SES) and overweight/obesity status.

Kindergarten-based cross-sectional survey within the ToyBox-study. A standardized protocol was used and parents/caregivers self-reported sociodemographic data and a semi-quantitative FFQ. A total DQI and its four subcomponents (diversity, quality, equilibrium and meal index) were calculated based on this FFQ. High total DQI scores indicate better diet quality than low scores. Results of the total DQI and the subcomponents were reported as percentages of maximum scores (100 %).

Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).

European pre-schoolers (aged 3·5–5·5 years) and their parents/caregivers (n 7063).

The mean total DQI score was 68·3 %. Mean scores of the subcomponents were 61·7 % for diversity, 56·5 % for quality, 65·4 % for equilibrium and 89·7 % for the meal index. Pre-schoolers of lower-SES backgrounds had lower scores on the total DQI and all its subcomponents. No clear differences were found by gender and overweight status. Results differed slightly according to country.

Pre-schoolers scored low on the total DQI and especially on dietary quality, as energy-dense, low-nutritious food items were more often consumed than highly nutritious food items. Furthermore, already in pre-schoolers lower-SES mothers were less likely to provide a good diet quality and this was consistent for all four subcomponents of the total DQI. Food intake in pre-schoolers should be enhanced, especially in pre-schoolers of lower-SES backgrounds.

The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations.

The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institute’s Automated Self-Administered 24 h Recall system.

Meal and snack time at 108 child-care centres in low-income communities in NYC.

Children aged 3–4 years old in classrooms selected by the directors of the participating child-care centres.

Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were <30 % of the DRI. Foods and beverages provided >50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %.

Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve children’s diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations.

Food insecurity increases risk of health conditions that may decrease military readiness. The aim of the present study was to define the prevalence of food insecurity among households with young children utilizing military installation childcare facilities and to describe household characteristics associated with food insecurity among this population.

Cross-sectional survey including demographic questions and the US Department of Agriculture Food Security Survey Module six-item short form given to households (n 248) enrolled in Joint Base San Antonio Child Development Centers (JBSA-CDC) during the spring of 2015.

Department of Defense families with at least one child less than 6 years old enrolled in a JBSA-CDC.

Joint Base San Antonio, TX, USA.

Nearly one in seven families reported food insecurity. Households were more likely to be food-insecure if the head of household’s highest level of education was high school or equivalent (P=0·003) and if the head of household was unmarried/unpartnered (P=0·001). Among food-insecure households headed by military service members, all were junior enlisted or non-commissioned officers (E1–E9). Food-insecure households were less likely to live off-post in owned or rented homes compared with those who were food-secure (P=0·016). Other characteristics associated with food insecurity included at least one family member enrolled in the Exceptional Family Member Program (P=0·020) and more children in the household (P=0·029). Few families reported enrolment in government supplemental food programmes.

Food insecurity is prevalent in military families. Targeted interventions and policies can be developed using the demographic risk factors identified in the present study.