Association of Dietary Sugars and Sugar-Sweetened Beverage Intake with Obesity in Korean Children and Adolescents

Few studies have examined the association between dietary sugar intake and obesity in Asian children and adolescents. We evaluated the association of dietary sugar intake and its food source with obesity in Korean children and adolescents. In this cross-sectional analysis, data were obtained from five studies conducted between 2002 and 2011. The study included 2599 children and adolescents who had completed more than three days of dietary records and had anthropometric data. Total sugar intake was higher in girls than in boys (54.3 g for girls and 46.6 g for boys, p < 0.0001). Sugar intake from milk and fruits was inversely associated with overweight or obesity in girls only (OR for overweight, 0.52; 95% CI, 0.32–0.84; p for trend = 0.0246 and OR for obesity, 0.42; 95% CI, 0.23–0.79; p for trend = 0.0113). Sugar-sweetened beverage (SSB) consumption was not associated with obesity in girls, while boys had lower odds ratios for obesity (OR for obesity, 0.52; 95% CI, 0.26–1.05; p for trend = 0.0310). These results suggest that total sugars and SSB intake in Asian children and adolescents remains relatively low and sugar intake from milk and fruits is associated with a decreased risk of overweight or obesity, especially in girls.     

The estimated daily manganese intake of Korean children aged 11-12

The purpose of this study was to estimate the daily manganese (Mn) intake of Korean children. This study was done using a three-day dietary intake survey of 257 Korean children (boys 123; girls 134). The Mn intake values were calculated based on a database that provides the Mn content of the frequently consumed Korean foods, alongside the food composition table provided by the Korean National Rural Living Science Institute. The average age, height, weight and body mass index of our subjects were 11.9 years, 155.4 cm, 48.9 kg and 20.2 kg/m² in boys and 11.9 years, 154.1 cm, 43.5 kg and 18.3 kg/m² in girls. The average daily energy intakes were 2,249.2 kcal in boys and 2,044.5 kcal in girls. Boys consumed significantly more Mn than girls, based on intake estimates of 4,585.3 µg (117.6% of adequate intake) and 4,029.3 µg (117.1% of adequate intake), respectively (P < 0.001). Boys had a Mn intake of 2,041.1 µg per 1,000 kcal of energy consumption, whereas for girls this was at 1,983.9 µg per 1,000 kcal. Neither group exceeded the tolerable upper intake level for Mn. The major food groups which contributed to Mn intake in our subjects were cereals (50.8%), vegetables (21.0%), seasonings (8.9%), and pulses (7.7%). Notably, boys derived a higher Mn intake through cereals and vegetable than did girls (P < 0.001, P < 0.05). The key food sources of Mn, in descending order, were rice, soybean curd, kimchi, black rice and cereals. We propose that the results of our study may be used as a basis for follow-up studies that examine the Mn intake of children.     

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity

ObjectiveTo investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents.DesignCross-sectional analysis of a randomized control trialSettingEighteen middle schools in Miami-Dade County, Florida.ParticipantsTwo-hundred and eighty Hispanic seventh- and eighth-grade studentsMain Outcome MeasuresPhysical activity, fruit and vegetable intake, and added sugar intake.AnalysisStructural equation modeling.ResultsThe findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (β = .30; P = .001; 95% confidence interval [CI], 0.52–2.68) and physical activity in girls (β = .26; P = .010; 95% CI, 0.16–1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [β= .18; P = .039; 95% CI, 0.02–2.60] but had a moderating effect on fruit and vegetable consumption in girls (β = .21; P = .015; 95% CI, 0.14–2.19).Conclusions and ImplicationsFamily mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.     

Parent–Child Associations in Selected Food Group and Nutrient Intakes among Overweight and Obese Adolescents

