Proyecto de investigación 2017-2019, financiado por la Universidad Peruana de Ciencias Aplicadas (UPC).

Objective: To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children. Design: Secondary analysis of the Young Lives cohort study in Peru. Setting: Twenty sentinel sites from a total of 1818 districts available in Peru. Subjects: Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds. Results: A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28). Conclusions: Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.

Purpose: This article examines changes in attitude and beverage consumption after a school-wide policy change replacing sweetened beverages in vending machines with 100% juice and bottled water. Methods: Written questionnaires were administered three times to high school students (n = 278) in an ethnically-diverse, southwest Virginia school district. X ² analysis was utilized and test-retest reliability was assessed with intra-class correlation coefficients. Results: Pearson correlation coefficients for reliability between test and re-test displayed a range from r =0.53 to r =0.73. There were no significant differences in demographics (gender and ethnicity) between time periods. X ² analysis revealed students were significantly more likely to choose healthier beverage vending options after one year compared to baseline (P<0.01). Although beverage vending purchases declined to near significance immediately following the change, there were no significant changes observed between baseline and follow-up (P<0.05). X ² analysis revealed no significant (P<0.05) changes in outside purchase patterns. Students also indicated that the top reasons for snack/beverage choices were hunger, taste, and price. Conclusion: This suggests that students purchase what is convenient and available, regardless of choices. Therefore, environmental changes may be beneficial to promote healthier beverage choices among adolescents.</p> / Master of Science

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INTRODUCTION: Research has strongly linked increased consumption of sugar-sweetened beverages (SSBs) to obesity/overweight in youth. AIM: This study aims to: (1) examine SSB consumption rates in high school students nationwide, (2) explore association between SSB consumption and adiposity (overweight/obesity), (3) examine gender, racial/ethnic, and physical activity (PA) status differences in SSB consumption. METHODS: The Youth Risk Behavior Survey (YRBS)-2015 was employed in this study. Weighted percentages were used to examine differences in SSB consumption and adiposity prevalence by gender, race and PA status. Multivariate logistic regression was used to determine association between SSB consumption and adiposity. Adjusted and unadjusted odds ratios and 95% CIs were calculated. RESULTS: Overall, 20% of students drank sodas daily ≥ 1 times a day and about 14% drank sports drinks daily. More male students consumed both sodas and sports drinks than female students. Soda consumption was largest in the group with zero days PA (25%) and consumption of sports drinks was highest in the daily PA category (24%) than the other categories. Multivariate logistic regression revealed higher odds of obesity among male students as compared to female students (OR=1.7, 95% CI=1.4, 2.1) and among Hispanic students as compared to white students (OR=1.5, 95% CI=1.2, 1.8), after adjusting for all other covariates. Students who engaged in daily PA had lower odds of obesity than those who had no PA (OR=0.6, 95% CI=0.5, 0.8). There was no significant difference in the odds of obesity between those who consumed SSBs and those who did not. DISCUSSION: This study provides insight into SSB consumption trends in US adolescents by socio- demographic factors and PA status, as well as its association with adiposity. Male gender, certain racial minorities and lack of physical activity can potentially be responsible for greater SSB consumption. Sports drinks consumption is high even in physically active youth. Lack of association between SSB intake and adiposity may be due to the limited SSBs included.

