Sugar intake among German adolescents: trends from 1990-2016 based on biomarker excretion in 24-h urine samples

Trend analyses based on dietary records suggest decreases in the intakes of total (TS), added (AS) and free sugar (FS) since 2005 among children and adolescents in Germany. In terms of age trends, TS intake decreased with increasing age. However, self-reported sugar intake in epidemiological studies is criticized, as it may be prone to bias due to selective underreporting. Furthermore, adolescents are more susceptible to underreporting than children. We thus analyzed time and age trends in urinary fructose excretion (FE), sucrose excretion (SE) and the sum of both (FE+SE) as biomarkers for sugar intake among 8.5-16.5-year-old adolescents. Urinary sugar excretion was measured by UPLC-MS/MS in 997 24-h urine samples collected from 239 boys and 253 girls participating in the DONALD study cohort between 1990 and 2016. Time and age trends of log-transformed FE, SE and FE+SE were analyzed using polynomial mixed-effects regression models. Between 1990 and 2016 FE as well as FE+SE decreased (linear time trend: p=0.0272 and p<0.0001, respectively). A minor increase in excretion during adolescence was confined to FE (linear age trend: p=0.0017). The present 24-h excretion measurements support a previously reported dietary-record based decline in sugar intake since 2005. However, the previous seen dietary record-based decrease in TS from childhood to late adolescence was not confirmed by our biomarker analysis, suggesting a constant sugar intake for the period of adolescence

Dietary glycaemic index and glycaemic load among Australian children and adolescents

There are no published data regarding the overall dietary glycaemic index (GI) and glycaemic load (GL) of Australian children and adolescents. We therefore aim to describe the dietary GI and GL of participants of the 2007 Australian National Children’s Nutrition and Physical Activity Survey (2007ANCNPAS), and to identify the main foods contributing to their GL. Children, aged 2–16 years, who provided two 24 h recalls in the 2007ANCNPAS were included. A final dataset of 4184 participants was analysed. GI of each food item was assigned using a previously published method. GL was calculated, and food groups contributing to the GL were described by age group and sex. The weighted mean dietary GI and GL of the participants were 54 (SD 5) and 136 (SD 44), respectively. Among the nutrients examined, Ca had the highest inverse relationship with GI (P,0·001), while percentage energy from starch was most positively associated with GI. The association between fibre density and GI was modest, and percentage energy from sugar had an inverse relationship with GI. Daily dietary GL contributed by energy-dense and/or nutrient-poor (EDNP) items in subjects aged 14–16 years was more than doubled that of subjects aged 2–3 years. To conclude, Australian children and adolescents were having a high-GI dietary pattern characterised by high-starchy food intake and low Ca intake. A significant proportion of their dietary GL was from EDNP foods. Efforts to reduce dietary GI and GL in children and adolescents should focus on energy-dense starchy foods. Key words: Dietary glycaemic index: Glycaemic index: Glycaemic load: Australian: Childre

Choice architecture interventions promoting sustained healthier food choice and consumption by students in a secondary school setting: a systematic review of intervention studies

Abstract Objective: To systematically review the impact of choice architecture interventions (CAI) on the food choice of healthy adolescents in a secondary school setting. Factors potentially contributing to the effectiveness of CAI types and numbers implemented and its long-term success were examined. Design: PUBMED and Web of Science were systematically searched in October 2021. Publications were included following predefined inclusion criteria and grouped according to the number and duration of implemented interventions. Intervention impact was determined by a systematic description of the reported quantitative changes in food choice and/or consumption. Intervention types were compared with regard to food selection and sustained effects either during or following the intervention. Setting: CAI on food choice of healthy adolescents in secondary schools. Participants: Not applicable. Results: Fourteen studies were included; four randomised controlled trials and five each of controlled or uncontrolled pre–post design, respectively. Four studies implemented a single CAI type, with ten implementing > 1. Three studies investigated CAI effects over the course of a school year either by continuous or repeated data collection, while ten studies’ schools were visited on selected days during an intervention. Twelve studies reported desired changes in overall food selection, yet effects were not always significant and appeared less conclusive for longer-term studies. Conclusions: This review found promising evidence that CAI can be effective in encouraging favourable food choices in healthy adolescents in a secondary school setting. However, further studies designed to evaluate complex interventions are needed

Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes

Objective Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM). Research design and methods A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia. Results Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001). Conclusions A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy

Overweight in Adolescence Can Be Predicted at Age 6 Years: A CART Analysis in German Cohorts

Objective: To examine, whether overweight in adolescents can be predicted from the body mass index (BMI) category, at the age of 6, the mother's education level and mother's obesity and to quantify the proportion of overweight at the age of 14 that can be explained by these predictors. Method: Pooled data from three German cohorts providing anthropometric and other relevant data to a total of 1 287 children. We used a classification and regression tree (CART) approach to identify the contribution of BMI category at the age of 6 (obese: BMI>97th percentile (P97);overweight: P90P90) at the age of 14. Results: While 4.8% [95% CI: 3.2;7.0] of 651 boys and 4.1% [95% CI: 2.6;6.2] of 636 girls with a BMI= P75. The lowest prevalence was 1.9% [95% CI: 0.8;3.8] in boys with a BMI P97 (similar results for girls). BMI >= P75 at the age of 6 explained 63.5% [95% CI: 51.1;74.5]) and 72.0% [95% CI: 60.4;81.8] of overweight/obesity at the age of 14 in boys and girls, respectively. Conclusions: Overweight/obesity in adolescence can be predicted by BMI category at the age of 6 allowing for parent counselling or risk guided interventions in children with BMI >= P75, who accounted for >2/3 of overweight/obesity in adolescents

A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Copyright © 2022. Published by Elsevier Inc.Bread is a major source of grain-derived carbohydrates worldwide. High intakes of refined grains, low in dietary fiber and high in glycemic index, are linked with increased risk for type 2 diabetes mellitus (T2DM) and other chronic diseases. Hence, improvements in the composition of bread could influence population health. This systematic review evaluated the effect of regular consumption of reformulated breads on glycemic control among healthy adults, adults at cardiometabolic risk or with manifest T2DM. A literature search was performed using MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials. Eligible studies employed a bread intervention (≥2 wk) in adults (healthy, at cardiometabolic risk or manifest T2DM) and reported glycemic outcomes (fasting blood glucose, fasting insulin, HOMA-IR, HbA1c, and postprandial glucose responses). Data were pooled using generic inverse variance with random-effects model and presented as mean difference (MD) or standardized MD between treatments with 95% CIs. Twenty-two studies met the inclusion criteria (n = 1037 participants). Compared with "regular" or comparator bread, consumption of reformulated intervention breads yielded lower fasting blood glucose concentrations (MD: -0.21 mmol/L; 95% CI: -0.38, -0.03; I2 = 88%, moderate certainty of evidence), yet no differences in fasting insulin (MD: -1.59 pmol/L; 95% CI: -5.78, 2.59; I2 = 38%, moderate certainty of evidence), HOMA-IR (MD: -0.09; 95% CI: -0.35, 0.23; I2 = 60%, moderate certainty of evidence), HbA1c (MD: -0.14; 95% CI: -0.39, 0.10; I2 = 56%, very low certainty of evidence), or postprandial glucose response (SMD: -0.46; 95% CI: -1.28, 0.36; I2 = 74%, low certainty of evidence). Subgroup analyses revealed a beneficial effect for fasting blood glucose only among people with T2DM (low certainty of evidence). Our findings suggest a beneficial effect of reformulated breads high in dietary fiber, whole grains, and/or functional ingredients on fasting blood glucose concentrations in adults, primarily among those with T2DM. This trial was registered at PROSPERO as CRD42020205458.publishersversionpublishe