Few studies have compared parent–child dietary intake among adolescents who are overweight or obese. The purpose of our study was to determine the relationship between parent–teen intake of selected dietary components among this sample. Baseline data from 165 parent and adolescent (aged 11 to 16 years) pairs who presented for a lifestyle behavior modification intervention were collected between 2010 and 2012. Parent and adolescent dietary intake (servings of fruits and vegetables [F/V]; grams of sugar; and percent energy from total fat, saturated fat, dessert/treats, sugar-sweetened beverages, and snacks) was assessed using web-based 24-hour dietary recalls. Multivariable linear and negative binomial regression models identified associations between parent and child dietary intake adjusting for relevant covariates. A large proportion of adolescents and parents did not meet dietary recommendations for F/V, total fat, and saturated fat. Parent–adolescent intake of F/V, total fat, saturated fat, sugar, sugar-sweetened beverages, and snacks were positively associated (r=0.19 to 0.37). No relationship was observed for dessert/treats. In multivariate models, significant interaction effects suggest that the parent–child association in diet was weaker for fat intake among parents with higher educational attainment (b=–.31; P<0.05) and for snacking among adolescent boys (b=–.30; P<.05). Parent intake of several dietary components important for good health, and related to obesity, was associated with adolescent intake. Helping parents improve their diet may promote improvements in their adolescent's diet and is a potential target for interventions designed to increase healthy eating among adolescents.     

Weight-control behaviors among adolescent girls and boys: implications for dietary intake

OBJECTIVE: To examine associations between healthful and unhealthful weight-control behaviors and dietary intake among adolescents. DESIGN: Cross-sectional survey (Project EAT [Eating Among Teens]).Subjects/Setting The study population included 4144 middle and high school students from Minneapolis/St. Paul public schools from diverse racial and socioeconomic backgrounds.Statistical analyses Dietary intake patterns were compared across adolescent girls and boys reporting unhealthful, only healthful, or no weight-control behaviors in unadjusted analyses and analyses adjusted for sociodemographic factors and energy intake. RESULTS: Among girls, mean intakes differed across weight-control behaviors for all foods and nutrients examined. P values ranged from P=.006 to P<.001. Girls using unhealthful weight-control behaviors had significantly lower intakes of fruit; vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc than girls using only healthful weight-control behaviors. Compared with girls reporting no weight-control behaviors, girls using unhealthful weight-control behaviors had lower intakes of grains, calcium, iron, vitamin B-6, folate, and zinc. In contrast to the girls, boys reporting unhealthful weight-control behaviors did not have poorer dietary intakes than boys not using weight-control behaviors or using only healthful behaviors. Among boys, there were no significant differences in mean intakes of vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc. Furthermore, boys using unhealthful weight-control behaviors had higher fruit intakes (P=.002) than boys reporting no weight-control behaviors. CONCLUSIONS: Adolescent girls who engage in unhealthful weight-control behaviors are at increased risk for dietary inadequacy. The findings demonstrate a need for interventions to prevent unhealthful weight-control behaviors in adolescent girls, and to promote healthful weight-control behaviors when indicated.     

Dietary patterns of obese high school girls: snack consumption and energy intake

In order to develop an obesity management program for teenagers, we compared obese and non-obese girls attending high schools in terms of their dietary practices related to snack consumption. Dietary records were collected for 7 days. No significant differences were found for the average daily energy intake between obese and non-obese girls. However, the highest energy intake was greater for obese girls while not much difference was found for the lowest amount of energy intake. Obese girls had significantly lower intakes in calcium (P < 0.01), vitamin A (P < 0.001) and folate (P < 0.01). Mean energy intake from snack (594.1 ± 312.1kcal) was significantly higher for obese girls than for non-obese girls (360.1 ± 173.1kcal) (P < 0.001). A significant, positive correlation was observed between energy intake from snack and total daily energy intake (r = 0.34 P < 0.01) only for obese girls. In case of dietary behaviors, obese adolescent girls consumed significantly greater number of items for snacks and fewer foods for regular meals compared to non-obese girls (P < 0.05). This study suggested that obesity management programs for adolescents should focus on providing strategies to reduce snack through enhancing balanced regular meals.     

Correlation between attention deficit hyperactivity disorder and sugar consumption, quality of diet, and dietary behavior in school children

This study investigated the correlation between consumption of sugar intake by fifth grade students in primary schools and development of Attention Deficit Hyperactivity Disorder (ADHD). A total of 107 students participated, and eight boys and one girl (8.4% of the total) categorized as high risk for ADHD according to diagnostic criteria. There were significant differences in the occupations and drinking habits of the respondents'' fathers between the normal group and risk group. In a comparison of students'' nutrition intake status with daily nutrition intake standards for Koreans, students consumed twice as much protein as the recommended level, whereas their calcium intake was only 60% of the recommended DRI (dietary reference intake). Regarding intake volume of vitamin C, the normal group posted 143.9% of the recommended DRI, whereas the risk group showed only 65.5% of the recommended DRI. In terms of simple sugar intake from snacks, students in the normal group consumed 58.4 g while the risk group consumed 50.2 g. These levels constituted 12.5% of their total daily volume of sugar intake from snacks, which is higher than the 10% standard recommended by the WHO. In conclusion, children who consumed less sugar from fruit snacks or whose vitamin C intake was less than RI was at increased risks for ADHD (P < 0.05). However, no significant association was observed between total volume of simple sugar intake from snacks and ADHD development.     

Food patterns of Australian children ages 9 to 13 y in relation to ω-3 long chain polyunsaturated intake

ObjectiveThe aim of this study was to examine food patterns of Australian children ages 9 to 13 y in relation to ω-3 long-chain polyunsaturated fatty acid (ω-3 LCPUFA) intake.MethodsSecondary analysis was conducted on nationally representative food data of 1110 Australian children ages 9 to 13 y (525 boys and 585 girls) that was obtained using two 24-h recalls. Principle component factor analysis was used to identify food patterns. Discriminant function analysis was used to identify the relationship between the food patterns and total ω-3 LCPUFA intake.ResultsFour major food patterns emerged for each sex. For boys these were labeled: “snack foods,” “soft drinks,” “vegetables,” and “pork and meat chops, steak, and mince.” For girls they were labeled: “vegetables,” “take-away,” “tea, coffee, iced coffee drinks” and “canned meals and soup.” Fish consumption bought from take-away outlets was more frequently consumed in the “soft drink” (r = 0.577) and take-away (r = 0.485) food pattern in boys and girls, respectively. In contrast, fish prepared at home was more often consumed in “vegetables” in both boys (r = 0.018) and girls (r = 0.106), as well as in the “pork and meat chops, steak and mince” food pattern in boys (r = 0.060). There was a trend that in boys, the “vegetables” group discriminated children who consumed ω-3 LCPUFA levels similar to adequate intakes (AI) (P = 0.067), whereas in girls, the take-away food pattern discriminated for being a fish consumer (P = 0.060).ConclusionsDietary patterns associated with a high consumption of vegetables and “take-aways” food that include meat and fish are likely to positively influence dietary ω-3 LCPUFA intake in Australian children.     

Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City

Objective: This study aimed to describe food and nutrient intake for low-income, urban African American children and adolescents, to highlight the need for further nutrition intervention programs and appropriate tools to address overweight and obesity.

Methods: This was a cross-sectional study using interviewer-administered single 24-hour dietary recalls. Participants were low-income African American boys and girls aged 5–16 years or their caregivers in Baltimore City. Frequency of food consumption and dietary intakes were analyzed by gender and age groups.

Results: Eighty-one participants were included for analysis. Mean daily energy intakes exceeded Dietary Reference Intakes (DRIs) from 10% to 71% across all gender-age groups: 2304 kcal for children aged 5–8 years; 2429 kcal and 2732 kcal for boys and girls aged 9–13 years, respectively; and 3339 kcal and 2846 kcal for boys and girls aged 14–16 years, respectively. The most frequently reported consumed foods were sweetened drinks, chips, candies, and milk across all age groups. The majority of participants (79–100%) did not meet the DRIs for dietary fiber and vitamin E across all gender-age groups. Milk accounted for 14%, 17%, and 21% of energy, fat, and protein intake, respectively, among children 5–8 years of age, while pizza was the top source of energy, fat, and protein (11%, 13%, and 18%, respectively) among 14-to 16-year-old adolescents. Sweetened drinks and sweetened juices were major sources of sugar, contributing 33% for 5–8 year olds, 29% for 9–13 year olds, and 35% for 14–16 year olds.

Conclusions: Mean daily energy intake exceeded dietary recommendations across all gender-age groups. This study has provided previously unavailable information on diet and highlights foods to be targeted in nutrition intervention programs.     

Do types of snacks,sleep hours,and eating places affect nutritional intakes and its adequacy in adolescents?

BACKGROUND/OBJECTIVESHigh-quality meal intake, including snacks, is necessary for optimal development during adolescence. The purpose of this study was to evaluate the nutritional intake of adolescents and the quality of their diet according to snack type, eating location, and sleep hours.SUBJECTS/METHODSA survey of middle school students living in Seoul and Gyeonggi province was conducted using questionnaires and the 24-h recall method to collect data on the 1-day dietary intake of the students from March to May, 2018. The data were analyzed using SPSS 23.0 and the CAN program.RESULTSThe average nutritional intake status among the respondents showed that the energy intake was lower than the recommended, showing 1,914.8 kcal for middle school boys and 1,752.7 kcal for girls. In terms of the nutritional intake status by gender, only the consumption of protein and niacin were significantly higher in boys than girls (P < 0.05). According to the sleep amounts, vitamin C intake was significantly higher in the sleep-deprived group than in the sleep-moderate or sleep-recommended group (P < 0.05), but the intake did not meet the recommendation in any group. The lower density nutrients found in the index of nutritional quality according to eating places were vitamin C, calcium, iron, and folic acid. School meals showed a higher nutritional density in protein, vitamin B₁, and niacin compared to convenience store meals (P < 0.05).CONCLUSIONSThis study suggested that sleep amount, and eating place affected the dietary quality of adolescents.     

Adolescent Consumption of Sports and Energy Drinks: Linkages to Higher Physical Activity,Unhealthy Beverage Patterns,Cigarette Smoking,and Screen Media Use

ObjectiveTo examine patterns of adolescent sports and energy drink (SED) consumption and identify behavioral correlates.DesignData were drawn from Eating and Activity in Teens, a population-based study.SettingAdolescents from 20 middle and high schools in Minneapolis/St Paul, MN completed classroom-administered surveys.ParticipantsA total of 2,793 adolescents (53.2% girls) in grades 6–12.Variables MeasuredBeverage patterns; breakfast frequency; moderate to vigorous physical activity (MVPA); media use; sleep; and cigarette smoking.AnalysisLinear and logistic regression models were used to estimate associations between health behaviors and SED consumption, adjusting for demographics.ResultsOver a third of adolescents consumed sports drinks and 14.7% consumed energy drinks at least once a week. Among boys and girls, both sports and energy drink consumption were related to higher video game use; sugar-sweetened beverage and fruit juice intake; and smoking (P < .05). Sports drink consumption was also significantly related to higher MVPA and organized sport participation for both genders (P < .01).Conclusions and ImplicationsAlthough sports drink consumption was associated with higher MVPA, adolescents should be reminded of recommendations to consume these beverages only after vigorous, prolonged activity. There is also a need for future interventions designed to reduce SED consumption, to address the clustering of unhealthy behaviors.     

Food and nutrient intakes of a population sample of 7-year-old children in the south-west of England in 1999/2000 – what difference does gender make?

Objectives To describe the diet of schoolchildren aged 7 years, and identify gender differences in food and nutrient intakes. Subjects A cohort of children resident in the south-west of England in 1999/2000. Methods Diet was assessed using three 1-day unweighed food diaries. Nutrient intakes were compared with dietary reference values for this age group, and with children aged 7–10 years in the British National Diet and Nutrition Survey. Food and nutrient intakes were contrasted between boys and girls. Results Median nutrient intakes exceeded the reference nutrient intake (RNI) for most nutrients. Median intakes of iron and zinc were below the RNI. Median sodium intake was greater than the maximum set by the Scientific Advisory Committee on Nutrition. The mean energy intake for boys and girls, respectively, were 7.3 and 6.8 MJ, this is below the estimated average requirement. The percentage of energy from fat was 35.3% for boys and 36.1% for girls. Boys had higher iron intakes than girls, even after adjustment for energy intake. There were differences in the types of foods eaten between boys and girls; girls ate more fruit and vegetables (P = 0.001) and boys ate more breakfast cereals (P = 0.016). Conclusions The dietary intakes of these 7-year-old children were adequate for most nutrients. However, a reduction in the sodium content of the diet would be advantageous. Fruit and vegetable consumption should be encouraged particularly among boys.     

Dietary patterns and C-peptide concentrations in a Japanese working population

ObjectiveIt remains unsettled whether dietary patterns play a role in insulin resistance. We assessed the association of major dietary patterns with C-peptide concentrations in a Japanese working population.MethodsA cross-sectional study was conducted in 456 municipal employees (270 men and 186 women) 21 to 67 y old who participated in a health survey at the time of their periodic checkup. The dietary patterns were derived by using the principal component analysis of the consumption of 52 food and beverage items, which was assessed by a validated brief dietary history questionnaire. Multiple regression analysis was used to estimate the means of C-peptide concentrations across tertiles of each dietary pattern score with the adjustment of potential confounders, including age, body mass index, physical activity, smoking, alcohol drinking, and energy intake.ResultsWe identified three dietary patterns: healthy, animal food, and Westernized breakfast patterns. The Westernized breakfast pattern was characterized by high intakes of bread, confectionaries, and milk and yogurt but low intakes of rice and alcohol and was inversely associated with C-peptide concentrations in women but not in men. The multivariable-adjusted means of C-peptide concentrations were 1.03 ng/mL (95% confidence interval 0.95–1.12), 0.95 ng/mL (95% confidence interval 0.88–1.03), and 0.89 ng/mL (95% confidence interval 0.82–0.97) for the lowest through the highest tertiles of the Westernized breakfast pattern score (P for trend = 0.015) in women. Other dietary patterns were not appreciably associated with C-peptide concentrations. In a subgroup, similar associations were observed between dietary patterns and the homeostasis model assessment of insulin resistance.ConclusionThe Westernized breakfast pattern may be associated with a lower insulin resistance in Japanese women.     

Dietary Intake Patterns of Low-Income Urban African-American Adolescents

Unhealthy eating increases risks for chronic disease. Few studies have examined the multifaceted aspects of dietary intake of low-income, urban African-American adolescents. This study aimed to describe dietary patterns including energy, nutrients, food groups, and diet quality and to identify areas to guide future interventions. Baseline data for a school-based obesity prevention study were collected from 382 African-American adolescents (10- to 14-year-olds) from four Chicago, IL, public schools in 2003. Diet was assessed using a 152-item food frequency questionnaire. Diet quality was measured using a modified version of the US Department of Agriculture Healthy Eating Index (HEI) and compared to published estimates for a nationwide sample. Participants reported high energy intakes and several unhealthy eating patterns: 58.6% consumed one or more servings of sweetened beverages per day and 15.7% consumed three or more servings per day; average fried food consumption was high (1.4 servings/day), 58.4% consumed one or more serving per day; and 75% consumed three or more three snacks per day. Only 49% of participants met the recommended three servings of dairy foods per day. Compared to a national, mostly white sample, participants had lower HEI scores (P<0.05); mean score was 66.0±12.8 (100=maximum HEI score) vs 70.3±13.0 in boys vs girls, one third had scores <60 (“needs improvement”) and only 15% scored >80 (“good”). This study reveals key areas of problematic dietary patterns for future interventions targeting low-income African-American adolescents, including frequent intakes of calorie-dense, low nutrient-rich foods, such as fried foods, snacks, and sweetened beverages.     

Preservation of a traditional Korean dietary pattern and emergence of a fruit and dairy dietary pattern among adults in South Korea: secular transitions in dietary patterns of a prospective study from 1998 to 2010

Transitions in nutrition patterns tend to emerge through industrialization and economic development. We hypothesized that the dietary patterns among South Korean adults who were 20 years or older have changed significantly from 1998 to 2010. Herein, a repeated cross-sectional analysis of data was followed for 140 601 adults. We noted changes in consumption, after adjusting for age, sex, body mass index, and exercise, and tested the trends across the study period. Factor and cluster analyses were used to derive dietary patterns. A decrease in traditional Korean food consumption, including cereals, vegetables (252-176 g), and Kimchi (127-82 g), occurred, whereas fruit (172-252 g), egg, and fried food intakes increased (P < .05). Total daily energy intake declined steadily from 1931 in 1998 to 1691 kcal in 2010. Carbohydrate intakes were unchanged over the study period; however, fat-derived energy intake increased slightly from 19.7% to 20.0% (P < .05). Our factor and cluster analyses identified 3 dietary patterns: “Korean” diet (rice, vegetables, and Kimchi), “Western” diet (soda, eggs, and oil), and “New” diet (low sugar and high fruit and dairy product intakes). Compared to 1998, approximately 40% of participants still followed a Korean diet in 2010. Interestingly, the popularity of the Western diet fell by approximately 20%, whereas the new diet pattern increased 2-fold over the study period. Overall, these data show secular trends in dietary patterns that included a preservation of the traditional Korean diet and the emergence of a new diet pattern, and it demonstrated a unique transition in food and nutrient intakes in Korea.     

The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls

BackgroundChildren in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood.ObjectiveThe current study examined associations between snacking and children’s diet quality along with differences across ethnicity or race, sex, and weight status.DesignCross-sectional data came from Phase I of the Family Matters Study, an observational study.Participants/settingThis study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis–Saint Paul, MN in 2017-2018.Main outcome measuresTotal daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls.Statistical analyses performedConditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only.ResultsAmong boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children’s consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds.ConclusionsFindings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children’s food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.     

Perceived Stress and Eating Behaviors by Sex,Obesity Status,and Stress Vulnerability: Findings from the Vitamins and Lifestyle (VITAL) Study

Stress has been associated with eating patterns in human studies with differences due to the type and duration of stressor, type of food, and individual susceptibility factors. Laboratory and smaller epidemiological studies have reported stress-associated preferences for foods high in sugar and fat; associations have been found more consistently among women and people who are obese. Larger studies are needed to sufficiently test these relationships. The aim of this study was to evaluate associations between self-reported amount of stress and dietary nutrient intakes (percentage energy from fat, carbohydrates, added sugar) and dietary behaviors (number of eating occasions and servings of fruits and vegetables, high-fat snacks, fast-food items, and sweetened drinks) by sex, obesity status, and stress vulnerability. Linear regression was used to estimate associations of perceived stress with eating patterns among 65,235 older adults while adjusting for demographic factors, body mass index, physical activity, alcohol intake, number of comorbidities, and other relevant covariates. Higher perceived stress was associated with greater intake of energy from fat, high-fat snacks, and fast-food items as well as lower intake of energy from carbohydrates (all P for trend ≤0.002). Among those with high perceived stress vulnerability, perceived stress was associated with fewer eating occasions (P for interaction <0.0001). Although associations were small, significant relationships were found for perceived stress arising from everyday experiences among an older, mostly white population. These findings have public health implications and suggest that stress may be important to consider in programs promoting healthy eating.     

Association of Dietary Patterns with Weight Status and Metabolic Risk Factors among Children and Adolescents

Unhealthy dietary patterns are associated with obesity in children and adolescents. However, few studies have investigated the relationships between dietary patterns and obesity-related metabolic disorders among Asians. We identified dietary patterns in children and adolescents and examined the associations between these patterns and obesity, insulin resistance, and metabolic syndrome in South Korea. This study is a cross-sectional design. We used baseline data from an intervention study of 435 Korean children and adolescents aged 6–17 years. Insulin resistance was assessed as HOMA-IR ≥ 2.6. Metabolic syndrome was diagnosed by cardiovascular disease risk factor clustering. Dietary intakes were estimated using 3-day food records. Factor analysis was used to obtain dietary patterns, and we examined the associations between dietary patterns and obesity-related markers adjusted for potential covariates. Three dietary patterns were identified as fast food and soda (FFS), white rice and kimchi (WRK), and oil and seasoned vegetable (OSV) patterns. Compared with participants in the lower intake of FFS pattern, those in the top intake were associated with a higher waist circumference (WC) (β = 1.55), insulin level (β = 1.25), and body mass index (BMI) (β = 0.53) and it was positively associated with HOMA-IR ≥ 2.6 (OR = 2.11; 95% CI: 1.227–3.638) (p < 0.05). WRK pattern was associated with lower weight and higher HDL cholesterol, and the OSV pattern was associated with a lower weight, WC, and insulin level (p < 0.05). The FFS pattern showed a positive relation with WC, serum insulin, and BMI, and the other two dietary patterns indicated a preventive effect of those parameters. The FFS pattern was associated with significantly elevated insulin resistance among children and adolescents.     

Relationships between sugar‐foods and the DMFT in 1968–1970

As shown in a sample of 2514 adolescent participants in the Ten‐State Nutrition Survey of The United States, there is a systematic relation between sugar‐food intakes and dental caries as shown by the DMFT index. Analyzed with respect to the DMFT, adolescents with high values of the DMFT reported sugar‐food ingestion ten times greater than did comparable adolescents with low DMFT values. Conversely, boys and girls and blacks and whites deemed high in sugar‐containing food intakes showed DMFT values approximately twice as high as in adolescents with low reported sugar‐food intakes. These findings attest to the practicability of investigating relationship between dietary habits and dental disease in mass‐data nutrition surveys.     

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.