Background: In the U.S., Hispanics have among the highest rates of overweight and obesity when compared to other racial/ethnic groups placing them at a greater risk for obesity-related disease. Identifying intervention strategies to reduce caloric intake and/or improve cardiometabolic health in Hispanics is critical to reducing morbidity and mortality among this large and growing population. Evidence exists to support diet-specific behavioral interventions, including beverage modifications, in reducing obesity-related health risks. However, the acceptability and feasibility of a beverage intervention in obese Hispanic adults has not been robustly evaluated. Methods: The objective of this pilot study is to assess the feasibility and acceptability of a randomized, controlled beverage intervention in 50 obese Hispanic adults ages 18-64 over 8-weeks. Eligible participants were obese (30-50.0 kg/m(2)), between the ages 18-64, self-identified as Hispanic, and were able to speak, read, and write in either English and/or Spanish. Study recruitment was completed August 2017. Upon the completion of baseline assessments, participants will be randomized to either Mediterranean lemonade, Green Tea, or flavored water control. After completing a 2-week washout period, participants will be asked to consume 32 oz. per day of study beverage for 6-weeks while avoiding all other sources of tea, lemonade, citrus, juice, and other sweetened beverages; water is permissible. Primary outcomes will be recruitment, retention, and acceptability of the intervention strategies. Our study will also evaluate participant-reported tolerance and as an exploratory aim, assess safety/toxicity-related to renal and/or liver function. Fasting blood samples will be collected at baseline and 8-weeks to assess the primary efficacy outcomes: total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Secondary outcomes include fasting glucose, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP). Discussion: This pilot study will provide important feasibility, safety, and early efficacy data necessary to design a larger, adequately-powered randomized controlled trial.

The former finance minister stated in his budget speech in 2016 that sugar tax would come into force in South Africa from 1 April 2017. The treasury's reason for implementing sugar taxation is to reduce the health problems caused by sugar. It is nothing new to use fiscal measures to recover both taxes and to prevent health problems but it was not yet possible to reach a definite conclusion about the impact of sugar tax on the consumption of sugary drinks and the prevalence of obesity. The reason for this is that there is evidence that the implementation of food tax in different countries has shown different results in terms of public health issues and tax benefits. In South Africa, the implementation of sugar tax can either reduce the prevalence of obesity and thereby have a positive effect on the economy or its implementation may adversely affect the economy. If treasury does not implement sugar tax the economy can also be adversely affected by the prevalence of obesity. This dissertation deals with the effects of non-communicable diseases and sugar tax on the South African economy. The focus is on how sugar tax is being implemented internationally and how South Africa intends to implement sugar tax. / Die voormalige minister van finansies het in sy begrotingstoespraak in 2016 vermeld dat suikerbelasting vanaf 1 April 2017 in Suid-Afrika in werking gaan tree. Die tesourie se rede vir die implementering van suikerbelasting is om, in samewerking met die Departement van Gesondheid, die gesondheidsprobleme wat deur suiker veroorsaak word te verminder. Dit is niks nuuts om fiskale maatstawwe te gebruik om beide belasting in te vorder en gesondheidsprobleme te voorkom nie, maar dit was nog nie moontlik om tot ’n definitiewe gevolgtrekking te kom oor die impak van suikerbelasting op die verbruik van suikerversoete drankies en die voorkoms van vetsug nie. Die rede hiervoor is dat daar bewyse is dat die implementering van voedselbelasting in verskillende lande verskillende resultate getoon het in terme van openbare gesondheidskwessies en belastingvoordele. In Suid-Afrika kan die implementering van suikerbelasting óf die voorkoms van vetsug verminder en sodoende die ekonomie bevoordeel óf die implementering daarvan kan die ekonomie negatief beïnvloed. Indien die tesourie nie suikerbelasting implementeer nie kan die ekonomie as gevolg van die voorkoms van vetsug negatief beïnvloed word. Die kern van hierdie skripsie handel oor die gevolge van nieoordraagbare siektes en suikerbelasting op die Suid-Afrikaanse ekonomie. Daar word spesifiek gefokus op hoe suikerbelasting internasionaal geïmplementeer word en hoe Suid-Afrika beoog om suikerbelasting te implementeer. / Mini Dissertation (LLM)--University of Pretoria, 2017. / Mercantile Law / LLM / Unrestricted

Background: Low health literacy is a significant problem affecting our country.  While the associations between low health literacy and poorer health outcomes have been well documented (Berkman et al., 2011), the literature lacks evidence of effective strategies to address health literacy in the context of health behaviors such as diet and physical activity (PA). Likewise, few interventions have reported on how health literacy status influences performance and engagement in the intervention. Two potential intervention strategies include the teach back method or teach to goal approach and interactive voice response (IVR) technology. These strategies hold promise as a means of improving health literacy and reaching vulnerable, low health literate populations, but these strategies have not been widely explored in the literature (Paasche-Orlow et al., 2005; Baker et al., 2011; Schillinger et al., 2009; Bennett et al., 2012; Piette et al., 1999). Primary Aims: This research was embedded in a larger trial, Talking Health, which is a 6-month, 2 group randomized controlled trial to determine the effects of a health behavior intervention on reducing sugar-sweetened beverage (SSB) consumption in Southwest Virginians. The primary aims of this study were to examine the associations between health literacy status and 1) number of rounds of teach back needed to reinforce key concepts, 2) proportion of correct answers on the first round of teach back, 3) level of intervention engagement (i.e., completion rates for teach back call, IVR calls, and small group classes), and 4) perceptions of the intervention components. Methods: The data reported represent the first 3 cohorts of the Talking Health trial including participants in Lee, Giles, and Pulaski Counties. Eligibility requirements included being 18 years or older, English speaking, consuming at least 200 calories per day from SSB, able to participate in moderate intensity PA, and having reliable access to a telephone. Data were collected at baseline and at the 6-month follow-up assessment. Health literacy was assessed using the validated Newest Vital Sign. Participants were randomized to a behavioral intervention aimed at decreasing SSB consumption (SipSmartER) or to a matched-contact control group targeting PA (Move More). Both groups participated in 3 small group education sessions, received a live teach back call, and 11 supportive IVR calls. Participants completed a summative evaluation at the 6-month follow-up, which captured their perceptions of the intervention components. ANOVAs were used to measure differences in outcomes by health literacy status, randomized condition, and interactions. Results: Of the 125 enrolled participants, 92.0% were Caucasian, 76.8% were female, 29.6% had d high school education, 64.0% had <$25,000 annual household income, and 32.8% had low health literacy skills. Eighty-five participants (68.0%) completed the teach back call. The overall model when looking at the degree to which health literacy status and randomized condition predicted the number of rounds of teach back needed to reinforce key concepts was significant (F= 8.323, p < 0.001). Out of 3 possible teach back attempts, participants in the low health literacy category required a significantly higher number of teach back attempts as compared to those with high health literacy (F= 16.769, p <0.001), and participants randomized to Move More required a significantly higher number of teach back attempts compared to SipSmartER participants (F=7.296, p= 0.008). Similarly, the overall model when looking at the degree to which health literacy status and randomized condition predicted the proportion correct on the first round of teach back was significant (F= 9.836, p<0.001), such that those with higher health literacy status  (F= 19.176, p< 0.001) and those randomized to SipSmartER condition answered a significantly higher proportion of questions correct (F= 9.783, p= 0.002). Intervention engagement including completion of the small group education sessions, the live teach back call, and the IVR calls did not vary significantly across randomized condition or literacy levels. Low health literate participants had a significantly higher overall perceived satisfaction with the IVR, as compared to high health literate participants (F= 5.849, p= 0.020). However, perceptions of other intervention components (e.g., small group sessions, teach back call, personal action plans, drink diaries/exercise logs,) were similar among participants with low and high health literacy status and across randomized conditions.   Conclusion: These data confirm the importance for multiple teach back opportunities and additional exposure to health information to ensure participant comprehension of key intervention content"in particular for those with lower health literacy. This research also supports that IVR is an effective approach to reaching vulnerable, low health literate populations. Future research should investigate the efficacy and cost-effectiveness of utilizing teach back methods delivered using automated technologies. Future research also is needed to determine how teach back performance are related to other study factors such as retention, engagement, and health outcomes. / Master of Science

BACKGROUND: Current efforts to control the obesity epidemic has focused on sugar sweetened beverages (SSB), particularly soda, and less on alcohol intake even though alcohol is also a source of “empty calories”. Few data are available about the association between soda and excessive alcohol consumption and whether people may substitute one form of beverage for the other, essentially “choosing their poison”. METHODS: We used the Behavioral Risk Factor Surveillance System (BRFSS) data from 2017 to examine the relationship between alcohol and soda consumption in adults 18 and older. We first compared the rates of different types of sweetened beverage consumption soda in our population. We then examined the association between the sugar-sweetened beverage and alcohol drinking status using regression models adjusted for potential confounders. Analyses were weighted and adjusted using SAS 9.4 to account for the complex sampling methods. RESULTS: Based on 2017 BRFSS data, we found an inverse relationship between heavy drinking and soda consumption after adjusting for age, sex, race, income, education, marital and insurance status, smoking, diabetes, and hypertension. Compared to those who don’t drink soda, the odds ratio of heavy drinking was 0.75 (95% CI 0.63, 0.90) for those who drink up to one soda/week; 0.66 (0.53, 0.81) for those drinking >1 to <7 sodas/week; 0.73 (0.65, 0.97) for ≥7 to <14 sodas/week; and 0.70 (0.49, 1.02) for ≥14 sodas/week. CONCLUSION: There seems to be an inverse association between soda and alcohol consumption. Public health efforts may want to consider targeting both behaviors concurrently to avoid beverage substitution.

Around 46.2 million Americans living in rural areas are disproportionately burdened by health disparities. Likewise, obesity and obesity-associated diseases (e.g., diabetes, cardiovascular disease) are much higher for rural residents when compared to their urban counterparts. There is a high need to understand and address the nutritional determinants of these health inequities among adults and adolescents. One area of concern in rural dietary habits pertains to added sugars and more specifically, sugar-sweetened beverages (SSB). Excessive added sugars and SSB intake have been strongly linked to many of the nutrition and chronic disease disparities impacting rural residents. Moreover, studies conducted in rural populations have found high consumptions of these in both adults and adolescents. There is an opportunity to better understand added sugars and SSB patterns in rural populations to inform the development of culturally relevant, multi-level interventions that address high consumption. Study #1 is a cross-sectional study that explores top food and beverage sources of added sugars in the diet of adults (n = 301) living in rural areas of Southwest Virginia. Study #2 uses a nationally representative sample of adolescents (n = 1,560) from the Family Life, Activity, Sun, Health and Eating (FLASHE) study sponsored by the National Cancer Institute, to explore factors across the levels of the socioecological model associated with adolescent SSB intake. Study #3 utilizes focus groups and a pilot trial to understand language preferences, acceptability and use of SMS aimed at caregivers to reduce SSB intake in both caregivers and adolescents living in rural areas of Southwest Virginia (n = 33). Collectively, these three studies offer recommendations and culturally relevant strategies for future large-scale trials aimed at reducing SSB intake among adolescents and caregivers in rural communities and ultimately reducing rural health disparities. / Doctor of Philosophy / Rural populations in the United States are at higher risk for being diagnosed with and dying from preventable and obesity-associated diseases like heart disease and cancer. Excessive added sugars and sugary drink (i.e. sodas, sweet tea/coffee, energy drinks, sweetened fruit drinks, sports drinks) intake have been strongly linked to many of the chronic diseases afflicting rural residents. Moreover, studies conducted in rural populations have found high consumptions of these, in both adults and adolescents. There is a great need to better understand added sugars and sugary drink patterns in rural populations so that we can develop programs to reduce consumption that are also culturally well received. Study #1 in this dissertation explores top food and beverage sources of added sugars in the diet of 301 adults living in rural areas of Southwest Virginia. Study #2 uses a nationally representative sample of 1,560 adolescents to explain why adolescent SSB intake might be higher. Study #3 aims to understand language preferences, acceptability and use of a text message program to reduce sugary drink intake in both caregivers and adolescents living in rural areas of Southwest Virginia. Collectively, these three studies offer recommendations and culturally relevant strategies for future large scale trials aimed at reducing sugary drink intake among adolescents and caregivers in rural communities and ultimately improving rural health.