Opinion Cascades and Echo-Chambers in Online Networks: A Proof of Concept Agent-Based Model

In online networks, the polarization of opinions (e.g., regarding presidential elections or referenda) has been associated with the creation of “echo-chambers” of like-minded peers, secluded from those of contrary viewpoints. Previous work has commonly attributed such phenomena to self-regarding preferences (e.g., confirmation bias), individual differences, and the pre-dispositions of users, with clusters forming over repeated interactions. The present work provides a proof of concept Agent-Based Model that demonstrates online networks are susceptible to echo-chambers from a single opinion cascade, due to the spatiotemporal order induced by lateral transmission. This susceptibility is found to vary as a function of degree of interconnectivity and opinion strength. Critically, such effects are found despite globally proportionate levels of opinions, equally rational agents (i.e. absent conformity, confirmation bias or pre-disposition architecture), and prior to cyclical interactions. The assumptions and implications of this work, including the value of Agent-Based Modelling to cognitive psychology, are discussed

Bistable Helmholtz dark spatial optical solitons in materials with self-defocusing saturable nonlinearity

We present, to the best of our knowledge, the first exact dark spatial solitons of a nonlinear Helmholtz equation with a self-defocusing saturable refractive-index model. These solutions capture oblique (arbitrary-angle) propagation in both the forward and backward directions, and they can also exhibit a bistability characteristic. A detailed derivation is presented, obtained by combining coordinate transformations and direct-integration methods, and the corresponding solutions of paraxial theory are recovered asymptotically as a subset. Simulations examine the robustness of the new Helmholtz solitons, with stationary states emerging from a range of perturbed input beams

FADS1 FADS2 gene cluster, PUFA intake and blood lipids in children

Elevated cholesterol levels in children can be a risk factor for cardiovascular diseases in later life. In adults, it has been shown that blood lipid levels are strongly influenced by polymorphisms in the fatty acid desaturase (FADS) gene cluster in addition to nutritional and other exogenous and endogenous determinants. Our aim was to investigate whether lipid levels are determined by the FADS genotype already in children and whether this association interacts with dietary intake of n-3 fatty acids. The analysis was based on data of 2006 children from two German prospective birth cohort studies. Total cholesterol, HDL, LDL and triglycerides were measured at 10 years of age. Six single nucleotide polymorphisms (SNPs) of the FADS gene cluster were genotyped. Dietary n-3 fatty acid intake was assessed by food frequency questionnaire. Linear regression modeling was used to assess the association between lipid levels, n-3 fatty acid intake and FADS genotype. Individuals carrying the homozygous minor allele had lower levels of total cholesterol [means ratio (MR) ranging from 0.96 (p = 0.0093) to 0.98 (p = 0.2949), depending on SNPs] and LDL [MR between 0.94 (p = 0.0179) and 0.97 (p = 0.2963)] compared to homozygous major allele carriers. Carriers of the heterozygous allele showed lower HDL levels [β between -0.04 (p = 0.0074) to -0.01 (p = 0.3318)] and higher triglyceride levels [MR ranging from 1.06 (p = 0.0065) to 1.07 (p = 0.0028)] compared to homozygous major allele carriers. A higher n-3 PUFA intake was associated with higher concentrations of total cholesterol, LDL, HDL and lower triglyceride levels, but these associations did not interact with the FADS1 FADS2 genotype. Total cholesterol, HDL, LDL and triglyceride concentrations may be influenced by the FADS1 FADS2 genotype already in 10 year old children. Genetically determined blood lipid levels during childhood might differentially predispose individuals to the development of cardiovascular diseases later in life

Perspective: a conceptual framework for adaptive personalized nutrition advice systems (APNASs)

Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic one-size-fits-all recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate individual goal preferences beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the personalization processes of behavior change by providing in situ, just-in-time information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a participatory dialogue between individuals and experts (e.g., actual or virtual dieticians, nutritionists, and advisors), when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation