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The food and beverage industry has been increasingly replacing sugar with non-nutritive sweeteners in their sweetened products to control or reduce total calories . Research comparing the effect of nutritive and non-nutritive sweeteners on emotional state of participants exposed to acute stressors is still limited . This study aim ed to determine the effect of drinking tea sweetened with either a nutritive sweetener ( sugar ) or a non-nutritive sweetener ( sucralose or stevia ) on emotional state , in terms of calmness and pleasantness , of participants exposed to an acute stressor . Effects of acute stress on sweetness intensity and overall liking of tea beverages were also determined . Results showed that the possibility of tea-induced calmness , calculated as the difference between calmness ratings after and before drinking a tea sample , was established on stress session in the sugar-sweetened tea .  Overall liking , but not the sweetness intensity , of the sugar-sweetened tea was affected by acute stress . In conclusion , this study provides empirical evidence that the consumption of tea sweetened with nutritive sweetener , but not with non-nutritive sweetener , has calming effect on consumers with acute stress , suggesting that this effect may not be due to the sweet taste of sugar , but due to the caloric nature of the sweetener INTRODUCTION Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages , but warnings ' effects on actual purchase behavior remain uncertain . This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases . STUDY DESIGN Participants completed one study visit to a life-sized replica of a convenience store in North Carolina . Participants chose six items ( two beverages , two foods , and two household products ) . One item was r and omly selected for them to purchase and take home . Participants also completed a question naire . Research ers collected data in 2018 and conducted analyses in 2019 . SETTING / PARTICIPANTS Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers ( usual consumption ≥12 ounces/week ) . INTERVENTION Research staff r and omly assigned participants to a health warning arm ( sugar-sweetened beverages in the store displayed a front-of-package health warning ) or a control arm ( sugar-sweetened beverages displayed a control label ) . MAIN OUTCOME MEASURES The primary trial outcome was sugar-sweetened beverage calories purchased . Secondary outcomes included reactions to trial labels ( e.g. , negative emotions ) and sugar-sweetened beverage perceptions and attitudes ( e.g. , healthfulness ) . RESULTS All 400 participants completed the trial and were included in analyses . Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants . In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity , health warnings led to lower sugar-sweetened beverage purchases ( adjusted difference , -31.4 calories ; 95 % CI= -57.9 , -5.0 ) . Unadjusted analyses yielded similar results ( difference , -32.9 calories ; 95 % CI= -58.9 , -7.0 ) . Compared with the control label , sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention , negative emotions , thinking about the harms of sugar-sweetened beverage consumption , and anticipated social interactions . Trial arms did not differ on perceptions of sugar-sweetened beverages ' added sugar content , healthfulness , appeal/coolness , or disease risk . CONCLUSIONS Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT . Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT03511937 Background : Substituting sweeteners with non-nutritive sweeteners ( NNS ) may aid in glycaemic control and body weight management . Limited studies have investigated energy compensation , glycaemic and insulinaemic responses to artificial and natural NNS . Objectives : This study compared the effects of consuming NNS ( artificial versus natural ) and sucrose ( 65 g ) on energy intake , blood glucose and insulin responses . Methods : Thirty healthy male subjects took part in this r and omised , crossover study with four treatments : aspartame- , monk fruit- , stevia- and sucrose-sweetened beverages . On each test day , participants were asked to consume a st and ardised breakfast in the morning , and they were provided with test beverage as a preload in mid-morning and ad libitum lunch was provided an hour after test beverage consumption . Blood glucose and insulin concentrations were measured every 15 min within the first hour of preload consumption and every 30 min for the subsequent 2 h. Participants left the study site 3 h after preload consumption and completed a food diary for the rest of the day . Results : Ad libitum lunch intake was significantly higher for the NNS treatments compared with sucrose ( P=0.010 ) . The energy ' saved ' from replacing sucrose with NNS was fully compensated for at subsequent meals ; hence , no difference in total daily energy intake was found between the treatments ( P=0.831 ) . The sucrose-sweetened beverage led to large spikes in blood glucose and insulin responses within the first hour , whereas these responses were higher for all three NNS beverages following the test lunch . Thus , there were no differences in total area under the curve ( AUC ) for glucose ( P=0.960 ) and insulin ( P=0.216 ) over 3 h between the four test beverages . Conclusions : The consumption of calorie-free beverages sweetened with artificial and natural NNS have minimal influences on total daily energy intake , postpr and ial glucose and insulin compared with a sucrose-sweetened beverage BACKGROUND Intake of sugar-sweetened beverages is associated with overweight in observational studies . A possible explanation is that liquid sugars do not satiate and that their intake is not compensated by reduced caloric intake from other foods . However , evidence from intervention studies for this hypothesis is inconclusive because previous studies were not blinded . Hence results may have been influenced by expectations and behavioral cues rather than by physiological mechanisms . METHODS We design ed the Double-blind , R and omized INtervention study in Kids ( DRINK ) to examine the effect on body weight of covertly replacing sugar-sweetened by sugar-free beverages .  Children were only eligible if they habitually drank sugar-sweetened beverages . We recruited 642 healthy children ( mean age 8.2 , range 4.8 - 11.9 ) . We design ed , tested and produced custom-made beverages containing 10 % sugar and sugar-free beverages with the same sweet taste and look . Children receive one 250 mL can of study beverage daily for 18 months . We perform body measurements at 0 , 6 , 12 and 18 months . The primary outcome is the z-score of BMI for age . The maximum predicted difference in this score between groups is 0.72 , which corresponds with a difference in body weight of 2.3 kg . DISCUSSION The double-blind design eliminates behavioral factors that affect body weight . If children gain less body fat when drinking sugar-free than when drinking sugar-sweetened beverages that would show that liquid sugar indeed bypasses biological satiation mechanisms . It would also suggest that a reduction in liquid sugars could decrease body fat more effectively than reduction of other calorie sources The effects of sugar-sweetened ( SSB ) and non-nutritive sweetened ( NSB ) beverages on the regulation of appetite , energy intake and body weight regulation remain controversial . Using a behavioral choice paradigm , we sought to determine the effects of consuming a SSB or NSB on appetite and the reinforcing value of sweet relative to salty/savory snack foods . In a r and omized crossover study , 21 healthy weight adults consumed 360 ml of SSB ( sucrose ; 31 g ) or NSB ( sucralose ; 4 g ) with a st and ardized meal . Hedonic ratings for the sweet and salty/savory snack foods used for the reinforcement task were assessed prior to the start of the study . Satiety and the desire to eat foods with a specific taste profile were assessed before and every 30 min post-meal for 4 h. The relative reinforcing value of the snack foods was assessed using a computer-based choice task ( operant responding with concurrent schedules of reinforcement ) 4 h post-meal . Hedonic ratings did not differ between the most highly liked sweet and salty/savory snack foods . Beverage type did not influence measures of satiety or the desire to eat foods with a specific taste . However , sweet snacks were more ( p < 0.05 ) reinforcing relative to salty/savory snack foods after consuming a NSB than after a SSB . In conclusion , this is the first study to demonstrate that NSB can increase the motivation to gain access to sweet snacks relative to salty/savory snack foods later in the day BACKGROUND Consumption of low-calorie sweeteners ( LCSs ) has increased markedly during the past several decades , yet the prevalence of LCS consumption in recent years is currently unknown . OBJECTIVE The aim of this study was to describe LCS consumption in the United States and to characterize consumption by sociodemographic subgroups , source , frequency , eating occasion , and location . DESIGN Cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2012 . The prevalence of LCS consumption was assessed using two 24-hour dietary recalls , while the frequency ( number of times per day ) , occasion ( meal vs snack vs alone ) , and location of LCS consumption ( at home vs away from home ) was assessed using data from the one , in-person , 24-hour dietary recall . PARTICIPANTS National Health and Nutrition Examination Survey participants ( 2 years old or older ) either in 2009 - 2010 ( n=9,047 ) or in 2011 - 2012 ( n=7,939 ) . After excluding participants with implausible energy intake ( n=44 ) , the final sample size was 16,942 . MAIN OUTCOME MEASURES The primary outcome was the proportion of individuals consuming one or more foods , beverages , or packets containing LCSs  during at least one of their two dietary recalls . STATISTICAL ANALYSES PERFORMED Data were weighted to provide national estimates and Stata frequency procedures for complex survey design were used for all analyses . RESULTS Our findings were that 25.1 % of children and 41.4 % adults reported consuming LCSs . Most LCS consumers reported use once daily ( 80 % of children , 56 % of adults ) and frequency of consumption increased with body weight in adults . LCS consumption was higher in females compared with males among adults , and in obese individuals , compared with overweight and normal-weight individuals . Individuals of non-Hispanic white race/ethnicity also had higher prevalence of consumption compared with non-Hispanic blacks and Hispanics and those in the highest tertile of income had higher LCS consumption compared with individuals of middle or low income across LCS product categories in adults , and for LCS beverages and LCS foods in children . Most LCS consumers reported consuming  LCS  with meals ( 64 % of adults , 62 % of children ) and the majority of LCS consumption occurred at home ( 71 % and 72 % among adults and children , respectively ) . CONCLUSIONS LCS consumption is highly prevalent in the United States , among both children and adults . Well-controlled , prospect i ve trials are required to underst and the health impact of this widespread LCS exposure Sugar-sweetened beverages ( SSBs ) are one of the largest added sugar sources to diets in the UK and USA . Health warning labels reduce hypothetical selection of SSBs in online studies but uncertainty surrounds their impact on selection of drinks for consumption . Calorie information labels are also promising but their impact on SSB selection is unclear . This laboratory study assessed the impact on SSB selection of ' on-pack ' labels placed directly on physical products : i.a pictorial health warning label depicting an adverse health consequence of excess sugar consumption ; and ii.calorie information labels . Potential moderation of any effects by socio-economic position ( SEP ) was also examined . Participants - 401 adults , resident in Engl and , approximately half of whom were of lower SEP and half of higher SEP , were asked to select a drink from a range of two non-SSBs and four SSBs ( subsequent to completing a separate study assessing the effects of food availability on snack selection ) . The drinks included ' on-pack ' labels according to r and omisation : Group 1:pictorial health warning label on SSBs ; Group 2:calorie information label on all drinks ; Group 3:no additional label . The primary outcome was the proportion of participants selecting an SSB . Compared to not having additional labels ( 39 % ) , neither the pictorial health warning label ( 40 % ) nor calorie information labels ( 43 % ) affected the proportion of participants selecting an SSB . Lower SEP participants ( 45 % ) were more likely to select an SSB compared to those of higher SEP ( 35 % ) , but SEP did not moderate the impact of labels on drink selection . In conclusion , pictorial health warning labels may be less effective in reducing SSB selection in lab-based compared with online setting s , or depending on label design and placement . Findings suggest that effects might be absent when choosing from real products with actual ' on-pack ' labels , positioned in a ' realistic ' manner . Field studies are needed to further assess the impact of ' on-pack ' SSB warning labels in real-world setting s to rule out the possible contribution of study design factors Sensory-specific satiety , which is defined as a relative decrease in pleasantness , is increased by greater oro-sensory stimulation . Both sensory-specific satiety and pleasantness affect taste activation in the orbitofrontal cortex . In contrast , metabolic satiety , which results from energy intake , is expected to modulate taste activation in reward areas . The aim of this study was to determine the effects of the amount of oro-sensory stimulation and energy content on consumption-induced changes in taste activation .  Ten men participated in a 2 × 2 r and omized crossover study . Subjects were scanned twice using functional magnetic resonance imaging : after fasting for at least 2h and after treatment , on four occasions . Treatment consisted of the ingestion of 450 mL of orangeade ( sweetened with 10 % sucrose or non-caloric sweeteners ) at 150 mL/min , with either small ( 5 mL ) or large ( 20 mL ) sips . During scanning , subjects alternately tasted orangeade , milk and tomato juice and rated its pleasantness . Before and after the scans , subjects rated pleasantness , prospect i ve consumption , desire to eat and sweetness for all tastants . Main findings were that , before treatment , the amygdala was activated more by non-caloric than by caloric orangeade . Caloric orangeade activated part of the striatum before , but not after treatment . We observed no main effects of sip size on taste activation and no interaction between sip size and caloric content . In conclusion , the brain responds differentially to caloric and non-caloric versions of a sweet drink and consumption of calories can modulate taste activation in the striatum . Further research is needed to confirm that the observed differences are due to caloric content and not to ( subliminal ) differences in the sensory profile . In addition , implication s for the effectiveness of non-caloric sweeteners in decreasing energy intake need to be established BACKGROUND Type 2 diabetes mellitus is an increasingly serious health problem among African American women . Consumption of sugar-sweetened drinks was associated with an increased risk of diabetes in 2 studies but not in a third ; however , to our knowledge , no data are available on African Americans regarding this issue . Our objective was to examine the association between consumption of sugar-sweetened beverages , weight gain , and incidence of type 2 diabetes mellitus in African American women . METHODS A prospect i ve follow-up study of 59,000 African American women has been in progress since 1995 . Participants reported on food and beverage consumption in 1995 and 2001 . Biennial follow-up question naires ascertained new diagnoses of type 2 diabetes . The present analyses included 43,960 women who gave complete dietary and weight information and were free from diabetes at baseline . We identified 2713 incident cases of type 2 diabetes mellitus during 338,884 person-years of follow-up . The main outcome measure was the incidence of type 2 diabetes mellitus . RESULTS The incidence of type 2 diabetes mellitus was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks . After adjustment for confounding variables including other dietary factors , the incidence rate ratio for 2 or more soft drinks per day was 1.24 ( 95 % confidence interval , 1.06 - 1.45 ) . For fruit drinks , the comparable incidence rate ratio was 1.31 ( 95 % confidence interval , 1.13 - 1.52 ) . The association of diabetes with soft drink consumption was almost entirely mediated by body mass index , whereas the association with fruit drink consumption was independent of body mass index . CONCLUSIONS Regular consumption of sugar-sweetened soft drinks and fruit drinks is associated with an increased risk of type 2 diabetes mellitus in African American women . While there has been increasing public awareness of the adverse health effects of soft drinks , little attention has been given to fruit drinks , which are often marketed as a healthier alternative to soft drinks Background : It is hypothesized that a solid form of food or food components suppresses subjective appetite and short-term food intake ( FI ) more than a liquid form . Objective : To compare the effect of eating solid vs drinking liquid forms of gelatin , sucrose and its component mixtures , and whey protein , on  subjective appetite and FI in young men . Design and subjects : A r and omized crossover design was used in three experiments in which the subjects were healthy males of normal weight .  Solid and liquid forms of gelatin ( 6 g ) ( experiment 1 , n=14 ) , sucrose ( 75 g ) and a mixture of 50 % glucose/50 % fructose ( G50:F50 ) ( experiment 2 , n=15 ) , and acid and sweet whey protein ( 50 g ) ( experiment 3 , n=14 ) were compared . The controls were water ( experiments 1 and 3 ) and calorie-free sweetened water with gelatin ( sweet gelatin , experiment 1 ) or calorie-free sweetened water ( sweet control , experiment 2 ) . Subjective average appetite was measured by visual analog scales over 1 h and ad libitum FI was measured 1 h after treatment consumption . Results : Average appetite area under the curve was not different between solid and liquid forms of sugars , but was larger , indicating greater satiety for solid compared with liquid forms of gelatin and sweet , but not acid whey protein . The FI was not different from that of control because of solid or liquid sugars or gelatin treatments . However , both solid and liquid forms of whey protein , with no difference among them , suppressed FI compared with control ( P<0.05 ) . Conclusion : Macronutrient composition is more important than physical state of foods in determining subjective appetite and FI Numerous front-of-package ( FOP ) nutrition labeling systems exist , but it is unclear if such labels influence behavior . A single- summary label called Smart Choices ( SC ) appeared briefly on products in the United States in 2009 . The current study aim ed to evaluate ( 1 ) the influence the SC symbol has on the serving and consumption of cereal ; and ( 2 ) the impact of providing calorie and serving size information on a FOP label . Two hundred and sixteen adults were r and omized to a high-sugar breakfast cereal  that had either ( 1 ) no label ; ( 2 ) the SC symbol ; or ( 3 ) a modified SC symbol with serving size information . Participants rated perceptions of healthfulness , taste , and purchase intent , estimated calories per serving and poured and ate the cereal for breakfast . Participants in the SC label conditions were better able to estimate calories per serving , but there were no differences across groups on perceptions of healthfulness , taste , purchase intent , and levels of vitamins , and sugar or amount of cereal poured or consumed . These results suggest that calories per serving information on FOP labels can increase knowledge , but the SC symbol had little impact on behavior . Studies examining FOP label influence on purchasing , consumption , and product reformulation are greatly needed to determine label utility CONTEXT Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes , but these relationships have been minimally addressed in adults . OBJECTIVE To examine the association between consumption of sugar-sweetened beverages and weight change and  risk of type 2 diabetes in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort analyses conducted from 1991 to 1999 among women in the Nurses ' Health Study II . The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991 . The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991 , 1995 , and 1999 . We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up . MAIN OUTCOME MEASURES Weight gain and incidence of type 2 diabetes . RESULTS Those with stable consumption patterns had no difference in weight gain , but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day ( multivariate-adjusted means , 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999 ) and was smallest among women who decreased their intake ( 1.34 and 0.15 kg for the 2 periods , respectively ) after adjusting for lifestyle and dietary confounders . Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption . After adjustment for potential confounders , women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [ RR ] of type 2 diabetes of 1.83 ( 95 % confidence interval [ CI ] , 1.42 - 2.36 ; P<.001 for trend ) compared with those who consumed less than 1 of these beverages per month . Similarly , consumption of fruit punch was associated with increased diabetes risk ( RR for > or = 1 drink per day compared with < 1 drink per month , 2.00 ; 95 % CI , 1.33 - 3.03 ; P = .001 ) . CONCLUSION Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of  type 2 diabetes in women , possibly by providing excessive calories and large amounts of rapidly absorbable sugars Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background It is still unclear whether carbohydrate consumption is associated with cardiovascular disease ( CVD ) risk . Genetic susceptibility might modify the associations between dietary intakes and disease risk . Objectives The aim was to examine the association between the consumption of carbohydrate-rich foods ( vegetables , fruits and berries , juice , potatoes , whole grains , refined grains , cookies and cakes , sugar and sweets , and sugar-sweetened beverages ) and the risk of incident ischemic CVD ( iCVD ; coronary events and ischemic stroke ) , and whether these associations differ depending on genetic susceptibility to dyslipidemia . Methods Among 26,445 individuals ( 44–74 years ; 62 % females ) from the Malmö Diet and Cancer Study cohort , 2,921 experienced an iCVD event during a mean follow-up time of 14 years . At baseline , dietary data were collected using a modified diet history method , and clinical risk factors were measured in 4,535 subjects . We combined 80 vali date d genetic variants associated with triglycerides and HDL-C or LDL-C , into genetic risk scores and examined the interactions between dietary intakes and genetic risk scores on the incidence of iCVD . Results Subjects in the highest intake quintile for whole grains had a 13 % ( 95 % CI : 3–23 % ; p-trend : 0.002 ) lower risk for iCVD compared to the lowest quintile . A higher consumption of foods rich in added sugar ( sugar and sweets , and sugar-sweetened beverages ) had a significant cross-sectional association with higher triglyceride concentrations and lower HDL-C concentrations . A stronger positive association between a high consumption of sugar and sweets on iCVD risk was observed among those with low genetic risk score for triglycerides ( p-interaction=0.05 ) . Conclusion In this prospect i ve cohort study that examined food sources of carbohydrates , individuals with a high consumption of whole grains had a decreased risk of iCVD . No convincing evidence of an interaction between genetic susceptibility for dyslipidemia , measured as genetic risk scores of dyslipidemia-associated variants , and the consumption of carbohydrate-rich foods on iCVD risk was observed Consumers often turn to non-caloric sweeteners ( NCS ) as a means of promoting a healthy body weight . However , several studies have now linked their long-term use to increased weight gain , raising the question of whether these products produce unintended psychological , physiological , or behavioral changes that have implication s for weight management goals . In the following , we present the results of three experiments bearing on this issue , testing whether NCS-consumption influences how  individuals think about and respond to food .  Participants in each of our three experiments were r and omly assigned to consume a sugar-sweetened beverage , an unsweetened beverage , or a beverage sweetened with NCS . We then measured their cognition ( Experiment 1 ) , product choice ( Experiment 2 ) , and subjective responses to a sugar-sweetened food ( Experiment 3 ) . Results revealed that consuming NCS-sweetened beverages influences psychological processes in ways that - over time - may increase calorie intake BACKGROUND Obesity in adolescence has been increasing in the past several decades . Beverage habits among adolescents include increased consumption of sugar-sweetened beverages and decreased consumption of milk . OBJECTIVE This study aim ed to examine the association between beverage consumption and 5-y body weight change  in 2294 adolescents . DESIGN Project EAT ( Eating Among Teens ) is a 5-y longitudinal study of eating patterns among adolescents . Surveys were completed in 1998 - 1999 ( time 1 ) and in 2003 - 2004 ( time 2 ) . Multivariable linear regression was used to examine the association between beverage consumption at time 2 and change in body mass index from time 1 to time 2 , with adjustments for age , socioeconomic status , race , cohort , physical activity , sedentary behavior , coffee , tea , time 1 body mass index , and beverage variables . RESULTS In prospect i ve analyses , consumption of beverages was not associated with weight gain , except for consumption of low-calorie soft drinks ( positive association , P = 0.002 ) and white milk ( inverse association , P = 0.03 ) , but these associations did not appear to be a monotonic linear dose-response relation . The positive association with low-calorie soft drinks was no longer present after adjustment for dieting and parental weight-related concerns , which suggests that the use of low-calorie soft drinks is a marker for more general dietary behaviors and weight concerns . CONCLUSIONS We showed no association between sugar-sweetened beverage consumption , juice consumption , and adolescent weight gain over a 5-y period . A direct association between diet beverages and weight gain appeared to be explained by dieting practice s. Adolescents who consumed little or no white milk gained significantly more weight than their peers who consumed white milk . Future research that examines beverage habits and weight among adolescents should address portion sizes , adolescent maturation , and dieting behaviors Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways . Therefore , associations between single nutrients and chronic disease may be difficult to identify and interpret , but when dietary patterns ( DPs ) are examined the combination of many food factors will be considered . An explorative literature search of published review articles was conducted to obtain a fuller underst and ing of current DPs in epidemiological research , to discuss pros and cons of DPs in nutrition research , and to identify results of studies linking DPs to chronic disease risk in adults . R and omized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits . Systematic review s of feeding trials and prospect i ve population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs . However , to date only a few review articles of DP studies have followed a systematic process using independent review ers with strict inclusion , exclusion , and study quality criteria . Diets with plenty of plants foods , fish , and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases . In contrast , Western-type DPs with food products low in essential nutrients and high in energy , like sugar-sweetened beverages , sweets , refined cereals and solid fats ( e.g. butter ) , and high in red and processed meats , are associated with adverse health effects . An emphasis on high- quality original research , and systematic review s following a structured process to objective ly select and judge studies , is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease To test the hypothesis that endogenous opiate peptides selectively influence hedonic response to sweet and high-fat foods , the opiate antagonist naloxone , opiate agonist butorphanol , and a saline placebo were administered by intravenous infusion to 16 obese and 25 normal-weight women . Twenty of the women ( 10 obese , 10 lean ) fulfilled DSM-III-R diagnostic criteria for bulimia nervosa , as determined by psychiatric interview . During drug infusion the women tasted and rated 20 sweetened dairy products and were presented with eight snack foods of varying sugar and fat content . Naloxone suppressed hedonic responses in all subject groups and suppressed the consumption of sweet and high-fat foods in binge eaters , but not in nonbingers . Food intakes of obese women were not affected by naloxone . Butorphanol had no effect on either hedonic response or on food consumption in any group . Although opiate blockade is not a viable strategy for weight reduction in the treatment of obesity , it may be useful in the clinical management of the binge-eating disorder BACKGROUND The consumption of beverages that contain sugar is associated with overweight , possibly because liquid sugars do not lead to a sense of satiety , so the consumption of other foods is not reduced . However , data are lacking to show that the replacement of sugar-containing beverages with noncaloric beverages diminishes weight gain . METHODS We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age . Participants were r and omly assigned to receive 250 ml ( 8 oz ) per day of a sugar-free , artificially sweetened beverage ( sugar-free group ) or a similar sugar-containing beverage that provided 104 kcal ( sugar group ) . Beverages were distributed through schools . At 18 months , 26 % of the children had stopped consuming the beverages ; the data from children who did not complete the study were imputed . RESULTS The z score for the body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) increased on average by 0.02 SD units in the sugar-free group and by 0.15 SD units in the sugar group ; the 95 % confidence interval ( CI ) of the difference was -0.21 to -0.05 . Weight increased by 6.35 kg in the sugar-free group as compared with 7.37 kg in the sugar group ( 95 % CI for the difference , -1.54 to -0.48 ) . The skinfold-thickness measurements , waist-to-height ratio , and fat mass also increased significantly less in the sugar-free group . Adverse events were minor . When we combined measurements at 18 months in 136 children who had discontinued the study with those in 477 children who completed the study , the BMI z score increased by 0.06 SD units in the sugar-free group and by 0.12 SD units in the sugar group ( P=0.06 ) . CONCLUSIONS Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children . ( Funded by the Netherl and s Organization for Health Research and Development and others ; DRINK Clinical Trials.gov number , NCT00893529 . ) STUDY OBJECTIVE To investigate the prevalence and nature of low energy reporting in a dietary survey of British adults over 65 years of age . DESIGN R and omly selected cross sectional sample of 2060 British adults over 65 years . Four day weighed food diaries and question naires on health , lifestyle and socioeconomic characteristics . SETTING Great Britain . PARTICIPANTS 539 women and 558 men over 65 years who were free living and completed four day food diaries .  MAIN RESULTS A high proportion of men and women were classified as low energy reporters ( LERs ) . Reported consumption of full fat dairy products , sugar and sweet foods , and alcoholic drinks differed most between LERs and non-LERs . Among LERs , reported protein and starch intakes were higher , fat , sugar and alcohol intakes were lower . LERs of either sex were more likely to be obese , male LERs were also more likely to belong to the manual social classes . CONCLUSIONS The high level of low energy reporting probably result ed from a coalescence of factors such as the weighed diary methodology and a reluctance to report consumption of unhealthy foods . The use of validatory biomarkers such as doubly labelled water needs to be more widespread Importance Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program ( SNAP ) are of interest to policymakers . Objective To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants ' diets . Design , Setting , and Participants Lower income participants ( n = 279 ) not currently enrolled in SNAP were r and omized to 1 of 4 experimental financial food benefit conditions : ( 1 ) incentive ( 30 % financial incentive for fruits and vegetables purchased using food benefits ) ; ( 2 ) restriction ( not allowed to buy sugar sweetened beverages , sweet baked goods , or c and ies with food benefits ) ; ( 3 ) incentive plus restriction ( 30 % financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages , sweet baked goods , or c and y with food benefits ) ; or ( 4 ) control ( no incentive or restrictions on foods purchased with food benefits ) . Participants in all conditions were given a study -specific debit card where funds were added every 4 weeks for a 12-week period . Outcome measures were collected at baseline and in the final 4 weeks of the experimental period . Main Outcomes and Measures Primary outcomes ( from 24-hour dietary recalls ) included intake of energy , discretionary calories , and overall diet quality . Results A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition . These included ( 1 ) reduced intake of energy ( -96 kcal/d , st and ard error [ SE ] , 59.9 ) ; ( 2 ) reduced intake of discretionary calories ( -64 kcal/d , SE 26.3 ) ; ( 3 ) reduced intake of sugar sweetened beverages , sweet baked goods , and c and ies ( -0.6 servings/d , SE 0.2 ) ; ( 4 ) increased intake of solid fruit ( 0.2 servings/d , SE 0.1 ) ; and ( 5 ) improved Healthy Eating Index score ( 4.1 points , SE 1.4 ) . Fewer improvements were observed in the incentive only and restriction only arms . Conclusions and Relevance A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions . Clinical Trial Registration clinical trials.gov Identifier : NCT02643576 BACKGROUND Despite safety reports of the artificial sweetener aspartame , health-related concerns remain . OBJECTIVE We prospect ively evaluated whether the consumption of aspartame- and sugar-containing soda is associated with  risk of hematopoetic cancers .  DESIGN We repeatedly assessed diet in the Nurses ' Health Study ( NHS ) and Health Professionals Follow-Up Study ( HPFS ) . Over 22 y , we identified 1324 non-Hodgkin lymphomas ( NHLs ) , 285 multiple myelomas , and 339 leukemias . We calculated incidence RRs and 95 % CIs by using Cox proportional hazards models . RESULTS When the 2 cohorts were combined , there was no significant association between soda intake and risks of NHL and multiple myeloma . However , in men , ≥1 daily serving of diet soda  increased risks of NHL ( RR : 1.31 ; 95 % CI : 1.01 , 1.72 ) and multiple myeloma ( RR : 2.02 ; 95 % CI : 1.20 , 3.40 ) in comparison with men who did not consume diet soda . We observed no increased risks of NHL and multiple myeloma in women . We also observed an unexpected elevated risk of NHL ( RR : 1.66 ; 95 % CI : 1.10 , 2.51 ) with a higher consumption of regular , sugar-sweetened soda in men but not in women . In contrast , when sexes were analyzed separately with limited power , neither regular nor diet soda  increased risk of leukemia but were associated with increased leukemia risk when data for men and women were combined ( RR for consumption of ≥1 serving of diet soda/d when the 2 cohorts were pooled : 1.42 ; 95 % CI : 1.00 , 2.02 ) . CONCLUSION Although our findings preserve the possibility of a detrimental effect of a constituent of diet soda , such as aspartame , on select cancers , the inconsistent sex effects and occurrence of an apparent cancer risk in individuals who consume regular soda do not permit the ruling out of chance as an explanation Objectives : To investigate the role of product evaluations , nutritional and persuasion knowledge on children ’s food choices conducted because of limited evidence about the role of product evaluations on consumer choices in conjunction with cognitive defences . Design : A r and omised controlled 2 × 2 factorial experiment with an exposure to a food and a control ( toy ) advertisement conducted in a non-laboratory setting at an annual event traditionally visited by families . Subjects : Children aged 7–13 years with biometric/weight data representative of the general Australian population . Measurements : Height and weight ( converted into body mass index z-scores ) measured in addition to children ’s nutritional and persuasion knowledge , product evaluations , age and gender . Results : The factors that undermine children ’s cognitive defences relate to taste , social appeal of foods and low nutritional and persuasion knowledge . An interplay between the above-mentioned factors was also observed , identifying four groups among young consumers , alluding to a complex and at times impulsive nature of children ’s decisions : ( 1 ) knowledgeable children with less positive product evaluations choosing a healthy snack ; ( 2 ) knowledgeable but hedonism-oriented children seeking peer conformity choosing an advertised product ; ( 3 ) knowledgeable children who chose a snack belonging to the same product category ; and ( 4 ) less knowledgeable children with positive product evaluations and low nutritional knowledge choosing snacks from the advertised product category . Obese children were more likely to belong to a cluster of less knowledgeable and hedonism-oriented children . Conclusions : The problem of consumption of less healthy foods is complex and multiple factors need to be considered by health practitioners , social marketers and parents to address the issue of childhood obesity . Nutritional knowledge alone is not sufficient to ensure children make healthier food choices and emphasis should also be placed on persuasion knowledge education , targeting of peer norms , self-efficacy and stricter regulation of advertising aim ed at children OBJECTIVES To test whether increased television viewing is associated with increased total energy intake and with increased consumption of foods commonly advertised on television , and to test whether increased consumption of these foods mediates the relationship between television viewing and total energy intake . DESIGN Prospect i ve observational study with baseline ( fall 1995 ) and follow-up ( spring 1997 ) measures of youth diet , physical activity , and television viewing . We used food advertising data to identify 6 food groups for study ( sweet baked snacks , c and y , fried potatoes , main courses commonly served as fast food , salty snacks , and sugar-sweetened beverages ) . SETTING AND PARTICIPANTS Five public schools in 4 communities near Boston . The sample included 548 students ( mean age at baseline , 11.70 years ; 48.4 % female ; and 63.5 % white ) . MAIN OUTCOME MEASURES Change in total energy intake and intake of foods commonly advertised on television  from baseline to follow-up . RESULTS After adjusting for baseline covariates , each hour increase in television viewing was associated with an additional 167 kcal/d ( 95 % confidence interval , 136 - 198 kcal/d ; P<.001 ) and with increases in the consumption of foods commonly advertised on television . Including changes in intakes of these foods in regression models provided evidence of their mediating role , diminishing or rendering nonsignificant the associations between change in television viewing and change in total energy intake . CONCLUSIONS Increases in television viewing are associated with increased calorie intake among youth . This association is mediated by increasing consumption of calorie-dense low-nutrient foods frequently advertised on television Consumption of sugar-sweetened beverages has been shown , largely in American population s , to increase type 2 diabetes incidence . We aim ed to evaluate the association of consumption of sweet beverages ( juices and nectars , sugar-sweetened soft drinks and artificially sweetened soft drinks ) with  type 2 diabetes incidence in European adults . We established a case – cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study . After exclusions , the final sample size included 11,684 incident cases and a subcohort of 15,374 participants . Cox proportional hazards regression models ( modified for the case – cohort design ) and r and om-effects meta-analyses were used to estimate the association between sweet beverage consumption ( obtained from vali date d dietary question naires ) and type 2 diabetes incidence . In adjusted models , one 336 g ( 12 oz ) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 ( 95 % CI 1.09 , 1.38 ) and 1.52 ( 95 % CI 1.26 , 1.83 ) , respectively . After further adjustment for energy intake and BMI , the association of sugar-sweetened soft drinks with type 2 diabetes persisted ( HR 1.18 , 95 % CI 1.06 , 1.32 ) , but the association of artificially sweetened soft drinks became statistically not significant ( HR 1.11 , 95 % CI 0.95 , 1.31 ) . Juice and nectar consumption was not associated with type 2 diabetes incidence . This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults OBJECTIVE Consumption of sugar-sweetened beverages ( SSBs ) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged population s. Studies on SSB consumption and glucose intolerance among pregnant women , however , are lacking . We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM ) . RESEARCH DESIGN AND METHODS This was a prospect i ve study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses ' Health Study II . GDM was self-reported and vali date d by medical record review in a sub sample . Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk . RESULTS During 10 years of follow-up , 860 incident GDM case subjects were identified . After adjustment for age , parity , race , physical activity , smoking , alcohol intake , prepregnancy BMI , and Western dietary pattern , intake of sugar-sweetened cola was positively associated with the risk of GDM , whereas no significant association was found for other SSBs and diet beverages . Compared with women who consumed < 1 serving/month , those who consumed ≥5 servings/week of sugar-sweetened cola had a 22 % greater GDM risk ( relative risk 1.22 [ 95 % CI 1.01–1.47 ] ) . CONCLUSIONS Findings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola ( ≥5 servings/week ) is associated with an elevated GDM risk , whereas no significant association with GDM risk was observed for other SSBs and diet beverages Chocolate milk increases milk consumption of children , but high sugar content raises health concerns . Interest in sugar reduction and parents ' preference for natural sweeteners necessitates further research on natural nonnutritive sweeteners . However , it is important to maintain consumer acceptability , especially for children , while reducing sugar in chocolate milk . The objectives of this study were to identify the sweetness intensity perception of stevia leaf ( STV ) and monk fruit ( MK ) extracts in skim chocolate milk ( SCM ) , to evaluate STV and MK as the sole or partial sweetener source for SCM for young adults ( 19 to 35 y ) and children ( 5 to 13 y ) , and to determine if information on natural nonnutritive sweeteners impacted parents ' acceptability of SCM . Power function and 2-alternative forced choice studies were used to determine the iso-sweetness of nonnutritive sweeteners to a sucrose control in SCM ( 51.4 g/L , SUC control ) . Young adults ( n = 131 ) evaluated 9 different SCM ( SUC control , STV , MK , STV : sucrose blends , or MK : sucrose blends ) in a completely r and omized 2-d test . Children ( n = 167 ) evaluated SUC control SCM and SCM with 39.7 g/L sucrose and 46 mg/L MK ( MK25 ) or 30 mg/L STV ( STV25 ) . Parents evaluated SUC control , MK25 , and STV25 in a balanced crossover design with a 40-d wait time between primed or unprimed ballots . Chocolate milks solely sweetened by nonnutritive sweeteners were less acceptable compared with SUC control by young adults . MK25 and STV25 were acceptable by young adults and children . The presentation of chocolate milk label information had different effects on parental acceptance . Traditional parents preferred sucrose sweetened SCM , and label conscious parents preferred SCM with natural nonnutritive sweeteners The sweet taste of nonnutritive sweeteners has been reported to increase hunger and food intake through the mechanism of cephalic-phase insulin release ( CPIR ) . We investigated the effect of oral sensation of sweetness on CPIR and other indexes associated with glucose metabolism using nutritive and nonnutritive sweetened tablets as stimuli . At lunchtime , 12 normal-weight men sucked for 5 min a sucrose , an aspartame-polydextrose , or an unsweetened polydextrose tablet ( 3 g ) with no added flavor . The three stimuli were administered in a counterbalanced order , each on a separate day at 1-wk intervals . Blood was drawn continuously for 45 min before and 25 min after the beginning of sucking and sample s were collected at 1-min intervals . Spontaneous oscillations in glucose , insulin , and glucagon concentrations were assessed as were increments ( slopes ) of fatty acid concentrations during the baseline period . The nature of the baseline ( oscillations : glucose , insulin , and glucagon ; and slopes : fatty acids ) was taken into account in the analyses of postexposure events . No CPIR and no significant effect on plasma glucagon or fatty acid concentrations were observed after the three stimuli . However , there was a significant decrease in plasma glucose and insulin after all three stimuli . Only the consumption of the sucrose tablet was followed by a postabsorptive increase in plasma glucose and insulin concentrations starting 17 and 19 min , respectively , after the beginning of sucking . In conclusion , this study suggested that oral stimulation provided by sweet nonflavored tablets is not sufficient for inducing CPIR BACKGROUND A population of over 12,000 mature subjects participated in a longitudinal study ( 8 years ) of nutrition and health ( the Su . Vi . Max Study ) . In this context , a specific cross-sectional study was carried out in a r and omly selected sub population . AIM To identify anthropometric , nutritional and biochemical correlates of spontaneous use of ' light ' foods and drinks in a free-living population . DESIGN Men ( n = 2299 ) and women ( n = 1979 ) , 45 - 60 years , reported their food intakes over six non-consecutive days . Consumers of low-fat and low-sugar foods and drinks , and artificial sweeteners , were compared with non-consumers . RESULTS Users of low-sugar products were heavier than non-users ; female consumers of low-fat products , but not males , had higher body weight and BMI than non-consumers . Users of low-sugar products had higher triacylglycerols and glycaemia than non-users while biochemical parameters were not different in users and non-users of low-fat products . Use of low-sugar products led to increased diet density of a few micronutrients , including cholesterol . Low-fat product selection was associated with increased intake of most micronutrients , both in absolute value and in density . CONCLUSIONS In mature adults , selection of fat-reduced products was associated with improved quality of the diet , while anthropometric and biological parameters appeared less favourable in consumers of low-sugar products vs. non-consumers . The longitudinal follow-up of the cohort in future years will help determine cause- and -effect relationships among these parameters Aims /hypothesisThis study aim ed to evaluate the association of types of sugar-sweetened beverages ( SSB ) ( soft drinks , sweetened-milk beverages , sweetened tea/coffee ) , artificially sweetened beverages ( ASB ) and fruit juice with incident type 2 diabetes and determine the effects of substituting non-SSB for SSB and the population -attributable fraction of type 2 diabetes due to total sweet beverages . Methods Beverage consumption of 25,639 UK-resident adults without diabetes at baseline ( 1993–1997 ) in the European Prospect i ve Investigation into Cancer and Nutrition (EPIC)-Norfolk study was assessed using 7-day food diaries . During 10.8 years of follow-up 847 incident type 2 diabetes cases were verified . Results In adjusted Cox regression analyses there were positive associations ( HR [ 95 % CI ] per serving/day ] ) for soft drinks 1.21 ( 1.05 , 1.39 ) , sweetened-milk beverages 1.22 ( 1.05 , 1.43 ) and ASB 1.22 ( 1.11 , 1.33 ) , but not for sweetened tea/coffee 0.98 ( 0.94 , 1.02 ) or fruit juice 1.01 ( 0.88 , 1.15 ) . Further adjustment for adiposity attenuated the association of ASB , HR 1.06 ( 0.93 , 1.20 ) . There was a positive dose – response relationship with total sweet beverages : HR per 5 % energy 1.18 ( 1.11 , 1.26 ) . Substituting ASB for any SSB did not reduce the incidence in analyses accounting for energy intake and adiposity . Substituting one serving/day of water or unsweetened tea/coffee for soft drinks and for sweetened-milk beverages reduced the incidence by 14%–25 % . If sweet beverage consumers reduced intake to below 2 % energy , 15 % of incident diabetes might be prevented . Conclusions /interpretationThe consumption of soft drinks , sweetened-milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independently of adiposity . Water or unsweetened tea/coffee appear to be suitable alternatives to SSB for diabetes prevention . These findings support the implementation of population -based interventions to reduce SSB consumption and increase the consumption of suitable alternatives BACKGROUND Food consumed outside the home accounts for a growing proportion of the North American diet and has been associated with increased obesity . PURPOSE To examine the effect of nutrition labeling on menus on awareness , use , and food consumption , including the impact of " traffic light " labeling and adding other nutrients . METHODS Blinded , r and omized trial with 635 Canadian adults conducted in 2010 - 2011 . Participants ordered a free meal from one of four experimental menus : 1 ) no nutritional information shown , 2 ) calorie amounts only , 3 ) calorie amounts in " traffic lights " , and 4 ) calorie , fat , sodium , and sugar shown in " traffic lights " .  Recall of nutrition information , knowledge of calorie content and nutrient consumption were assessed . RESULTS Participants in the calorie conditions were more likely to recall the calorie content of meals and to report using nutrition information when ordering . The calorie content of meals was not significantly different across conditions ; however , calorie consumption was significantly lower among participants in the Calorie-only condition compared to the No information condition ( mean=-96 kcal , p=.048 ) . CONCLUSIONS Menu labeling increased awareness and use of nutrition information and reduced consumption . Adding " traffic lights " , fat , sodium , and sugar amounts to menus had little impact compared to calorie-only labeling Introduction Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity , especially abdominal obesity , remain entrenched despite substantial low-calorie sweetener use . We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity . Participants and Methods We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products , from 1454 participants ( 741 men , 713 women ) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years ( range : 0–28 years ) . At baseline , 785 were low-calorie sweetener non-users ( 51.7 % men ) and 669 participants were low-calorie sweetener users ( 50.1 % men ) . Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported . We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes —body mass index , waist circumference , obesity and abdominal obesity — with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality . All models were adjusted for year of visit , age , sex , age by sex interaction , race , current smoking status , dietary intake ( caffeine , fructose , protein , carbohydrate , and fat ) , physical activity , diabetes status , and Dietary Approaches to Stop Hypertension score as confounders . Results With median follow-up of 10 years , low-calorie sweetener users had 0.80 kg/m2 higher body mass index ( 95 % confidence interval [ CI ] , 0.17–1.44 ) , 2.6 cm larger waist circumference ( 95 % CI , 0.71–4.39 ) , 36.7 % higher prevalence ( prevalence ratio = 1.37 ; 95 % CI , 1.10–1.69 ) and 53 % higher incidence ( hazard ratio = 1.53 ; 95 % CI 1.10–2.12 ) of abdominal obesity than low-calorie sweetener non-users . Conclusions Low-calorie sweetener use is independently associated with heavier relative weight , a larger waist , and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control BACKGROUND Previous laboratory research on alcohol absorption has found that substitution of artificially sweetened alcohol mixers for sucrose-based mixers has a marked effect on the rate of gastric emptying , result ing in elevated blood alcohol concentrations . Studies conducted in natural drinking setting s , such as bars , have indicated that caffeine ingestion while drinking is associated with higher levels of intoxication . To our knowledge , research has not examined the effects of alcohol mixers that contain both an artificial sweetener and caffeine , that is , diet cola . Therefore , we assessed the event-specific association between diet cola consumption and alcohol intoxication in bar patrons . We sought to determine whether putative increases in blood alcohol , produced by accelerated gastric emptying following diet cola consumption , as identified in the laboratory , also appear in a natural setting associated with impaired driving . METHODS We conducted a secondary analysis of data from 2 nighttime field studies that collected anonymous information from 413 r and omly selected bar patrons in 2008 and 2010 . Data sets were merged and recoded to distinguish between energy drink , regular cola , diet cola , and noncaffeinated alcohol mixers . RESULTS Caffeinated alcohol mixers were consumed by 33.9 % of the patrons . Cola-caffeinated mixed drinks were much more popular than those mixed with energy drinks . A large majority of regular cola-caffeinated mixed drink consumers were men ( 75 % ) , whereas diet cola-caffeinated mixed drink consumers were more likely to be women ( 57 % ) . After adjusting for the number of drinks consumed and other potential confounders , number of diet cola mixed drinks had a significant association with patron intoxication ( β = 0.233 , p < 0.0001 ) . Number of drinks mixed with regular ( sucrose-sweetened ) cola and energy drinks did not have significant associations with intoxication ( p > 0.05 ) . CONCLUSIONS Caffeine 's effect on intoxication may be most pronounced when mixers are artificially sweetened , that is , lack sucrose which slows the rate of gastric emptying of alcohol . Risks associated with on-premise drinking may be reduced by greater attention given to types of mixers , particularly diet colas OBJECTIVE To examine the effects of non-alcoholic beverage and caffeine consumption on  all-cause mortality in older adults . METHODS The Leisure World Cohort Study is a prospect i ve study of residents of a California retirement community . A baseline postal health survey included details on coffee , tea , milk , soft drink , and chocolate consumption .  Participants were followed for 23 years ( 1981 - 2004 ) . Risk ratios ( RRs ) of death were calculated using Cox regression for 8644 women and 4980 men ( median age at entry , 74 years ) and adjusted for age , gender , and multiple potential confounders . RESULTS Caffeine consumption exhibited a U-shaped mortality curve . Moderate caffeine consumers had a significantly reduced risk of death ( multivariable-adjusted RR=0.94 , 95 % CI : 0.89 , 0.99 for 100 - 199 mg/day and RR=0.90 , 95 % CI : 0.85 , 0.94 for 200 - 399 mg/day compared with those consuming < 50 mg/day ) . Individuals who drank more than 1 can/week of artificially sweetened ( but not sugar-sweetened ) soft drink ( cola and other ) had an 8 % increased risk ( 95 % CI : 1.01 - 1.16 ) . Neither milk nor tea had a significant effect on mortality after multivariable adjustment . CONCLUSIONS Moderate caffeine consumption appeared beneficial in reducing risk of death . Attenuation in the observed associations between mortality and intake of tea and milk with adjustment for potential confounders suggests that such consumption identifies those with other mortality-associated lifestyle and health risks . The increased death risk with consumption of artificially sweetened , but not sugar-sweetened , soft drinks suggests an effect of the sweetener rather than other components of the soft drinks , although residual confounding remains a possibility OBJECTIVE We tested whether the presence of both  child-targeted and nutrition-focused ( i.e. parent-targeted ) marketing cues on food packaging was associated with the nutritional content of these products . DESIGN We conducted a quantitative content analysis of 403 food packages chosen r and omly from the supermarket 's online portal along with all products ( n 312 ) from the cereal aisle in a supermarket from the Southeastern USA . We examined main and interaction effects for cues on nutritional content ( e.g. energy density , sugar , sodium , fibre ) . SETTING A regional supermarket chain in the Southeastern USA . RESULTS Tests of main effects indicated that increased presence of nutritional cues was linked to more nutritious content ( e.g. less sugar , less saturated fat , more fibre ) while the increased presence of child-targeted cues was uniformly associated with less nutritious content ( e.g. more sugar , less protein , less fibre ) . Among the interaction effects , results revealed that products with increased nutrition-focused and child-targeted cues were likely to contain significantly more sugar and less protein than other products . CONCLUSIONS Products that seek to engage children with their packaging in the supermarket are significantly less nutritious than foods that do not , while product packages that suggest nutritional benefits have more nutritious content . More importantly , the study provides evidence that those products which try to engage both child and parent consumers are significantly less healthy in crucial ways ( e.g. more sugar , less fibre ) than products that do not OBJECTIVE To test the efficacy of nutritional guidelines for school lunch cooks aim ing to reduce added sugar in school meals and their own sugar intake . METHODS A controlled r and omized cluster trial was carried out in twenty public schools in the municipality of Niteroi in Rio de Janeiro , Southeastern Brazil , from March to December 2007 . A nutrition educational program was implemented in the schools in question through messages , activities and printed educational material s encouraging reduced levels of added sugar in school meals and in the school lunch cooks ' own intake . The reduced availability of added sugar in schools was evaluated using spreadsheets including data on the monthly use of food item supplies . The cooks ' individual food intake was evaluated by a Food Frequency Question naire . Anthropometric measurements were taken according to st and ardized techniques and variation in weight was measured throughout the duration of the study . RESULTS There was a more marked reduction in the intervention schools compared to the control schools ( -6.0 kg versus 0.34 kg ) , but no statistically significant difference ( p = 0.21 ) , although the study power was low . Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages , but the difference in sugar intake was not statistically significant . Weight loss and a reduction in total energy consumption occurred in both groups , but the difference between them was not statistically significant , and there was no alteration in the percentages of adequacy of macronutrients in relation to energy consumption . CONCLUSIONS The strategy of reducing the use and consumption of sugar by school lunch cooks from public schools could not be proved to be effective BACKGROUND Consumption of sugar-sweetened soda has been associated with an increased risk of cardiometabolic disease . The relation with cerebrovascular disease has not yet been closely examined . OBJECTIVE Our objective was to examine patterns of soda consumption and substitution of alternative beverages for soda in relation to stroke risk . DESIGN The Nurses ' Health Study , a prospect i ve cohort study of 84,085 women followed for 28 y ( 1980 - 2008 ) , and the Health Professionals Follow-Up Study , a prospect i ve cohort study of 43,371 men followed for 22 y ( 1986 - 2008 ) , provided data on soda consumption and incident stroke . RESULTS We documented 1416 strokes in men during 841,770 person-years of follow-up and 2938 strokes in women during 2,188,230 person-years of follow-up .  The pooled RR of total stroke for ≥ 1 serving of sugar-sweetened soda/d , compared with none , was 1.16 ( 95 % CI : 1.00 , 1.34 ) . The pooled RR of total stroke for ≥ 1 serving of low-calorie soda/d , compared with none , was 1.16 ( 95 % CI : 1.05 , 1.28 ) . Compared with 1 serving of sugar-sweetened soda/d , 1 serving of decaffeinated coffee/d was associated with a 10 % ( 95 % CI : 1 % , 19 % ) lower risk of stroke and 1 serving of caffeinated coffee/d with a 9 % ( 95 % CI : 0 % , 17 % ) lower risk . Similar estimated reductions in risk were seen for substitution of caffeinated or decaffeinated coffee for low-calorie soda . CONCLUSIONS Greater consumption of sugar-sweetened and low-calorie sodas was associated with a significantly higher risk of stroke . This risk may be reduced by substituting alternative beverages for soda OBJECTIVE The Dutch Obesity Intervention in Teenagers ( DOiT ) is a school-based r and omised controlled trial that was effective in decreasing the consumption of sugar-sweetened beverages among adolescents . The present study examined , using mediation analysis , whether this decrease in consumption of sugar-sweetened beverages could be explained by an increase in the consumption of water or diet drinks . DESIGN Participants completed a question naire about their beverage consumption at baseline and at 8 months ( immediately post-intervention ) , 12- and 20-month follow-ups . A series of multi-level linear regression analyses were performed to examine water and diet drink consumption as potential mediators of the intervention effect on the consumption of sugar-sweetened beverages . SETTING Eighteen Dutch secondary schools . SUBJECTS A total of 747 adolescents ( mean age : 12·7 years ) . RESULTS In addition to the DoiT intervention effect of a reduction in the consumption of sugar-sweetened beverages at 8 months ( -284 ml/d ; 95 % CI -420 , -148 ) and 12 months ( -260 ml/d ; 95 % CI -360 , -160 ) , there was also a significant reduction in diet drinks at 8 months ( -52 ml/d ; 95 % CI -89 , -16 ) . There was no significant difference in water consumption at any follow-up . The decrease in sugar-sweetened beverage consumption could not be explained by an increase in water or diet drink consumption at any time point . CONCLUSIONS Interventions aim ed at reducing sugar-sweetened beverage consumption may be effective without changing consumption of other beverages . Reducing sugar-sweetened beverages was , however , a main message of the DOiT intervention . It is possible that a concomitant promotion of water may have result ed in a greater increase in water intake and replacement of sugar-sweetened beverages with water Background Unhealthy dietary behaviours are one of the key risk factors for many lifestyle-related diseases worldwide . This r and omised controlled trial aim ed to increase the level of fruit , vegetable and fibre intake and decrease the fat and sugar consumption of mothers with young children ( 0 - 5 years ) via the playgroup setting . Methods Playgroups located in 60 neighbourhoods in Perth , Western Australia were r and omly assigned to an intervention ( n = 249 ) or control group ( n = 272 ) . Those in the intervention group received a 6-month multi- strategy primarily home-based physical activity and nutrition program ( data is only presented on dietary behaviours ) . Data on dietary consumption was collected via the Fat and Fibre Barometer and frequency of serves of fruit and vegetable and cups of soft drink , flavoured drink and fruit juice . The effects of the intervention on continuous outcome measures were assessed using analysis of variance ( ANOVA ) , after adjusting for mother ’s age and the corresponding variables . Results The outcomes of the intervention were positive with the intervention group showing statistically significant improvements , when compared to the control group in the overall consumption of fat and fibre ( p < 0.0005 ) ; of fibre ( p < 0.0005 ) - fruit and vegetables ( p < 0.0005 ) , wholegrain ( p = 0.002 ) : and fat ( p = 0.005 ) - dairy products ( p = 0.006 ) and lean meat and chicken ( p = 0.041 ) . There were no significant changes in the consumption of sweet drinks . Conclusions This intervention was successful in improving dietary intake in the intervention group participants . The moderate positive outcomes indicate that playgroups potentially provide quite a viable setting to recruit , engage and retain this hard to reach group of mothers of young children in programs that support the adoption of health-enhancing behaviours . This adds valuable information to this under research ed area . Trial registration Australian and New Zeal and Clinical Trials Registry https://www.anzctr.org.au/Trial/ Registration /Trial Review OBJECTIVE . The obesity epidemic in the United States continues to increase . Because obesity tends to track over time , the increase in overweight among young children is of significant concern . A number of eating patterns have been associated with overweight among preschool-aged children . Recently , 100 % fruit juice and sweetened fruit drinks have received considerable attention as potential sources of high-energy beverages that could be related to the prevalence of obesity among young children . Our aim was to evaluate the beverage intake among preschool children who participated in the National Health and Nutrition Examination Survey 1999–2002 and investigate associations between types and amounts of beverages consumed and weight status in preschool-aged children . METHODS . We performed a secondary analysis of the data from the National Health and Nutrition Examination Survey 1999–2002 , which is a continuous , cross-sectional survey of a nationally representative sample of the noninstitutionalized population of the United State . It included the collection of parent reported demographic descriptors , a  24-hour dietary recall  , a  measure of physical activity  , and a st and ardized physical examination .  The 24-hour dietary recall was obtained in person by a trained interviewer and reflected the foods and beverages that were consumed by the participant the previous day . The National Health and Nutrition Examination Survey food groups were classified on the basis of the US Department of Agriculture 's Food and Nutrient Data base for Dietary Studies . We review ed the main food descriptors used and classified all beverages listed . One hundred percent fruit juice was classified as only beverages that contained 100 % fruit juice , without sweetener . Fruit drinks included any sweetened fruit juice , fruit-flavored drink ( natural or artificial ) , or drink that contained fruit juice in part . Milk included any type of cow milk and then was subcategorized by percentage of milk fat . Any sweetened soft drink , caffeinated or uncaffeinated , was categorized as soda . Diet drinks included any fruit drink , tea , or soda that was sweetened by low-calorie sweetener . Several beverages were removed from the analysis because of low frequency of consumption among the sample . Water was not included in the analysis because it is not part of the US Department of Agriculture 's Food and Nutrient Data base categories . For the purpose s of this analysis , the beverages were converted and reported as ounces , rather than grams , as reported by the National Health and Nutrition Examination Survey , to make it more clinical ly relevant . The child 's BMI percentile for age and gender were calculated on the basis of Centers for Disease Control and Prevention criteria and used to identify children 's weight status as underweight ( < 5 % ) , normal weight ( 5 % to < 85 % ) , at risk for overweight ( 85 % to < 95 % ) , or overweight ( ≥95 % ) . Because of the small number of children in the underweight category , they were included in the normal-weight category for this analysis . Data were analyzed using SUDAAN 9.0.1 statistical software programs . SUDAAN allows for improved accuracy and validity of results by calculating test statistics for the stratified , multistage probability design of the National Health and Nutrition Examination Survey . Sample weights were applied to all analyses to account for unequal probability of selection from oversampling low-income children and black and Mexican American children . Descriptive and χ2 analyses and analysis of covariance , adjusting for age , gender , ethnicity , household income , energy intake , and physical activity , were conducted . RESULTS . All children who were aged 2 to 5 years were identified ( N = 1572 ) . Those with missing data were removed from additional analysis , result ing in a final sample of 1160 preschool children . Of the 1160 children analyzed , 579 ( 49.9 % ) were male . White children represented 35 % , black children represented 28.3 % , and Hispanic children represented 36.7 % of the sample . Twenty-four percent of the children were overweight or at risk for overweight ( BMI ≥85 % ) , and 10.7 % were overweight ( BMI ≥95 % ) . There were no statistically significant differences in BMI between boys and girls or among the ethnicities . Overweight children tended to be older ( mean age : 3.83 years ) compared with the normal-weight children ( mean age : 3.48 years ) . Eighty-three percent of children drank milk , 48 % drank 100 % fruit juice , 44 % drank fruit drink , and 39 % drank soda .  Whole milk was consumed by 46.5 % of the children , and 3.1 % and 5.5 % of the children consumed skim milk and 1 % milk , respectively . Preschool children consumed a mean total beverage volume of 26.93 oz/day , which included 12.32 oz of milk , 4.70 oz of 100 % fruit juice , 4.98 oz of fruit drinks , and 3.25 oz of soda . Weight status of the child had no association with the amount of total beverages , milk , 100 % fruit juice , fruit drink , or soda consumed . There was no clinical ly significant association between the types of milk ( percentage of fat ) consumed and weight status . In analysis of covariance , daily total energy intake increased with increased consumption of milk , 100 % fruit juice , fruit drinks , and soda . However , there was not a statistically significant increase in BMI on the basis of quantity of milk , 100 % fruit juice , fruit drink , or soda consumed . CONCLUSIONS . On average , preschool children drank less milk than the 2005 Dietary Guidelines for Americans recommendation of 16 oz/day . Only 8.6 % drank low-fat or skim milk , as recommended for children who are older than 2 years . On average , preschool children drank < 6 oz/day 100 % fruit juice . Increased beverage consumption was associated with an increase in the total energy intake of the children but not with their BMI . Prospect ively study ing preschool children beyond 2 to 5 years of age , through their adiposity rebound ( ∼5.5–6 years ) to determine whether there is a trajectory increase in their BMI , may help to clarify the role of beverage consumption in total energy intake and weight status OBJECTIVE Consumption of sugar-sweetened beverages ( SSB ) is linked to obesity . The authors hypothesized that school-based nutrition education would decrease SSB consumption . DESIGN Self-selected interventional cohort with r and om selection for pre and post measurements . SETTING Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools . PARTICIPANTS R and omly selected ( 9 % ) fourth- and fifth- grade classroom students . INTERVENTION The  University of Arizona Nutrition Network provided general nutrition education training and material s to teachers , to be delivered to their students . The University of Arizona Nutrition Network administered behavioral question naires to students in both fall and spring . MAIN OUTCOME MEASURE(S ) Change in SSB consumption . ANALYSES Descriptive statistics were computed for student demographics and beverage consumption on the day before testing . Paired t tests evaluated change in classroom averages . Linear regression assessed potential correlates of SSB consumption . RESULTS Fall mean SSB consumption was 1.1 ( ± 0.2 ) times ; mean milk and water intake were 1.6 ( ± 0.2 ) and 5.2 ( ± 0.7 ) times , respectively . Beverage consumption increased ( 3.2 % ) in springtime , with increased SSBs ( 14.4 % ) accounting for the majority ( P = .006 ) . Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat ( P ≤ .05 ) . CONCLUSIONS AND IMPLICATION S The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather Background Underst and ing the correlates of dietary intake is necessary in order to effectively promote healthy dietary behavior among children and adolescents . A literature review was conducted on the correlates of the following categories of dietary intake in children and adolescents :  Fruit , Juice and Vegetable Consumption , Fat in Diet , Total Energy Intake , Sugar Snacking , Sweetened Beverage Consumption , Dietary Fiber , Other Healthy Dietary Consumption , and Other Less Healthy Dietary Consumption in children and adolescents . Methods Cross-sectional and prospect i ve studies were identified from PubMed , PsycINFO and PsycArticles by using a combination of search terms . Quantitative research examining determinants of dietary intake among children and adolescents aged 3–18 years were included . The selection and review process yielded information on country , study design , population , instrument used for measuring intake , and quality of research study . Results Seventy-seven articles were included . Many potential correlates have been studied among children and adolescents . However , for many hypothesized correlates substantial evidence is lacking due to a dearth of research . The correlates best supported by the literature are : perceived modeling , dietary intentions , norms , liking and preferences . Perceived modeling and dietary intentions have the most consistent and positive associations with eating behavior . Norms , liking , and preferences were also consistently and positively related to eating behavior in children and adolescents . Availability , knowledge , outcome expectations , self-efficacy and social support did not show consistent relationships across dietary outcomes . Conclusion This review examined the correlates of various dietary intake ; Fruit , Juice and Vegetable Consumption , Fat in Diet , Total Energy Intake , Sugar Snacking , Sweetened Beverage Consumption , Dietary Fiber , Other Healthy Dietary Consumption , and Other Less Healthy Dietary Consumption in cross-sectional and prospect i ve studies for children and adolescents . The correlates most consistently supported by evidence were perceived modeling , dietary intentions , norms , liking and preferences . More prospect i ve studies on the psychosocial determinants of eating behavior using broader theoretical perspectives should be examined in future research Although blood cholesterol levels in the United States have decreased slightly since the late 1980s ( 1 ) , consumption of saturated and trans fats remains above recommended maximum levels ( 2 , 3 ) , and only one quarter of U.S. adults with high cholesterol have it under control ( 4 ) . Some 24 million U.S. adults report taking cholesterol-lowering medications ( 5 ) . Changing a person 's nutrition-related behavior to improve cholesterol control is challenging ( 6 ) and a source of frustration for clinicians ( 7 ) . Public health action can complement health care provider efforts . The New York City Department of Health and Mental Hygiene adopted such a strategy when it restricted the use of artificial trans fat in restaurant food . We describe the rationale and process that led to this New York City Health Code amendment and the Department 's experience implementing the rule . Artificial trans fat is an unnecessary ingredient that poses a substantial risk to heart health . Although no r and omized , controlled trials have assessed the effect of trans fat consumption on cardiovascular events , evidence from experimental studies , dietary trials , and prospect i ve observational studies ( 3 , 8) demonstrates that consumption of trans fatty acids provides no apparent nutritional benefit and has considerable potential for harm . The Institute of Medicine ( 3 ) concluded that a positive linear trend exists between  trans fatty acid intake and low-density lipoprotein cholesterol level , which increases the risk for coronary heart disease . Unlike saturated fat , trans fat also decreases high-density lipoprotein cholesterol levels ( 3 , 8 , 9 ) . Trans fat intake has a large effect on cardiovascular health : A mere 2 % increase in energy intake from trans fat may increase the risk for a coronary event by up to 23 % ( 8) . Other potential adverse effects have been noted , such as affecting insulin sensitivity and increasing systemic inflammation , which raises additional public health concerns ( 8 , 10 ) . Each year , 6 % to 19 % of coronary heart disease events and 30000 or more premature deaths are estimated to occur in the United States because of trans fat consumption ( 8 , 11 ) . The Institute of Medicine , the American Heart Association , the U.S. Department of Agriculture , and other leading health organizations recommend minimizing trans fat intake ( 3 , 1215 ) . To achieve this , health care providers are asked to counsel patients ( 12 ) . However , such advice is unlikely to be broadly effectivemillions of Americans would need to routinely study package labels on groceries and actively seek information on trans fat in restaurant foods , where a growing proportion of calories are now consumed . Health would be better served by making the use of safer fats the default in food preparation . The Emergence of Artificial Trans Fat and Recognition of Its Risks Trans fats occur naturally in small amounts in some meat and dairy products ( 3 ) ; however , these sources make up only 21 % of total trans fat intake ( 16 ) . The remaining trans fat in the U.S. diet is artificial , produced by partial hydrogenation of vegetable oils and found mostly in processed foodsespecially baked and fried goods and spreads . Partial hydrogenation was patented in 1903 . Eight years later , Crisco ( J.M. Smucker , Orrville , Ohio ) became the first such product widely marketed in the United States ( 17 ) . These chemically modified oils , like several food ingredients in the 20th century , entered the food supply without a full evaluation of human health effects and were generally recognized as safe on the basis of experience ( 18 ) . Industrial advantages , such as extended product shelf life and fry oil stability , led to increased use in the 1950s . In the 1970s , margarine made from partially hydrogenated oil was promoted as a healthier alternative to butter ( 19 ) . However , by the 1990s , studies began to identify trans fat as a health hazard ( 9 ) . In 2003 , the U.S. Food and Drug Administration ( FDA ) required that all packaged goods display information on trans fat content by 2006 ( 20 ) . The regulation allows products that contain less than 0.5 grams of trans fat per serving to be labeled zero grams trans fat . This prompted a widespread industry response of reformulating products to declare zero grams trans fat on front-of-package labeling ( 2123 ) , although such products may still contain trans fat in small amounts , which can add up . The nutrition facts labeling allowed attentive consumers to avoid trans fat in packaged foods ; however , restaurantswhich provide one third of daily caloric intake (24)generally do not disclose nutritional information , leaving consumers no practical way to avoid trans fat . At the time of the FDA action , only Denmark limited trans fat in its entire food supply ( 25 ) . Although local health departments do not commonly regulate packaged goods , inspecting , licensing , and regulating restaurants and retail food outlets are core local public health functions ( 26 ) . Building on its food safety infrastructure , the Department trained restaurant inspectors in May 2005 to assess the presence of artificial trans fat in products used for frying , baking , or cooking or in spreads by means of food label inspection . Because inspection visits are scheduled each year on the basis of original restaurant licensing date and compliance records , a survey fielded during regularly scheduled inspections approximates a r and om sample of these establishments . In May and June 2005 , inspectors assessed the use of trans fat in oils , shortenings , and spreads used for frying , baking , or cooking or in spreads in 529 restaurants . Of the 478 restaurants that used fats for any of these purpose s and for which complete data were collected , trans fat presence could not be determined in one third . Where it could be assessed , 50 % of restaurants used artificial trans fat to prepare food . Educational Campaign In August 2005 , the Department launched an educational campaign to reduce restaurant artificial trans fat use . Information was sent to the 30000 licensed food outlets in the city , 15000 suppliers and supermarkets , and hundreds of thous and s of consumers . Mailings urged restaurants to remove artificial trans fat from food , suppliers to promote 0-grams trans fat products , and patrons to inquire about oils used . Press coverage was extensive ( 2729 ) . More than 7800 restaurant operators received training on the issue during the m and atory food protection course . Nearly a year later , inspectors surveyed 1021 restaurants in April and May 2006 by following the same methodology as the previous year . Despite the educational campaign , prevalence of artificial trans fat use remained virtually unchanged at 51 % in places where it could be assessed . Given survey findings of a wide range of restaurants that cooked without artificial trans fat , successful reformulation of packaged foods , and the Danish experience , the Department concluded that food choice and quality would be unaffected by replacing artificial trans fat and proposed using its regulatory authority to reduce artificial trans fat use ( 26 ) . Crafting Regulation Department clinical staff , food safety experts , and lawyers considered a range of regulatory options , from disclosure-only requirements to content restrictions . Labeling trans fat would benefit only consumers who were aware of and would act on the dangers of trans fat and would be difficult to enforce . A restriction , however , would benefit all New Yorkers , regardless of language , literacy , level of health awareness , or age . Protecting children , who consume French fries and other quick-service foods that are common sources of artificial trans fat ( 30 ) , was particularly important . Because artificial trans fat is both harmful and fully replaceable , allowing continued use , even with disclosure , could not be justified . Similarly , restricting trans fat in cooking oils and spreads onlyalthough easier to achievewould be insufficient because baked goods are the largest dietary source of trans fat ( 16 ) . Given that an estimated one third of calories comes from away-from-home sources , removing most trans fat from restaurants could be expected to reduce trans fatassociated deaths proportionately . The Department drafted a broad proposal to restrict artificial trans fat use in fry oils ; spreads ; and all other ingredients and products , including baked goods . For the regulation to be clear and enforceable , the Department adopted the FDA threshold used for labeling of up to 0.5 grams of trans fat per serving for products containing any trans fat ( 20 ) . The regulation would apply to all licensed food establishments , including restaurants , school cafeterias , caterers , senior centers , and street-food vendors . It intentionally did not affect products that contained only natural trans fat . The Department design ed enforcement to rely on existing infrastructure . Inspectors check product labels , which restaurants now must maintain , during their regular annual inspections . The rule included a 6-month phase-out period for artificial trans fat in fry oils and spreads and 18 months for all other items , to give restaurants time to identify alternatives and reformulate ( 31 ) . Fines for violations range from $ 200 to $ 2000 . From Concept to Action The regulation was proposed as an amendment to the city 's Health Code , approvable by the Board of Health . Nearly 2300 public comments were received , with supporters outnumbering opponents 31 to 1 . Local , regional , and national organizations and professional medical associations made statements of support . Opposition came primarily from industry associations , including the National Restaurant Association and its state affiliate and the Grocery Manufacturers Association ( 32 ) . The restaurant industry , which often opposes regulation on principle , alleged that the elimination of artificial trans fat would result in more expensive and less flavorful food and also cl aim ed that the supply of alternative oils was insufficient and the regulatory timeline A substance commercially described as ' sugar free , ' used as a sweetener for paracetamol suspension , was evaluated on measures of  neonatal pain . Sixty infants were r and omly allocated to receive one of four solutions before heel stab blood sampling : sterile water ( placebo ) ; 25 or 50 % sucrose ( weight/volume ) ; and the commercial sweet-tasting solution . There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls . It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions Interventions aim ed at improving glucose regulatory mechanisms have been suggested as a possible source of cognitive enhancement in the elderly . In particular , previous research has identified episodic memory as a target for facilitation after either moderate increases in glycaemia ( after a glucose drink ) or after improvements in glucose regulation . The present study aim ed to extend this research by examining the joint effects of glucose ingestion and glucose regulation on cognition . In addition , risk factors associated with the development of poor glucose regulation in middle-aged adults were considered . In a repeated measures design , thirty-three middle-aged adults ( aged 35 - 55 years ) performed a battery of memory and non-memory tasks after either 25 g or 50 g glucose or a sweetness matched placebo drink . To assess the impact of individual differences in glucose regulation  , blood glucose measurements were taken on four occasions during testing . A lifestyle and diet question naire was also administered . Consistent with previous research , episodic memory ability benefited from glucose ingestion when task dem and s were high . Blood glucose concentration was also found to predict performance across a number of cognitive domains . Interestingly , the risk factors associated with poor glucose regulation were linked to dietary impacts traditionally associated with poor health , e.g. the consumption of high-sugar sweets and drinks . The research replicates earlier work suggesting that task dem and s are critical to the glucose facilitation effect . Importantly , the data demonstrate clear associations between elevated glycaemia and relatively poor cognitive performance , which may be partly due to the effect of dietary and lifestyle factors OBJECTIVE To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . METHODS Of the 27 redefined EPIC study centres , 19 contributed subjects of both genders and eight centres female participants only ( men , women , after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total ) .  Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software . The major sources of dietary carbohydrate were identified , and 16 food groups were examined . RESULTS The 10 food groups contributing most carbohydrate were bread ; fruit ; milk and milk products ; sweet buns , cakes and pies ; potato ; sugar and jam ; pasta and rice ; vegetables and legumes ; crispbread ; and fruit and vegetable juices .  Consumption of fruits as well as vegetables and legumes  was higher in southern compared with northern centres , while soft drinks consumption was higher in the north . Italian centres had high pasta and rice consumption , but breakfast cereal , potato , and sweet buns , cakes and pies were higher in northern centres . In Sweden , lower bread consumption was balanced with a higher consumption of crispbread , and with sweet buns , cakes and pies . Overall , men consumed higher amounts of vegetables and legumes , bread , soft drinks , potatoes , pasta and rice , breakfast cereal and sugar and jam  than women , but fruit consumption appeared more frequent in women . CONCLUSION The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region . When comparing and interpreting diet-disease relationships across population s , research ers need to consider all types of foods This systematic literature review examined the role of dietary macronutrient composition , food consumption and dietary patterns in predicting  weight or waist circumference ( WC ) change , with and without prior weight reduction . The literature search covered year 2000 and onwards . Prospect i ve cohort studies , case – control studies and interventions were included . The studies had adult ( 18–70 y ) , mostly Caucasian participants . Out of a total of 1,517 abstract s , 119 full papers were identified as potentially relevant . After a careful scrutiny , 50 papers were quality grade d as A ( highest ) , B or C. Forty-three papers with grading A or B were included in evidence grading , which was done separately for all exposure- outcome combinations . The grade of evidence was classified as convincing , probable , suggestive or no conclusion . We found probable evidence for high intake of dietary fibre and nuts predicting less weight gain , and for high intake of meat in predicting more weight gain . Suggestive evidence was found for a protective role against increasing weight from whole grains , cereal fibre , high-fat dairy products and high scores in an index describing a prudent dietary pattern . Likewise , there was suggestive evidence for both fibre and fruit intake in protection against larger increases in WC . Also suggestive evidence was found for high intake of refined grains , and sweets and desserts in predicting more weight gain , and for refined ( white ) bread and high energy density in predicting larger increases in WC . The results suggested that the proportion of macronutrients in the diet was not important in predicting changes in weight or WC . In contrast , plenty of fibre-rich foods and dairy products , and less refined grains , meat and sugar-rich foods and drinks were associated with less weight gain in prospect i ve cohort studies . The results on the role of  dietary macronutrient composition  in prevention of weight regain ( after prior weight loss ) were inconclusive INTRODUCTION Product characteristics that impact e-cigarette appeal by altering the sensory experience of vaping need to be identified to formulate evidence -based regulatory policies . While products that contain sweet flavorings and produce a " throat hit " ( i.e. , desirable airway irritation putatively caused by nicotine ) are anecdotally cited as desirable reasons for vaping among young adults , experimental evidence of their impact on user appeal is lacking . This experiment applied a novel laboratory protocol to assess whether : ( 1 ) sweet flavorings and nicotine affect e-cigarette appeal ; ( 2 ) sweet flavorings increase perceived sweetness ; ( 3 ) nicotine increases throat hit ; and ( 4 ) perceived sweetness and throat hit are associated with appeal . METHODS Young adult vapers ( N=20 ; age 19 - 34 ) self-administered 20 st and ardized doses of aerosolized e-cigarette solutions varied according to a 3 flavor ( sweet [ e.g. , cotton c and y ] vs. non-sweet [ e.g. , tobacco-flavored ] vs. flavorless) × 2 nicotine ( 6mg/mL nicotine vs. 0mg/mL [ placebo ] ) double-blind , cross-over design . Participants rated appeal ( liking , willingness to use again and perceived monetary value ) , perceived sweetness and throat hit strength after each administration . RESULTS Sweet-flavored ( vs. non-sweet and flavorless ) solutions produced greater appeal and perceived sweetness ratings . Nicotine produced greater throat hit ratings than placebo , but did not significantly increase appeal nor interact with flavor effects on appeal . Controlling for flavor and nicotine , perceived sweetness was positively associated with appeal ratings ; throat hit was not positively associated with appeal . CONCLUSIONS Further identification of compounds in e-cigarette solutions that enhance sensory perceptions of sweetness , appeal , and utilization of e-cigarettes are warranted to inform evidence -based regulatory policies Background Substituting sugar-free for sugar-sweetened beverages reduces  weight gain . A possible explanation is that sugar-containing and sugar-free beverages cause the same degree of satiety . However , this has not been tested in long-term trials . Methods We r and omized 203 children aged 7 - 11 years to receive 250 mL per day of an artificially sweetened sugar-free beverage or a similarly looking and tasting sugar-sweetened beverage . We measured satiety on a 5-point scale by question naire at 0 , 6 , 12 and 18 months . We calculated the change in satiety from before intake to 1 minute after intake and 15 minutes after intake . We then calculated the odds ratio that satiety increased by 1 point in the sugar-group versus the sugar-free group . We also investigated how much the children liked and wanted the beverages . Results 146 children or 72 % completed the study . We found no statistically significant difference in satiety between the sugar-free and sugar-sweetened group ; the adjusted odds ratio for a 1 point increase in satiety in the sugar group versus the sugar-free group was 0.77 at 1 minute ( 95 % confidence interval , 0.46 to 1.29 ) , and 1.44 at 15 minutes after intake ( 95 % CI , 0.86 to 2.40 ) . The sugar-group liked and wanted their beverage slightly more than the sugar-free group , adjusted odds ratio 1.63 ( 95 % CI 1.05 to 2.54 ) and 1.65 ( 95 % CI 1.07 to 2.55 ) , respectively . Conclusions Sugar-sweetened and sugar-free beverages produced similar satiety . Therefore when children are given sugar-free instead of sugar-containing drinks they might not make up the missing calories from other sources . This may explain our previous observation that children in the sugar-free group accumulated less body fat than those in the sugar group . Trial Registration Clinical Trials.gov NCT00893529 http:// clinical BACKGROUND Previous studies have linked full-calorie sugar-sweetened beverages ( SSBs ) with greater weight gain and an increased risk of type 2 diabetes . OBJECTIVE We prospect ively examined the association between consumption of SSBs and the risk of coronary heart disease ( CHD ) in women . DESIGN Women ( n = 88,520 ) from the Nurses ' Health Study aged 34 - 59 y , without previously diagnosed coronary heart disease ( CHD ) , stroke , or diabetes in 1980 , were followed from 1980 to 2004 . Consumption of SSBs was derived from 7 repeated food-frequency question naires administered between 1980 and 2002 . Relative risks ( RRs ) for CHD were calculated by using Cox proportional hazards models and adjusted for known cardiovascular disease risk factors . RESULTS During 24 y of follow-up , we ascertained 3105 incident cases of CHD  ( nonfatal myocardial infa rct ion and fatal CHD ) . After st and ard and dietary risk factors were adjusted for , the RRs ( and 95 % CIs ) of CHD according to categories of cumulative average of SSB consumption ( < 1/mo , 1 - 4/mo , 2 - 6/wk , 1/d , and > or = 2 servings/d ) were 1.0 , 0.96 ( 0.87 , 1.06 ) , 1.04 ( 0.95 , 1.14 ) , 1.23 ( 1.06 , 1.43 ) , and 1.35 ( 1.07 , 1.69 ) ( P for trend < 0.001 ) . Additional adjustment for body mass index , energy intake , and incident diabetes attenuated the associations , but they remained significant . Artificially sweetened beverages were not associated with CHD . CONCLUSION Regular consumption of SSBs is associated with a higher  risk of CHD in women , even after other unhealthful lifestyle or dietary factors are accounted for Background Non-nutritive sweeteners ( NNS ) , especially in form of diet soda , have been linked to metabolic derangements ( e.g. obesity and diabetes ) in epidemiologic studies . We aim ed to test acute metabolic effects of NNS in isolation ( water or seltzer ) and in diet sodas . Methods We conducted a four-period , cross-over study at the National Institutes of Health Clinical Center ( Bethesda , Maryl and ) . Thirty healthy adults consumed 355 mL water with 0 mg , 68 mg , 170 mg , and 250 mg sucralose , and 31 individuals consumed 355 mL caffeine-free Diet Rite Cola ™ , Diet Mountain Dew ™ ( 18 mg sucralose , 18 mg acesulfame-potassium , 57 mg aspartame ) , and seltzer water with NNS ( 68 mg sucralose and 41 mg acesulfame-potassium , equivalent to Diet Rite Cola ™ ) in r and omized order , prior to oral glucose tolerance tests . Blood sample s were collected serially for 130 min . Measures included GLP-1 , GIP , glucose , insulin , C-peptide , glucose absorption , gastric emptying , and subjective hunger and satiety ratings . Results Diet sodas  augmented active GLP-1 ( Diet Rite Cola ™ vs. seltzer water , AUC , p = 0.039 ; Diet Mountain Dew ™ vs. seltzer water , AUC , p = 0.07 ) , but gastric emptying and satiety were unaffected . Insulin concentrations were nominally higher following all NNS conditions without altering glycemia . Sucralose alone ( at any concentration ) did not affect metabolic outcomes . Conclusions Diet sodas but not NNS in water augmented GLP-1 responses to oral glucose . Whether the trends toward higher insulin concentrations after NNS are of clinical importance remains to be determined . Our findings emphasize the need to test metabolic effects of NNS after chronic consumption . Trial registration The data for this manuscript were gathered from clinical trial # NCT01200940 Background “ Nudging”—modifying environments to change people ’s behavior , often without their conscious awareness — can improve health , but public acceptability of nudging is largely unknown . Methods We compared acceptability , in the United Kingdom ( UK ) and the United States of America ( USA ) , of government interventions to reduce consumption of sugar-sweetened beverages . Three nudge interventions were assessed : i. reducing portion Size , ii . changing the Shape of the drink containers , iii . changing their shelf Location ; alongside two traditional interventions : iv . Taxation and v. Education . We also tested the hypothesis that describing interventions as working through non-conscious processes decreases their acceptability . Predictors of acceptability , including perceived intervention effectiveness , were also assessed . Participants ( n = 1093 UK and n = 1082 USA ) received a description of each of the five interventions which varied , by r and omisation , in how the interventions were said to affect behaviour : ( a ) via conscious processes ; ( b ) via non-conscious processes ; or ( c ) no process stated . Acceptability was derived from responses to three items . Results Levels of acceptability for four of the five interventions did not differ significantly between the UK and US sample s ; reducing portion size was less accepted by the US sample . Within each country , Education was rated as most acceptable and Taxation the least , with the three nudge-type interventions rated between these . There was no evidence to support the study hypothesis : i.e. stating that interventions worked via non-conscious processes did not decrease their acceptability in either the UK or US sample s. Perceived effectiveness was the strongest predictor of acceptability for all interventions across the two sample s. Conclusion In conclusion , nudge interventions to reduce consumption of sugar-sweetened beverages seem similarly acceptable in the UK and USA , being more acceptable than taxation , but less acceptable than education . Contrary to prediction , we found no evidence that highlighting the non-conscious processes by which nudge interventions may work decreases their acceptability . However , highlighting the effectiveness of all interventions has the potential to increase their acceptability BACKGROUND Consumption of sugar-sweetened beverages ( SSBs ) is associated with an increased risk of hypertension  in cross-sectional studies . However , prospect i ve data are limited . OBJECTIVE To examine the associations between SSBs and artificially sweetened beverages ( ASBs ) with incident hypertension . DESIGN AND SETTING Prospect i ve analysis using Cox proportional hazards regression to examine the association between SSBs and ASBs with incident hypertension in three large , prospect i ve cohorts , the Nurses ' Health Studies I ( n = 88,540 women ) and II ( n = 97,991 women ) and the Health Professionals ' Follow-Up Study ( n = 37,360 men ) . MEASUREMENTS Adjusted hazard ratios for incident clinical ly diagnosed hypertension . RESULTS Higher SSB  and ASB intake was associated with an increased risk of developing hypertension in all three cohorts . In a pooled analysis , participants who consumed at least one SSB daily had an adjusted HR for incident hypertension of 1.13 ( 95 % CI , 1.09–1.17 ) compared with those who did not consume SSBs ; for persons who drank at least one ASB daily , the adjusted HR was 1.14 ( 95 % CI , 1.09–1.18 ) . The association between sweetened beverage intake and hypertension was stronger for carbonated beverages versus non-carbonated beverages , and for cola-containing versus non-cola beverages in the NHS I and NHS II cohorts only . Higher fructose intake from SSBs as a percentage of daily calories was associated with increased hypertension risk in NHS I and NHS II ( p-trend = 0.001 in both groups ) , while higher fructose intake from sources other than SSBs was associated with a decrease in hypertension risk in NHS II participants ( p-trend = 0.006 ) . LIMITATIONS Residual confounding factors may interfere with the interpretation of results . CONCLUSIONS SSBs and ASBs are independently associated with an increased risk of incident hypertension after controlling for multiple potential confounders . These associations may be mediated by factors common to both SSBs and ASBs ( e.g. , carbonation or cola ) , but are unlikely to be due to fructose BACKGROUND Increased intake of sugar-sweetened beverages and fruit juice has been associated with overweight in children . OBJECTIVE This study prospect ively assessed beverage consumption patterns and their relationship with weight status in a cohort of children born at different risk for obesity . METHODS AND PROCEDURES Participants were children born at low risk ( n = 27 ) or high risk ( n = 22 ) for obesity based on maternal prepregnancy BMI ( kg/m(2 ) ) . Daily beverage consumption was generated from 3-day food records from children aged 3 - 6 years and coded into seven beverage categories ( milk , fruit juice , fruit drinks , caloric and non-caloric soda , soft drinks including and excluding fruit juice ) . Child anthropometric measures were assessed yearly . RESULTS High-risk children consumed a greater percentage of daily calories from beverages at age 3 , more fruit juice at ages 3 and 4 , more soft drinks ( including fruit juice ) at ages 3 - 5 , and more soda at age 6 compared to low-risk children . Longitudinal analyses showed that a greater 3-year increase in soda intake was associated with an increased change in waist circumference , whereas a greater increase in milk intake was associated with a reduced change in waist circumference . There was no significant association between change in intake from any of the beverage categories and change in BMI z-score across analyses . DISCUSSION Children 's familial predisposition to obesity may differentially affect their beverage consumption patterns . Future research should examine the extent to which dietary factors may play a role in pediatric body fat deposition over time BACKGROUND Concern about the carcinogenic potential of aspartame was raised after an increase in lymphomas and leukemia was reported in an animal study at doses similar to human exposure . Two prospect i ve cohort studies published after the report found inconsistent results for estimated aspartame intake , artificially sweetened beverage consumption , and risk of lymphoid neoplasms . OBJECTIVE The objective of this study was to examine associations of artificially and sugar-sweetened carbonated beverage consumption ( for comparison ) and aspartame intake with risk of non-Hodgkin lymphoma ( NHL )  overall and by major histologic subtype in the Cancer Prevention Study -II Nutrition Cohort . METHODS Among 100,442 adult men and women who provided information on diet and lifestyle factors in 1999 , 1196 NHL cases were verified during a 10-y follow-up period . Cox proportional hazards regression was used to estimate multivariable-adjusted RRs and 95 % CIs . RESULTS In women and men combined , there were no associations of consumption of ≥1 ( 355 mL ) servings/d of artificially ( RR : 0.92 ; 95 % CI : 0.73 , 1.17 ; P-trend : 0.14 ) or sugar- ( RR : 1.10 ; 95 % CI : 0.77 , 1.58 ; P-trend : 0.62 ) sweetened carbonated beverages with NHL risk , compared to no consumption ( P-heterogeneity by gender : 0.11 - 1.00 ) . Similarly , aspartame intake was not associated with NHL risk ( RR : 1.02 ; 95 % CI : 0.84 , 1.24 ; P-trend : 0.69 , top vs. bottom quintile ) . Associations with NHL subtype ( multiple myeloma , diffuse large B-cell lymphoma , chronic lymphocytic leukemia/small lymphocytic lymphoma , and follicular and other B-cell lymphoma ) were generally null . CONCLUSION These findings do not support associations of daily consumption of artificially or sugar-sweetened carbonated beverages , or aspartame , with NHL risk Objective To evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners ( NNS ) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program . Methods The study used a r and omized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity . All participants participated in a weight loss program plus assignment to consume 24 ounces ( 710 ml ) of water or NNS beverages daily for 1 year . Results NNS and water treatments were non‐equivalent , with NNS treatment  showing greater weight loss at the end of 1 year . At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg ( P < 0.001 for difference ) . Conclusions Water and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program . NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users  of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program . These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children Breakfast has psychological and nutritional benefits due to physiological mechanisms and expectations about health impact . Beliefs people hold about calories in food can adversely affect mood and body-image satisfaction and such adverse reactions can be predicted by body mass index . The objectives were to test the effect of consuming isocaloric breakfasts , appearing different in calorie content , on appetite , mood and body-image satisfaction , and to assess impact on daily nutrient intake .  One-hundred- and -twenty-three women were r and omly assigned to eat a cereal or muffin breakfast which " appeared " different in calorie content while unaware they were isocaloric . Participants estimated calories of breakfast , appetite , mood , and body-image satisfaction on a daily basis for seven-days . The cereal breakfast was perceived to be lower in calories , made participants fuller , happier , relaxed , and more satisfied about weight and body compared to the muffin breakfast . Differences in estimated daily fibre and micronutrient intake were compatible with the design . Breakfasts were isocaloric yet the cereal breakfast was rated lower in calories and produced more positive psychological reactions . This evidence indicates the power of perceptions of foods to influence important attributes of health and well-being which could be valuable in dietary interventions where mood and body image satisfaction affect outcome Background Numerous studies in schools in the Western Cape Province , South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat . HealthKick ( HK ) was a three-year r and omised controlled trial aim ed at promoting healthy eating habits . Methods Sixteen schools were selected from two low-income school districts and r and omly allocated to intervention ( n = 8) or control school ( n = 8) status . The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support .  Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools , and repeated in 2010 and 2011 . A dietary diversity score ( DDS ) was calculated from nine food groups and frequency of snack food consumption was determined . A school level analysis was performed . Results The mean baseline ( 2009 ) DDS was low in both arms 4.55 ( SD = 1.29 ) and 4.54 ( 1.22 ) in the intervention and control arms respectively , and 49 % of learners in HK intervention schools had a DDS ≤4 ( = low diversity ) . A small increase in DDS was observed in both arms by 2011 : mean score 4.91 ( 1.17 ) and 4.83 ( 1.29 ) in the intervention and control arms respectively . The estimated DSS intervention effect over the two years was not significant [ 0 .04 ( 95 % CI : −0.37 to 0.46 ) ] . Food groups least consumed were eggs , fruit and vegetables . The most commonly eaten snacking items in 2009 were table sugar in beverages and /or cereals ( 80.5 % ) ; followed by potato crisps ( 53.1 % ) ; non-carbonated beverages ( 42.9 % ) ; sweets ( 26.7 % ) and sugar-sweetened carbonated beverages ( 16 % ) . Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools . Discussion The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking . We attribute this to the finding that the intervention model used by the research ers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty . Conclusions The HK intervention did not significantly improve quality of diet of children BACKGROUND Soyfoods provide healthful options for school breakfasts and lunches that are lower in saturated fat , cholesterol , fat , and calories and can help meet dem and s for vegetarian choices . Research ers tested acceptance of soy-based options substituted for popular lunch items with a diverse student population . METHODS Research ers conducted a plate waste study in 5 middle schools in Montgomery County , Maryl and , to test the comparability of soy-based alternatives to 4 popular meat-based menu items . Initially , students ranked taste , appearance , and texture of 15 soyfoods to narrow to " hybrid " beef patties , soy-based nuggets , soy-based chicken-less slices , and soy macaroni and cheese . After the meal , trained observers r and omly tagged and collected trays with and without test items and weighed leftover entrées . Research ers used a proportional odds model to compare amounts and proportions of food consumed , and a mixed model to account for differences between schools . RESULTS Students consumed the same amount of soy-based and traditional patties , nuggets , and pasta , and less soy than regular chicken in the salad ( odds ratio 0.122 , p value < .0001 ) . Students consumed higher proportions ( p value < .05 ) of traditional chicken nuggets , beef patties , chicken slices , and pasta compared to soy-based alternative products . On average , soy-based entrées had fewer calories ; less total fat , saturated fat , and cholesterol ; and more iron , fiber , and sodium compared to traditional menu items . CONCLUSIONS This study indicates that middle school students readily consume almost equal numbers of soy-based products compared to popular school lunch items . Soyfoods provide nutritional advantages The objective of this study was to evaluate an educational module for Latino parents about the health effects of sweet beverages . Latino parents were r and omized to receive the beverage module or a control module .  Child beverage consumption was assessed at baseline , 2 weeks , 2 months , and 3 months via a beverage recall survey . At 2-week follow-up , children of intervention participants had a mean reduction in 7-day total sugar-sweetened beverage and 100 % fruit juice consumption of 16 ounces while controls had a mean increase of 4 ounces ( P = .01 ) . At 2-month and 3-month follow-up , there was a reduction in mean total sugar-sweetened beverage and 100 % fruit juice consumption among both intervention and control children . An educational module on beverages for Latino parents  reduced child consumption of sweet beverages at 2-week follow-up . However , study participation appears to have also reduced controls ’ beverage consumption suggesting that frequent intensive surveys of beverage intake may be an intervention unto itself Background This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people . Methods Participants ( n=279 ) were r and omized to groups : 1 ) Incentive- 30 % financial incentive for fruits and vegetables purchased with food benefits ; 2 ) Restriction- no purchase of sugar-sweetened beverages , sweet baked goods , or c and ies with food benefits ; 3 ) Incentive plus Restriction ; or 4 ) Control- no incentive or restrictions . Participants received a study -specific debit card where funds were added monthly for 12-weeks . Food purchase receipts were collected over 16 weeks . Total dollars spent on grocery purchases and by targeted food categories were computed from receipts . Group differences were examined using general linear models . Results Weekly purchases of fruit significantly increased in the Incentive plus Restriction ( $ 4.8 ) compared to the Restriction ( $ 1.7 ) and Control ( $ 2.1 ) groups ( p < .01 ) . Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction(−$0.8 per week ) and Restriction ( $ -1.4 per week ) groups compared to the Control group ( + $ 1.5 ; p < .0001 ) . Sweet baked goods purchases significantly decreased in the Restriction ( −$0.70 per week ) compared to the Control group ( + $ 0.82 per week ; p < .01 ) . Conclusions Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions . Clinical trial registration Clinical trials.gov Identifier : NCT02643576 Purpose Consumption of sugar-reformulated products ( commercially available foods and beverages that have been reduced in sugar content through reformulation ) is a potential strategy for lowering sugar intake at a population level . The impact of sugar-reformulated products on body weight , energy balance ( EB ) dynamics and cardiovascular disease risk indicators has yet to be established . The REFORMulated foods ( REFORM ) study examined the impact of an 8-week sugar-reformulated product exchange on body weight , EB dynamics , blood pressure , arterial stiffness , glycemia and lipemia . Methods A r and omized , controlled , double-blind , crossover dietary intervention study was performed with fifty healthy normal to overweight men and women ( age 32.0 ± 9.8 year , BMI 23.5 ± 3.0 kg/m2 ) who were r and omly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks , separated by 4-week washout period . Body weight , energy intake ( EI ) , energy expenditure and vascular markers were assessed at baseline and after both interventions . Results We found that carbohydrate ( P < 0.001 ) , total sugars ( P < 0.001 ) and non-milk extrinsic sugars ( P < 0.001 ) ( % EI ) were lower , whereas fat ( P = 0.001 ) and protein ( P = 0.038 ) intakes ( % EI ) were higher on the sugar-reduced than the regular diet . No effects on body weight , blood pressure , arterial stiffness , fasting glycemia or lipemia were observed . Conclusions Consumption of sugar-reduced products , as part of a blinded dietary exchange for an 8-week period , result ed in a significant reduction in sugar intake . Body weight did not change significantly , which we propose was due to energy compensation Childhood overweight and obesity are major health problems . School-based programs enable intervening with large groups of children , but program overall health impact is rarely completely assessed . A RE- AIM ( Reach , Efficacy , Adoption , Implementation , Maintenance ) analysis tested the overall public health impact of the  fourth- grade “ Nutrition Pathfinders ” school-based nutrition-education program .  A r and omized controlled trial in 47 fourth- grade California classrooms ( 1713 students ) tested program efficacy , and a secondary analysis of archival data tested program dissemination . Desired effects were seen in child nutrition knowledge , attitudes , consumption of low-nutrient high-density foods , sugar-sweetened beverages , proteins , grains , and parent willingness to serve new foods . The program was disseminated to ∼25 % of public school fourth- grade classrooms in California and cost about $ 1.00 per student to implement . The Nutrition Pathfinders program demonstrates potential for moderate to high public health impact due to its wide dissemination , effectiveness in altering attitudes and behaviors , and its relatively inexpensive cost of implementation Objective The objective of this study is to assess population -level trends in children 's dietary intake and weight status before and after the implementation of a  provincial school nutrition policy in the province of Nova Scotia , Canada . Method Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population -level study with grade 5 students in 2003 ( n = 5215 ) and 2011 ( 5508 ) , prior to and following implementation of the policy . We applied r and om effects regression methods to assess the effect of the policy on dietary and health outcomes . Results In 2011 , students reported consuming more milk products , while there was no difference in mean consumption of vegetables and fruits in adjusted models . Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption . Despite significant temporal decreases in dietary energy intake and increases in diet quality , prevalence rates of overweight and obesity continued to increase . Conclusion This population -level intervention research suggests a positive influence of school nutrition policies on diet quality , energy intake and healthy beverage consumption , and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity Micronutrient deficiencies are a public health concern among young children in low-income countries , and novel strategies are needed to improve the nutritional status of children at risk . One promising approach is the use of lipid-based nutrient supplements ( LNS ) , which can be added to complementary food at the time of consumption . The optimal amount of zinc to include in LNS is uncertain , and concerns have been expressed about possible adverse effects of zinc on sensory characteristics of LNS . We conducted a series of acceptability studies of LNS containing either 0 or 10 mg of zinc per daily 20 g LNS dose among Burkinabe children 9 - 15 months old and their mothers . These acceptability studies included observations of children 's consumption , maternal and child sensory reaction to the products using a 5-unit hedonic scale , a triangle test for detection of differences and a review of maternal reports of their child-feeding experiences during a 2-week home-feeding trial . The LNS products were well appreciated by the mothers and children during the sensory trials and the 2-week home-feeding trial . The addition of 10 mg zinc to LNS did not affect the consumed proportion of the offered porridge-LNS-mixture ( P = 0.43 ) . Results of the triangle test with mothers confirmed that there was no detectable difference between products containing 0 or 10 mg zinc per 20 g LNS dose . Most importantly , interviews and focus groups following the 2-week home-feeding trial indicated good acceptability of the products by mothers and their children Previous studies have yielded inconsistent results when documenting the association between key dietary factors and adolescent weight change over time . The purpose of this study was to examine the extent to which changes in adolescent sugar-sweetened beverage ( SSB ) , diet soda , breakfast , and fast-food consumption were associated with changes in BMI and percent body fat ( PBF ) . This study analyzed data from a sample of 693 Minnesota adolescents followed over 2 years . R and om coefficient models were used to examine the relationship between  dietary intake and BMI and PBF and to separate cross-sectional and longitudinal associations . Adjusting for total physical activity , total energy intake , puberty , race , socioeconomic status , and age , cross-sectional findings indicated that for both males and females , breakfast consumption was significantly and inversely associated with BMI and PBF , and diet soda intake was significantly and positively associated with BMI and PBF among females . In longitudinal analyses , however , there were fewer significant associations . Among males there was evidence of a significant longitudinal association between SSB consumption and PBF ; after adjustment for energy intake , an increase of one serving of SSB per day was associated with an increase of 0.7 units of PBF among males . This study adds to previous research through its method ological strengths , including adjustment for physical activity and energy intake assessed using state-of-the-art methods ( i.e. , accelerometers and 24-h dietary recalls ) , as well as its evaluation of both BMI and PBF . Additional research is needed to better underst and the complex constellation of factors that contribute to adolescent weight gain over time BACKGROUND High consumption of sugar-sweetened drinks has been associated with  weight gain and obesity in the United States . This trend may also be affecting population s with different eating patterns who increasingly are adopting typical US dietary patterns . OBJECTIVE We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population . DESIGN This was a prospect i ve cohort analysis of 7194 men and women with a mean age of 41 y who were followed-up for a median of 28.5 mo with mailed question naires . Dietary exposure was assessed with a previously vali date d semiquantitative food-frequency question naire . RESULTS During follow-up , we observed that 49.5 % of the participants increased their weight ( x weight gain : 0.64 kg ; 95 % CI : 0.55 , 0.73 kg ) . In the participants who had gained > or =3 kg in the 5 y before baseline , the adjusted odds ratio of subsequent weight gain for the fifth quintile compared with the first quintile of sugar-sweetened soft drink consumption was 1.6 ( 95 % CI : 1.2 , 2.1 ; P for trend = 0.02 ) . This association was absent in the participants who had not gained weight in the 5-y period before baseline . The consumption of hamburgers , pizza , and sausages ( as a proxy for fast-food consumption ) was also independently associated with weight gain ( adjusted odds ratio for the fifth compared with the first quintile = 1.2 ; 95 % CI : 1.0 , 1.4 ; P for trend = 0.05 ) . We also found a significant , but weaker , association between weight gain and both red meat and sweetened fruit juice consumption . CONCLUSION In a Mediterranean cohort , particularly in the participants who had already gained weight , an increased consumption of sugar-sweetened soft drinks and of hamburgers , pizza , and sausages was associated with a higher risk of additional subsequent weight gain BACKGROUND The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices . OBJECTIVE To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container , but are reasonably consumed at a single eating occasion . DESIGN Participants were r and omly assigned to study conditions that varied on label format , product , and nutrition profile . Data were collected via an online consumer panel . PARTICIPANTS / SETTING Adults aged 18 years and older were recruited from Synovate 's online household panel . Data were collected during August 2011 . A total of 32,897 invitations were sent for a final sample of 9,493 interviews . INTERVENTION Participants were r and omly assigned to one of 10 label formats classified into three groups : listing 2 servings per container with a single column , listing 2 servings per container with a dual column , and listing a single serving per container . Within these groups there were versions that enlarged the font size for " calories , " removed " calories from fat , " and changed the wording for serving size declaration . MAIN OUTCOME MEASURES The single product task measured product healthfulness , the amount of calories and various nutrients per serving and per container , and label perceptions . The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving . STATISTICAL ANALYSES PERFORMED Analysis of covariance models with Tukey-Kramer tests were used . Covariates included general label use , age , sex , level of education , and race/ethnicity . RESULTS Single-serving and dual-column formats performed better and scored higher on most outcome measures . CONCLUSIONS For products that contain 2 servings but are customarily consumed at a single eating occasion , using a single-serving or dual-column labeling approach may help consumers make healthier food choices Anorexia Nervosa ( AN ) is a disorder of self-starvation characterized by decreased meal size and food intake . While it is possible that reduced food intake in AN reflects an excess of inhibitory factors , e.g. , cognitive inhibition related to fear of weight gain or abnormal postingestive negative feedback , it is also possible that decreased intake reflects diminished orosensory stimulation of food intake . This has been difficult to test directly because the amount of food ingested during a test meal by patients with AN reflects an integration of orosensory excitatory , and cognitive , learned , and postingestive inhibitory controls of eating . To begin to dissociate these controls , we adapted the modified sham feeding technique ( MSF ) to measure the intake of a series of sweetened solutions in the absence of postingestive stimulation . Subjects with AN ( n=24 ) and normal controls ( NC , n=10 ) were r and omly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame ( 0 , 0.01 , 0.03 , 0.08 and 0.28 % ) in a closed opaque container fitted with a straw . They were instructed to sip as much as they wanted of the solution during 15 1-minute trials and to spit the fluid out into another opaque container . Subjects with AN sipped less unsweetened solution than NC ( p<0.05 ) . Because this difference appeared to account completely for the smaller intakes of sweetened solutions by AN , responsiveness of intake to sweet taste per se was not different in AN and NC . Since MSF eliminated postingestive and presumably cognitive inhibitory controls , and the orosensory response to sweet taste was not different in AN than NC , we conclude that decreased intake by AN subjects under these conditions reflects the increased inhibition characteristic of this disorder that is presumably learned , with a possible contribution of decreased potency of orosensory stimulation by the sipped solutions BACKGROUND Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic in the US population , but their causal relation remains unclear . OBJECTIVE The objective of this study was to examine how changes in beverage consumption affect  weight change among adults . DESIGN This was a prospect i ve study of 810 adults participating in the PREMIER trial , an 18-mo r and omized , controlled , behavioral intervention trial .  Measurements ( weight , height , and 24-h dietary recall ) were made at baseline , 6 mo , and 18 mo . RESULTS Baseline mean intake of liquid calories was 356 kcal/d ( 19 % of total energy intake ) . After potential confounders and intervention assignment were controlled for , a reduction in liquid calorie intake of 100 kcal/d was associated with a weight loss of 0.25 kg ( 95 % CI : 0.11 , 0.39 ; P < 0.001 ) at 6 mo and of 0.24 kg ( 95 % CI : 0.06 , 0.41 ; P = 0.008 ) at 18 mo . A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss . Of the individual beverages , only intake of sugar-sweetened beverages ( SSBs ) was significantly associated with weight change . A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg ( 95 % CI : 0.11 , 0.82 ; P = 0.006 ) at 6 mo and of 0.65 kg ( 95 % CI : 0.22 , 1.09 ; P = 0.003 ) at 18 mo . CONCLUSIONS These data support recommendations to limit liquid calorie intake among adults and to reduce SSB consumption as a means to accomplish weight loss or avoid excess weight gain . This trial was registered at clinical trials.gov as NCT00000616 Objective : To model the health benefits and cost-effectiveness of  banning television ( TV ) advertisements in Australia for energy-dense , nutrient-poor food and beverages during children 's peak viewing times . Methods : Benefits were modelled as changes in body mass index ( BMI ) and disability-adjusted life years ( DALYs ) saved . Intervention costs ( AUD$ ) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions . Changes in BMI were assumed to be maintained through to adulthood . The comparator was current practice , the reference year was 2001 , and the discount rate for costs and benefits was 3 % . The impact of the withdrawal of non-core food and beverage advertisements on children 's actual food consumption was drawn from the best available evidence ( a r and omized controlled trial of advertisement exposure and food consumption ) . Supporting evidence was found in ecological relationships between TV advertising and childhood obesity , and from the effects of marketing bans on other products . A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of ‘ strength of evidence ’ , ‘ equity ’ , ‘ acceptability to stakeholders ’ , ‘ feasibility of implementation ’ , ‘ sustainability ’ and ‘ side-effects ’ . Results : The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 ( 95 % uncertainty interval ( UI ) $ 2.40 , $ 7.70 ) per DALY . Total DALYs saved were 37 000 ( 95 % UI 16 000 , 59 000 ) . When the present value of potential savings in future health-care costs was considered ( AUD$ 300 m ( 95 % UI $ 130 m , $ 480 m ) , the intervention was ‘ dominant ’ , because it result ed in both a health gain and a cost offset compared with current practice . Conclusions : Although recognizing the limitations of the available evidence , restricting TV food advertising to children would be one of the most cost-effective population -based interventions available to governments today . Despite its economic credentials from a public health perspective , the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government Dietary supplementation is approximately a $ 30 billion industry in the United States , with more than 90 000 products on the market . In recent national surveys , 52 % of US adults reported use of at least 1 supplement product , and 10%reporteduseofatleast4suchproducts.1 Vitamins and minerals are among the most popular supplements and are taken by 48 % and 39 % of adults , respectively , typically to maintain health and prevent disease . Despite this enthusiasm , most r and omized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency . Indeed , some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg , high doses of beta carotene , folic acid , vitamin E , or selenium — may have harmful effects , including increased mortality , cancer , and hemorrhagic stroke.2 In this Viewpoint , we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients , as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals . Importantly , clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and , in most cases , provides little if any benefit beyond that conferred by such a diet . Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements . Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects.2,3 A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form . Indeed , research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.3 Although routine micronutrient supplementation is not recommended for the general population , targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone , including people at certain life stages and those with specific risk factors ( discussed in the next 3 sections and in the Box ) Background Discretionary food and beverages ( products high in saturated fat , added sugars , and salt ) are detrimental to a healthy diet . Nevertheless , they provide 42 % of total energy and account for 53 % of food and beverage expenditure for remote living Aboriginal and Torres Strait Isl and er Australians , contributing to the excessive burden of chronic diseases experienced by this population group . Objective The aim of this study is to test an intervention to reduce sales of discretionary products , in collaboration with the Arnhem L and Progress Aboriginal Corporation ( ALPA ) , which operates 25 stores in very remote Australia , by reducing their merch and ising and substituting with core products in remote Australian communities . Methods We will use a community-level r and omized controlled pragmatic trial design . Stores r and omized to the intervention group will be supported by ALPA to reduce merch and ising of 4 food categories ( sugar , sugar-sweetened beverages , sweet biscuits , and confectionery ) that together provide 64 % of energy from discretionary foods and 87 % of total free sugars in very remote community stores . The remaining stores ( 50 % of total ) will serve as controls and conduct business as usual . Electronic store sales data will be collected at baseline , 12-weeks intervention , and 24-weeks postintervention to objective ly assess the primary outcome of percent change in purchases of free sugars ( g/megajoule ) and secondary business- and diet-related outcomes . Critical to ensuring translation to improved store policies and healthier diets in remote Indigenous Australia , we will conduct ( 1 ) an in-depth implementation evaluation to assess fidelity , ( 2 ) a customer intercept survey to investigate the relationship between customer characteristics and discretionary food purchasing , and ( 3 ) a qualitative study to identify policy supports for scale-up of health-enabling policy action in stores . Results As of August 2018 , 20 stores consented to participate and were r and omized to receive the intervention or continue usual business . The 12-week strategy ended in December 2018 . The 24-week postintervention follow-up will occur in May 2019 . Trial results are expected for 2019 . Conclusions Novel pragmatic research approaches are needed to inform policy for healthy retail food environments . This research will greatly advance our underst and ing of how the retail food environment can be used to improve population -level diet in the remote Australian Aboriginal and Torres Strait Isl and er context and retail setting s globally . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12618001588280 ; http://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=375933 ( Archived by WebCite at http://www.webcitation.org/76dbQEmwN ) International Registered Report Identifier ( IRRID ) DERR1 - The objective of this study was to identify physical , social , and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods . Students were recruited from high schools with a minimum level of 25 % free or reduced cost lunches . Using ecological momentary assessment , participants ( N=158 ) were trained to answer brief question naires on h and held PDA devices : ( a ) each time they ate or drank , ( b ) when prompted r and omly , and ( c ) once each evening . Data were collected over 7days for each participant . Participants reported their location ( e.g. , school grounds , home ) , mood , social environment , activities ( e.g. , watching TV , texting ) , cravings , food cues ( e.g. , saw a snack ) , and food choices . Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school , being with friends , feeling lonely or bored , craving a drink or snack , and being exposed to food cues . Surprisingly , sweet drink consumption was associated with exercising . Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks . These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions design ed to disrupt these food-related , cue-behavior linked habits BACKGROUND Evidence exists that beverages do not trigger appropriate anticipatory physiologic responses , such as cephalic phase insulin release . Therefore , it is of interest to eluci date the food properties necessary for triggering adaptive responses . Previously , we found a prolonged dose-dependent decrease in the hypothalamic functional magnetic resonance imaging signal after ingestion of a glucose solution . OBJECTIVES The aims of the present study were to measure the effects of sweet taste and energy content on the hypothalamic response to glucose ingestion and to measure the concomitant changes in blood glucose and insulin concentrations . DESIGN Five healthy , normal-weight men participated in a r and omized crossover design trial . The subjects were scanned 4 times for 37 min on separate days with functional magnetic resonance imaging . After 7 min , they ingested 1 of the following 4 stimuli ( 300 mL of each ) : water ( control ) , a glucose solution , an aspartame ( sweet taste ) solution , or a maltodextrin ( nonsweet carbohydrate ) solution . RESULTS Glucose ingestion result ed in a prolonged and significant signal decrease in the upper hypothalamus ( P < 0.05 ) . Water , aspartame , and maltodextrin had no such effect . Glucose and maltodextrin ingestions result ed in similar increases in blood glucose and insulin concentrations . However , only glucose triggered an early rise in insulin concentrations . Aspartame did not trigger any insulin response . CONCLUSIONS Our findings suggest that both sweet taste and energy content are required for a hypothalamic response . The combination of sweet taste and energy content could be crucial in triggering adaptive responses to sweetened beverages Reliable tables of glycemic index ( GI ) compiled from the scientific literature are instrumental in improving the quality of research examining the relation between GI , glycemic load , and health . The GI has proven to be a more useful nutritional concept than is the chemical classification of carbohydrate ( as simple or complex , as sugars or starches , or as available or unavailable ) , permitting new insights into the relation between the physiologic effects of carbohydrate-rich foods and health . Several prospect i ve observational studies have shown that the chronic consumption of a diet with a high glycemic load ( GI x dietary carbohydrate content ) is independently associated with an increased risk of developing type 2 diabetes , cardiovascular disease , and certain cancers . This revised table contains almost 3 times the number of foods listed in the original table ( first published in this Journal in 1995 ) and contains nearly 1300 data entries derived from published and unpublished verified sources , representing > 750 different types of foods tested with the use of st and ard methods . The revised table also lists the glycemic load associated with the consumption of specified serving sizes of different foods BACKGROUND Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake . OBJECTIVE We investigated whether energy intakes and dietary patterns were different in subjects who were r and omly assigned to  substitute caloric beverages with either water or diet beverages ( DBs ) . DESIGN Participants from the Choose Healthy Options Consciously Everyday r and omized clinical trial ( a 6-mo , 3-arm study ) were included in the analysis [ water groups : n = 106 ( 94 % women ) ; DB group : n = 104 ( 82 % women ) ] . For energy , macronutrient , and food and beverage intakes , we investigated the main effects of time , treatment , and the treatment-by-time interaction by using mixed models . RESULTS Overall , the macronutrient composition changed in both groups without significant differences between groups over time . Both groups reduced absolute intakes of total daily energy , carbohydrates , fat , protein , saturated fat , total sugar , added sugar , and other carbohydrates . The DB group decreased energy from all beverages more than the water group did only at month 3 ( P-group-by-time < 0.05 ) . Although the water group had a greater reduction in grain intake at month 3 and a greater increase in fruit and vegetable intake at month 6 ( P-group-by-time < 0.05 ) , the DB group had a greater reduction in dessert intake than the water group did at month 6 ( P-group-by-time < 0.05 ) . CONCLUSIONS Participants in both intervention groups showed positive changes in energy intakes and dietary patterns . The DB group showed decreases in most caloric beverages and specifically reduced more desserts than the water group did . Our study does not provide evidence to suggest that a short-term consumption of DBs , compared with water , increases preferences for sweet foods and beverages . This trial was registered at clinical trials.gov as NCT01017783 Xylitol research has been conducted since the early 70 ’s ; at the beginning of 2009 there were almost 500 PubMed - indexed papers on “ xylitol and dental ” . Xylitol research was initiated in Finl and , but nowadays the majority of papers are published by non-Finnish authors . Xylitol studies have been criticized mainly by European research ers . This criticism is reflected for example in the most recent textbook of cariology , Dental Caries – The Disease and its Clinical Management ( 2008 ) , used by students in all Nordic countries . It shows a figure with reduction in caries occurrence in the Turku Sugar Studies as an example , not of the effect of total substitution of dietary sugars with xylitol , but rather “ indicating the importance of removal of sugar from the diet , rather than starch , in caries control “ . Moreover , a frequently cited review in Caries Research in 2004 came to the conclusion that “ there is no evidence for a caries-therapeutic effect of xylitol”.1 Xylitol studies are easy to criticize especially by authors who have never been involved in field trials . For example , to avoid exchange of test products between children of the same class r and omisation has to be done by schools or school classes . This is rarely recognized by the critics of xylitol studies . In addition , it is hard to find volunteers to comply with 2–3 years chewing of a hard and tasteless gum base , which is the control often suggested for chewing gum trials . Polyols like maltitol and sorbitol are by no means inert and are thus not valid controls for xylitol . Fortunately , US dental experts have critically , but positively , conducted research and review ed the literature on xylitol.2–5 One consequence of practical problems associated with field trials is that in systematic review s of methods for caries control and prevention the strict exclusion criteria leave only few xylitol studies for evaluation . For example , the inclusion criteria for a Swedish systematic review on methods of caries prevention ( SBU ; www.sbu.se ) were so strict that hardly any recommendations concerning caries prevention could be made . This also applied to xylitol : according to the report , the evidence on the clinical efficacy for xylitol was inconclusive . In a critical evaluation of the SBU report , the following question was asked “ where does this leave the confused dental practitioner , who has to offer chairside advice to patients , but can not wait of further ( good- quality ) research to be conducted and published , providing a more solid evidence -base ? ” ( Stillman-Lowe , 2005 ) . On the other h and , xylitol has been recommended for use in caries control and prevention by several dental associations . Also the European Food Safety Authority evaluated the literature on xylitol in 2008 and came to the conclusion that “ xylitol chewing gum reduces the risk of caries in children ” . The cl aim had to be reformulated since chewing gum is not a medicine and can thus not be cl aim ed to reduce the risk of a disease , caries . In Europe , there is a strong interest not to give xylitol a better status than for other polyol sweeteners . Xylitol differs from other polyols as is obvious to all experts familiar with microbiology . Xylitol has beneficial effects on the oral flora not shared by other polyols . The evidence so far supports specific xylitol-effects on oral bacteria , but not on saliva .  Xylitol can not be metabolized by plaque bacteria , contrary to sorbitol and other 6-carbon polyols , and may thus favour mineralization . The accumulated evidence suggests that 1 ) mutans streptococci are the target organisms of xylitol in vivo , 2 ) mutans streptococci are reduced and stay on a lower level even during long-term xylitol consumption as long as the consumption lasts , 3 ) xylitol consumption reduces the accumulation of plaque , 4 ) xylitol consumed by mothers reduces the mother-child transmission of mutans streptococci and consequently , caries occurrence in their children,6,7 and 5 ) xylitol consumption reduces the risk of caries in children.4 In clinical trials on xylitol mostly chewing gum with high xylitol concentrations has been used . Studies with low daily doses of xylitol are known as a rule to fail to show any caries-preventive effects . To obtain beneficial xylitol-effects on mutans streptococci , on plaque and caries occurrence xylitol must be consumed three times or more per day , with a daily dose of 5–6 grams.4,7 When using chewing gums or pastilles , saliva stimulation always occurs due to chewing or sucking . Some authors have cl aim ed that the beneficial effects of xylitol are solely based on saliva stimulation and that all sugar-free gums are similar in this respect . In fact , in conditions where caries occurrence is high , even sorbitol gum can prevent caries.8 A recent study elegantly shows caries prevention with xylitol without any saliva stimulation . In this study fifteen-month-old children were given xylitol or sorbitol syrup with a syringe for 12 months.9 The xylitol syrup prevented  early childhood caries  effectively , while sorbitol had no effect . In spite of the abundant literature still more studies are needed on the action of xylitol . Biofilm models could be very useful in xylitol research . There is a clear need for properly design ed , r and omized , controlled , clinical trials to demonstrate 1 ) the feasibility of  xylitol prevention in different population s with different dietary and oral hygiene habits , 2 ) suitable vehicles to deliver xylitol , 3 ) the extent to which xylitol can be “ diluted ” with other polyols without losing the caries preventive effects , and 4 ) the minimum daily xylitol dose and frequency of xylitol are needed to obtain the expected xylitol-effects on mutans streptococci , plaque and most importantly , on caries occurrence . Clinical trials often aim to improve treatment methods . When several clinical trials give similar results , clinicians can be given treatment guidelines based on findings verified by research . In this way research serves the clinicians in treating patients according to evidence -based solid information . Systematic review s are currently required to up date guidelines for caries prevention . As such , critical evaluation of the existing literature is a positive goal , but if it leads to a situation where no treatment guidelines can be given , something is wrong . This also applies to xylitol studies . Though strict inclusion criteria prevent conclusions based on systematic review s of the literature , evidence -based treatment guidelines can still be given for the use of xylitol . Xylitol is a useful adjunct to traditional methods for caries control and prevention . Caries prevention with xylitol has been cl aim ed to be expensive , but if true primary prevention is obtained , as demonstrated in the mother-child study , 6,7 it may be worth it Restrained  eaters  have been shown to disinhibit their eating when under stressful situations . However , the majority of laboratory studies that have demonstrated this effect utilized a single test food , typically ice cream . There is a lack of research investigating if this interaction is still evident when multiple foods are offered , and if so , the food choices that restrained and non-restrained eaters make when under stressful situations . The present study examined the impact of stress on food choices in individuals with varying degrees of restraint . Several classes of foods were offered ( i.e. , high fat/high sugar ; low fat/high sugar ; high fat/low sugar ; low fat/low sugar ) . A total of 153 females were r and omly assigned to either a stress or no-stress situation , and then both groups participated in a taste test . There was no significant difference in total amount of consumption between restrained and non-restrained eaters when under stress . However , further analyses found that restrained eaters under stress consumed more potato chips than those who were not under stress . Findings are discussed in terms of possible limitations of the stress-induced eating paradigm for restrained eaters PURPOSE Cigarette packaging is the most prominent form of tobacco marketing remaining in countries such as the United Kingdom . The current study examined perceptions of cigarette packaging among female youth and the potential impact of " plain " cigarette packaging regulations . METHODS A national sample of 947 16- to 19-year-old female subjects in the United Kingdom completed an online survey . Participants were r and omized to view 10 cigarette packs design ed according to one of four experimental conditions : fully br and ed female packs , the same packs without descriptor words , the same packs without br and imagery or descriptors ( " plain " packs ) , and br and ed non-female br and s. Participants rated packs on measures of appeal and health risk , positive smoker image , and completed a behavioral pack selection task . RESULTS Plain packs were rated as the least appealing and worse tasting compared with all other conditions . Plain packs were also associated with fewer false beliefs about health risks compared with br and ed packs . Removing br and descriptors from packs significantly reduced measures of appeal and taste , particularly for br and s with flavor descriptors , such as cherry and vanilla . Plain packs were significantly less likely to be associated with positive images , such as glamour , sophistication , and slimness . Most importantly , respondents were significantly less likely to accept a pack of cigarettes when offered only plain versus br and ed packs ( p = .026 ) . CONCLUSIONS Marketing in the form of pack br and ing remains a potent tool for increasing the appeal of tobacco products to young women . The findings provide empirical support for plain cigarette packaging regulations in Australia to be implemented in 2012 Habitual iron intakes during pregnancy are typically lower than dietary guidelines , a risk for iron deficiency . The aim of this study was to determine whether regular consumption of bread naturally rich in iron could help women to achieve dietary targets . Thirty-three primiparous mothers were r and omized to eat 3–4 slices of iron-rich or control bread daily for 6 weeks . Two 24-h-prompted ( multiple-pass ) dietary recalls were completed , and vali date d algorithms were used to determine the amount of ‘ available iron ’ from the diet . Regular consumption of iron-rich bread helped pregnant women to achieve UK dietary recommendations ; the quantity of bread consumed by the participants contributed 27 % versus 9 % UK Reference Nutrient Intake ( RNI ) ( 14.8 mg/d ) in the intervention versus the control group . Levels of total ‘ available iron ’ were similar in both groups and correlated positively with total dietary iron ( r = 0.78 , P = 0.0001 ) , vitamin C ( r = 0.43 , P = 0.017 ) and non-haem iron ( r = 0.77 , P = 0.0001 ) . Findings from this study show that iron-rich staple foods can help women  reach dietary targets for iron . This is an area of great potential that could be of particular benefit to low-income/ethnically diverse population groups who have some of the lowest iron intakes . Further research using fortified staple foods containing higher levels of iron is now warranted to establish physiological benefits The influence of sweet taste sensitivity on food intake is not well understood . We investigated the involvement of salivary leptin and SNP of the sweet taste receptor genes ( TAS1R2/TAS1R3 ) on sweet taste sensitivity , sensory-specific satiety ( SSS ) and macronutrient intake in healthy human adults . In all , nineteen high sweet sensitivity ( HS ) and eleven low sweet sensitivity ( LS ) subjects were classified based on the sweetness perception of one solution ( 9 mm sucrose ) forced-choice triangle test . All participants completed a r and omised crossover design experiment where they consumed one of three iso-energetic soup preloads differing in primary taste quality ( sweet , non-sweet taste-control or no-taste energy-control ) . A period of 1 h after the preload , participants were offered a buffet meal consisting of foods varying in taste ( sweet or non-sweet ) and fat content . Subjective measures included hunger/fullness and SSS for sweetness . Saliva and buccal cells were collected to measure leptin level and to study the TAS1R2/TAS1R3 specific SNP , respectively . Salivary leptin concentrations were significantly higher in LS than HS participants ( P<0·05 ) . In addition , HS showed stronger sweet SSS compared with LH participants ( P<0·05 ) , and consumed less carbohydrate ( % energy ) and more non-sweet foods than LS ( P<0·01 and P<0·05 , respectively ) . Alleles from each TAS1R2 locus ( GG compared with AA alleles of rs12033832 , and CT/CC compared with TT alleles of rs35874116 ) were related to higher consumption of carbohydrates ( % energy ) and higher amount of sweet foods , respectively ( P<0·05 ) . In contrast , no associations were found for the TAS1R3 alleles . These results contribute to underst and the links between taste sensitivity , macronutrient appetite and food consumption OBJECTIVE —The aim of this study was to identify a dietary pattern associated with insulin resistance and investigate whether this pattern was prospect ively associated with type 2 diabetes . RESEARCH DESIGN AND METHODS — Analysis was based on 7,339 participants of the Whitehall II study .  Dietary intake  was measured using a 127-item food frequency question naire . We used the reduced rank regression method to determine dietary patterns using the homeostasis model assessment of insulin resistance as the intermediate or response variable . The association between the dietary pattern identified and incidence of type 2 diabetes was investigated using Cox proportional hazard regression models . RESULTS —We identified a dietary pattern characterized by high consumption of low-calorie/diet soft drinks , onions , sugar-sweetened beverages , burgers and sausages , crisps and other snacks , and white bread and low consumption of medium-/high-fiber breakfast cereals , jam , French dressing/vinaigrette , and wholemeal bread . Higher dietary pattern scores were associated with increased risk of type 2 diabetes ( hazard ratio for top quartile 2.95 [ 95 % CI 2.19–3.97 ] ; adjusted for age , sex , and energy misreporting ) . This relationship was attenuated after adjustment for ethnicity , employment grade , health behaviors ( smoking , alcohol use , and physical activity ) but remained significant after further adjustment for blood pressure and BMI ( 1.51 [ 1.10–2.09 ] ) . CONCLUSIONS —A dietary pattern associated with insulin resistance predicts type 2 diabetes risk after adjustment for a range of confounders . This study adds to the evidence that dietary patterns are an important risk factor for type 2 diabetes National Institutes of Health ( NIH ) consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1 ) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality ( AHRQ ) , 2 ) presentations by investigators working in areas relevant to the conference questions during a 2-day public session , 3 ) questions and statements from conference attendees during open discussion periods that are part of the public session , and 4 ) closed deliberations by the panel during the remainder of the second day and the morning of the third . This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government . The statement reflects the panel 's assessment of medical knowledge available at the time the statement was written . Thus , it provides a snapshot in time of the state of knowledge on the conference topic . When reading the statement , keep in mind that new knowledge is inevitably accumulating through medical research . At least half of American adults take a dietary supplement , the majority of which are multivitamin/multimineral ( MVM ) supplements . As more and more Americans seek strategies for maintaining good health and preventing disease , and as the marketplace offers an increasing number of products to fulfill that desire , it is important that consumers have the best possible information to make their choices . Assessing the available scientific evidence on the benefits of MVM supplement use for chronic disease prevention , identifying the gaps in the evidence , and recommending an appropriate research agenda to meet the shortfalls are subjects considered in this report . The word vitamine was coined in 1912 , as an abbreviated term meant to capture the notion of important factors in the diet , or vital amines . This was preceded more than 150 years earlier by British navy physician James Lind 's discoveryin the first recorded controlled trialthat citrus juice , a good source of what was found 2 centuries later to be vitamin C , could prevent scurvy in sailors . In 1913 , the first vitamin was isolated : thiamin , the deficiency of which caused beriberi . Thirteen vitamins and 15 essential minerals have now been identified as important to human nutrition . Large-scale fortification of diets began in the United States with the addition of iodine to table salt in 1924 to prevent goiter , followed by the addition of vitamin D to milk in 1933 to prevent rickets and the addition of thiamin , riboflavin , niacin , and iron to flour in 1941 . Multivitamin/multimineral products providing more than vitamins A and D became available in pharmacies and grocery stores in the mid-1930s . In the early 1940s , the first MVM tablet was introduced . Although clinical deficiency of vitamins or minerals , other than iron , is now uncommon in the United States , growth in supplement use has accelerated rapidly with marketing spurred by cl aims some based on scientific studies that chronic conditions could be prevented or treated by supplement use . Annual sales of supplements to Americans are now reported at about $ 23 billion , a substantial share of which is spent on vitamins and minerals . Because of such widespread use of MVM , increasing public and medical confusion over apparently contradictory results from studies , and reports of possible adverse effects from overuse in certain circumstances , the Office of Dietary Supplements and the Office of Medical Applications of Research of the NIH convened a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention , held on 1517 May 2006 , in Bethesda , Maryl and . The goal of the conference was to assess the evidence available on MVM use and outcomes for chronic disease prevention in the generally healthy population of adults and to make recommendations for future research . The conference focused on vitamins and minerals and did not deal with botanicals , hormones , or other supplements . It also did not address the treatment of vitamin or mineral deficiencies . Except for considerations of safety , the conference also did not review issues of primary relevance to pregnant women or children . Specifically , the conference explored the following key questions : 1 ) What are the current patterns and prevalence of the public 's use of MVM supplements ? 2 ) What is known about the dietary nutrient intake of MVM users versus nonusers ? 3 ) What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention ? 4 ) What is the efficacy of MVM  in chronic disease prevention in the general population of adults ? 5 ) What is known about the safety of MVM  for the generally healthy population ? and 6 ) What are the major knowledge gaps and research opportunities regarding MVM use ? During the first 2 days of the conference , experts presented information on each of the key questions . After weighing the scientific evidence , including the data presented by the speakers and a formal evidence report commissioned through AHRQ , an independent panel prepared and presented a draft of this state-of-the-science statement addressing the conference questions . The evidence report prepared for the conference is available at www.ahrq.gov/clinic/tp/multivittp.htm . For the purpose of this statement , the term MVM refers to any supplement containing 3 or more vitamins and minerals but no herbs , hormones , or drugs , with each component at a dose less than the tolerable upper level determined by the Food and Nutrition Boardthe maximum daily intake likely to pose no risk for adverse health effects . Our review also included studies of the relationship of single-nutrient supplements and 2-nutrient supplements to certain disease outcomes . The term primary prevention refers to preventing the development of disease in a person who does not have the disease in question . The chronic conditions assessed include cancer ; age-related sensory loss ; and cardiovascular , endocrine , neurologic , musculoskeletal , gastroenterologic , renal , and pulmonary diseases . A word is warranted about the nature of the evidence base considered by the panel . The range of vitamins and minerals of possible interest was so broad that the conference planning committee chose to focus the evidence report on nutrients for which the potential for impact had been most strongly suggested and on conditions for which supplements were thought to have the most potential influence . The planning committee also limited the scope of the evidence report to consideration of r and omized , controlled trials ( RCTs ) , which are generally considered the gold st and ard for evidence -based decision making . These are studies in which participants are allocated by chance alone to receive or not to receive 1 of 2 or more clinical interventions . For example , while folate supplementation was initially shown to decrease the risk for neural tube defects in animal studies , outcome data in nonhuman models were not considered sufficient evidence on which to base policy recommendations . At the next level of evidence , observational studies in humans suggested efficacy of folate supplementation to prevent such defects . However , these were criticized because they were not r and omized and were potentially subject to bias . Not until these findings were confirmed by RCTs in humans was public policy implemented , including fortification of cereal grains with folate . An observational study is one in which the exposure or treatment of interest is not assigned to the participant by the investigator . Such studies suggested that -carotene intake might protect against the development of some types of cancer . However , RCTs of -carotene supplementation not only showed no benefit , they also found an increased risk for lung cancer in persons who smoked cigarettes or who were exposed to asbestos . These examples illustrate both the risk of relying only on observational studies and the advantage of RCTs in identifying both benefits and risks of MVM supplementation . Limiting the focus of our statement to RCTs has some inherent limitations , given the potential of other types of studies to provide important insights . Observational studies , for example , are particularly useful for generating hypotheses , defining adverse effects , and documenting long-term treatment consequences . They are often essential precursors to the well-conducted RCTs important for policy formation . Our principal recommendations focus on the compelling research activities that must be supported to better inform the decisions that millions of Americans are making each day to use or not to use MVM supplements to prevent chronic disease . At the same time , mindful of the constraints of the available evidence base , we have also taken care not to make premature recommendations about whether generally healthy Americans should or should not take MVM supplements . Because of the need for more reliable information on MVMs , we have made strong recommendations for research and for increased U.S. Food and Drug Administration ( FDA ) oversight of the MVM industry . 1 . What Are the Current Patterns and Prevalence of the Public 's Use of MVM Supplements ? More than half of American adults take dietary supplements in the belief that they will make them feel better , give them greater energy , improve their health , and prevent and treat disease . The use of supplements has been steadily increasing , and growth appears likely to continue . Currently , users spend more than $ 23 billion per year on supplements , and among this supplement-using population , MVM is the major category of supplements , used by about one third of Americans . Uncertainty remains in estimating prevalence of use because of problems defining these products ; increasing complexity in the formulation of supplements , including more non-MVM components and specialized formulas ; and varying frequency of use . It appears that use is higher Purpose . Examine the reach , efficacy , adoption , implementation , and maintenance of a physical activity and nutrition curriculum for middle-school students . Design . Nonexperimental pilot evaluation of a statewide dissemination trial . Setting . California middle schools during the 2006 to 2007 school year . Subjects . Sixteen classes ( N = 668 students and 16 teachers ) sample d from the statewide pool who used the program . Intervention . An eight-lesson nutrition and physical activity curriculum , “ Exercise Your Options ” ( EYO ) , including a teacher guide , video clips , a student activity booklet , and ancillary material s was made available to teachers . Measures . Program records , classroom observations , teacher surveys , and student presurveys and postsurveys ( assessing physical activity , sedentary behaviors , and dietary intake ) . Analysis . Descriptive statistics and multilevel r and om-coefficient modeling . Results . The EYO program reached 234 , 442 middle-school students in California . During the program , total physical activity increased ( p ≤ .001 ) , whereas watching TV/DVDs and playing electronic games/computer use decreased ( p ≤ .05 ) . Intake of dairy products increased ( p < .05 ) , whereas consumption of sugars/sweets decreased ( p < .001 ) . Forty-two percent of eligible middle-school classrooms ordered the program material s. Eighty-six percent of sample d teachers implemented all of the lessons . Over the past 5 years , 51 % of all middle-school students in California were exposed to the program . Conclusions . The EYO program showed its potential for moderate to high public health impact among California middle-school students BACKGROUND Vegetable consumption among preschool children is below recommended levels . New evidence -based approaches to increase preschoolers ' vegetable intake , particularly in the child care setting , are needed . This study tests the effectiveness of two community-based r and omized interventions to increase vegetable consumption and willingness to try vegetables : ( 1 ) the pairing of a vegetable with a familiar , well-liked food and ( 2 ) enhancing the visual appeal of a vegetable . METHODS Fifty-seven preschoolers enrolled in a Child and Adult Care Food Program-participating child care center participated in the study ; complete lunch and snack data were collected from 43 and 42 children , respectively . A within-subjects , r and omized design was used , with order of condition counterbalanced . For lunch , steamed broccoli was served either on the side of or on top of cheese pizza . For a snack , raw cucumber was served either as semicircles with chive and an olive garnish or arranged in a visually appealing manner ( in the shape of a caterpillar ) . Paired t-tests were used to determine differences in consumption of meal components , and McNemar 's test was performed to compare willingness to taste . RESULTS Neither visual appeal enhancement nor pairing with a liked food increased vegetable consumption . Pairing increased willingness to try the vegetable from 79 % to 95 % of children ( p=0.07 ) . Greater vegetable intake occurred at snack than at lunch . CONCLUSIONS Further research should explore the strategy of pairing vegetables with liked foods . Greater consumption at snack underscores snack time as a critical opportunity for increasing preschool children 's vegetable intake Nutritional state ( e.g. fasted vs. fed ) and different food stimuli ( e.g. high-calorie vs. low-calorie , or appetizing vs. bl and foods ) are both recognized to change activity in brain reward systems . Using functional magnetic resonance imaging , we have studied the interaction between nutritional state and different food stimuli on brain food reward systems . We examined how blood oxygen level-dependent activity within a priori regions of interest varied while viewing pictures of high-calorie and low-calorie foods . Pictures of non-food household objects were included as control stimuli . During scanning , subjects rated the appeal of each picture . Twenty non-obese healthy adults [ body mass index 22.1 + /- 0.5 kg/m(2 ) ( mean + /- SEM ) , age range 19 - 35 years , 10 male ] were scanned on two separate mornings between 11:00 and 12:00 h , once after eating a filling breakfast ( ' fed ' : 1.6 + /- 0.1 h since breakfast ) , and once after an overnight fast but skipping breakfast ( ' fasted ' : 15.9 + /- 0.3 h since supper ) in a r and omized cross-over design . Fasting selectively increased activation to pictures of high-calorie over low-calorie foods in the ventral striatum , amygdala , anterior insula , and medial and lateral orbitofrontal cortex ( OFC ) . Furthermore , fasting enhanced the subjective appeal of high-calorie more than low-calorie foods , and the change in appeal bias towards high-calorie foods was positively correlated with medial and lateral OFC activation . These results demonstrate an interaction between homeostatic and hedonic aspects of feeding behaviour , with fasting biasing brain reward systems towards high-calorie foods Background — Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes mellitus .  Few studies have tested for a relationship with coronary heart disease ( CHD ) or intermediate biomarkers . The role of artificially sweetened beverages is also unclear . Methods and Results — We performed an analysis of the Health Professionals Follow-Up Study , a prospect i ve cohort study including 42 883 men . Associations of cumulatively averaged sugar-sweetened ( eg , sodas ) and artificially sweetened ( eg , diet sodas ) beverage intake with incident fatal and nonfatal CHD ( myocardial infa rct ion ) were examined with proportional hazard models . There were 3683 CHD cases over 22 years of follow-up . Participants in the top quartile of sugar-sweetened beverage intake had a 20 % higher relative risk of CHD than those in the bottom quartile ( relative risk=1.20 ; 95 % confidence interval , 1.09–1.33 ; P for trend < 0.01 ) after adjustment for age , smoking , physical activity , alcohol , multivitamins , family history , diet quality , energy intake , body mass index , pre-enrollment weight change , and dieting . Artificially sweetened beverage consumption was not significantly associated with CHD ( multivariate relative risk=1.02 ; 95 % confidence interval , 0.93–1.12 ; P for trend=0.28 ) . Adjustment for self-reported high cholesterol , high triglycerides , high blood pressure , and diagnosed type 2 diabetes mellitus slightly attenuated these associations . Intake of sugar-sweetened but not artificially sweetened beverages was significantly associated with increased plasma triglycerides , C-reactive protein , interleukin-6 , and tumor necrosis factor receptors 1 and 2 and decreased high-density lipoprotein , lipoprotein(a ) , and leptin ( P<0.02 ) . Conclusions — Consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids , inflammatory factors , and leptin . Artificially sweetened beverage intake was not associated with CHD risk or biomarkers Background Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death . The burden of these deaths is rapidly shifting to low and middle-income countries , such as Brazil . Brazil has prohibited most forms of tobacco advertising ; however , the cigarette pack remains a primary source of marketing . The current study examined how tobacco packaging influences br and appeal and perceptions of health risk among young women in Brazil . Methods A between-subjects experiment was conducted in which 640 Brazilian women aged 16–26 participated in an online survey . Participants were r and omized to view 10 cigarette packages according to one of three experimental conditions : st and ard br and ed packages , the same packs without br and imagery ( “ plain packaging ” ) , or the same packs without br and imagery or descriptors ( e.g. , flavors ) . Participants rated packages on perceived appeal , taste , health risk , smoothness , and smoker attributes . Finally , participants were shown a range of br and ed and plain packs from which they could select one as a free gift , which constituted a behavioral measure of appeal . Results Br and ed packs were rated as significantly more appealing , better tasting , and smoother on the throat than plain packs . Br and ed packs were also associated with a greater number of positive smoker attributes including style and sophistication , and were perceived as more likely to be smoked by females than the plain packs . Removing descriptors from the plain packs further decreased the ratings of appeal , taste and smoothness , and also reduced associations with positive attributes . In the pack offer , participants were three times more likely to select br and ed packs than plain packs . Conclusions Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults , and consequently reduce smoking susceptibility . Overall , the findings provide support for plain packaging regulations , such as those in Australia Objectives To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia . Design Cross- sectional , observational . Setting Community , nursing homes and rehabilitation or acute care facilities in four Italian regions . Participants A r and om sample of 526 subjects , aged 65 years and older ( 217 free living individuals , 213 residents in nursing homes , and 93 patients in rehabilitation and acute wards ) . Measurements All subjects underwent a  multidimensional geriatric evaluation of : nutritional status , anthropometric parameters , health and cognitive status , depression , taste , chewing and swallowing function , and some hormones related to appetite . Diet variety  was assessed , considering the frequency of consumption of different food groups ( milk and dairy products ; meat , fish , and eggs ; cereals and derivatives ; fruit and vegetables ) . Results In anorexic elderly subjects the global food intake was reduced , and the eating pattern was characterized by the reduced consumption of certain food groups ( “ meat , eggs and fish ” and “ fruit and vegetables ” ) whereas the frequency of consumption of milk and cereals remained almost unchanged . Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety . Conclusion Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status , further research should be prompted to establish an intervention . protocol allowing the early diagnosis of anorexia of aging , aim ed at identifying its causes and at optimizing treatment of anorexic patients Background Some governments have recently shown a willingness to introduce taxes on unhealthy foods and drinks . In 2011 , the Irish Minister for Health proposed a 10 % tax on sugar sweetened beverages ( SSBs ) as a measure to combat childhood obesity . Whilst this proposed tax received considerable support , the Irish Department of Finance requested a Health Impact Assessment of this measure . As part of this assessment we set out to model the impact on obesity . Methods We used price elasticity estimates to calculate the effect of a 10 % SSB tax on SSB consumption . SSBs were assumed to have an own-price elasticity of −0.9 and we assumed a tax pass-on rate to consumers of 90 % . Baseline SSB consumption and obesity prevalence , by age , sex and income-group , for Irel and were taken from the 2007 Survey on Lifestyle and Attitude to Nutrition . A comparative risk assessment model was used to estimate the effect on obesity arising from the predicted change in calorie consumption , both for the whole population and for sub-groups ( age , sex , income ) . Sensitivity analyses were conducted on price-elasticity estimates and tax pass-on rates . Results We estimate that a 10 % tax on SSBs will result in a mean reduction in energy intake of 2.1 kcal/person/day . After adjustment for self-reported data , the 10 % tax is predicted to reduce the percentage of the obese adult population ( body mass index [ BMI ] ≥30 kg/m2 ) by 1.3 % , equating to 9,900 adults ( 95 % credible intervals : 7,750 to 12,940 ) , and the overweight or obese population ( BMI ≥ 25 kg/m2 ) by 0.7 % , or 14,380 adults ( 9,790 to 17,820 ) . Reductions in obesity are similar for men ( 1.2 % ) and women ( 1.3 % ) , and similar for each income group ( between 1.1 % and 1.4 % across income groups ) . Reductions in obesity are greater in young adults than older adults ( e.g. 2.9 % in adults aged 18–24 years vs 0.6 % in adults aged 65 years and over ) . Conclusions This study suggests that a tax on SSBs in Irel and would have a small but meaningful effect on obesity . While such a tax would be perceived as affecting the whole population , from a health prospect i ve the tax will predominantly affect younger adults who are the main consumers of SSBs OBJECTIVE To study the effects of school lessons about healthy food on  adolescents '  self-reported beliefs and behaviour regarding the purchase and consumption of soft drinks , water and extra foods , including sweets and snacks . The lessons were combined with the introduction of lower-calorie foods , food labelling and price reductions in school vending machines . DESIGN A cluster-r and omized controlled design was used to allocate schools to an experimental group ( i.e. lessons and changes to school vending machines ) and a control group ( i.e. ' care as usual ' ) . Question naires were used pre-test and post-test to assess students ' self-reported purchase of extra products and their knowledge and beliefs regarding the consumption of low-calorie products . SETTING Secondary schools in the Netherl and s. SUBJECTS Twelve schools participated in the experimental group ( 303 students ) and fourteen in the control group ( 311 students ) . The students ' mean age was 13.6 years , 71.5 % were of native Dutch origin and mean BMI was 18.9 kg/m(2 ) . RESULTS At post-test , the experimental group knew significantly more about healthy food than the control group . Fewer students in the experimental group ( 43 % ) than in the control group ( 56 % ) reported bringing soft drinks from home . There was no significant effect on attitude , social norm , perceived behavioural control and intention regarding the consumption of low-calorie extra products . CONCLUSIONS The intervention had limited effects on students ' knowledge and self-reported behaviour , and no effect on their beliefs regarding low-calorie beverages , sweets or snacks . We recommend a combined educational and environmental intervention of longer duration and engaging parents . More research into the effects of such interventions is needed IMPORTANCE Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease ( CVD ) risk factors . Few prospect i ve studies have examined the association of added sugar intake with CVD mortality . OBJECTIVE To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality . DESIGN , SETTING , AND PARTICIPANTS National Health and Nutrition Examination Survey ( NHANES , 1988 - 1994 [ III ] , 1999 - 2004 , and 2005 - 2010 [ n = 31,147 ] ) for the time trend analysis and NHANES III Linked Mortality cohort ( 1988 - 2006 [ n = 11 733 ] ) , a prospect i ve cohort of a nationally representative sample of US adults for the association study . MAIN OUTCOMES AND MEASURES Cardiovascular disease mortality . RESULTS Among US adults , the adjusted mean percentage of daily calories from added sugar  increased from 15.7 % ( 95 % CI , 15.0%-16.4 % ) in 1988 - 1994 to 16.8 % ( 16.0%-17.7 % ; P = .02 ) in 1999 - 2004 and decreased to 14.9 % ( 14.2%-15.5 % ; P < .001 ) in 2005 - 2010 . Most adults consumed 10 % or more of calories from added sugar ( 71.4 % ) and approximately 10 % consumed 25 % or more in 2005 - 2010 . During a median follow-up period of 14.6 years , we documented 831 CVD deaths during 163,039 person-years . Age- , sex- , and race/ethnicity-adjusted hazard ratios ( HRs ) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 ( reference ) , 1.09 ( 95 % CI , 1.05 - 1.13 ) , 1.23 ( 1.12 - 1.34 ) , 1.49 ( 1.24 - 1.78 ) , and 2.43 ( 1.63 - 3.62 ; P < .001 ) , respectively . After additional adjustment for sociodemographic , behavioral , and clinical characteristics , HRs were 1.00 ( reference ) , 1.07 ( 1.02 - 1.12 ) , 1.18 ( 1.06 - 1.31 ) , 1.38 ( 1.11 - 1.70 ) , and 2.03 ( 1.26 - 3.27 ; P = .004 ) , respectively . Adjusted HRs were 1.30 ( 95 % CI , 1.09 - 1.55 ) and 2.75 ( 1.40 - 5.42 ; P = .004 ) , respectively , comparing participants who consumed 10.0 % to 24.9 % or 25.0 % or more calories from added sugar with those who consumed less than 10.0 % of calories from added sugar . These findings were largely consistent across age group , sex , race/ethnicity ( except among non-Hispanic blacks ) , educational attainment , physical activity , health eating index , and body mass index . CONCLUSIONS AND RELEVANCE Most US adults consume more added sugar than is recommended for a healthy diet . We observed a significant relationship between added sugar consumption and increased risk for CVD mortality BACKGROUND Informed and engaged parents and healthful home environments are essential for the health of youth . Although research has shown health benefits associated with family meals , to date , no r and omized controlled trial ( RCT ) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes . METHODS / DESIGN The Healthy Home Offerings via the Mealtime Environment ( HOME ) Plus study is a two-arm ( intervention versus attention-only control ) RCT being conducted in Minneapolis/St . Paul . Built on previous pilot research , HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children 's sedentary behavior , particularly screen time , to promote healthier eating and activity behaviors and prevent obesity . HOME Plus is delivered to families in community setting s. The program includes 10 monthly sessions focused on nutrition and activity education , meal planning and preparation skill development . In addition , five motivational goal - setting phone calls are conducted with parents . The primary outcome measure is age- and gender-adjusted child BMI -z score at post-intervention by treatment group . Secondary household-level outcomes include family meal frequency , home availability of healthful foods ( fruits/vegetables ) and unhealthful foods ( high-fat/sugary snacks ) and beverages ( sugar-sweetened beverages ) , and the quality of foods served at meals and snacks . Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time . CONCLUSIONS The HOME Plus RCT actively engages whole families of 8 - 12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use Background / Objectives : This longitudinal study describes the relationship between young children ’s screen time , dietary habits  and anthropometric measures . The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages ( SSB ) and increased BMI , BMI z-score and waist to height ratio ( WHtR ) two years later . A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures .Subjects/ Methods : The study is a part of the prospect i ve cohort study IDEFICS ( “ Identification and prevention of dietary and lifestyle-induced health effects in children and infants ” ) , investigating diet , lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries ( baseline n=16 225 , two-year follow-up ; n=11 038 ) .  Anthropometry was objective ly measured , and behaviours were parent-reported . Results : The main hypothesis was supported , but the second hypothesis was not confirmed . The odds ratio of being in the highest quintile of % change in WHtR was 1.26 ( 95 % CI : 1.17–1.36 ) and in BMI 1.22 ( 95 % CI : 1.13–1.31 ) , for each hour per day watching television . The odds ratio of having  increased SSB consumption was 1.19 ( 95 % CI : 1.09–1.29 ) for each hour per day watching TV . The associations for total screen time were slightly weaker . Conclusions : The results indicate substantial effects of TV viewing and other screen activities for young children , both on their consumption of sugary drinks and on an increase in BMI and central obesity . Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group Abstract Purpose The aim of the study was to assess associations between intake of combined soft drinks ( sugar sweetened and artificially sweetened ) and fruit and vegetable juices and the risk of hepatocellular carcinoma ( HCC ) , intrahepatic bile duct ( IHBC ) and biliary tract cancers ( GBTC ) using data from the European Prospect i ve Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries . Methods After 11.4 years of follow-up , 191 HCC , 66 IHBC and 236 GBTC cases were identified .  Hazard ratios and 95 % confidence intervals ( HR ; 95 % CI ) were estimated with Cox regression models with multivariable adjustment ( baseline total energy intake , alcohol consumption and intake pattern , body mass index , physical activity , level of educational attainment and self-reported diabetes status ) . Results No risk associations were observed for IHBC or GBTC . Combined soft drinks consumption of > 6 servings/week was positively associated with HCC risk : HR 1.83 ; 95 % CI 1.11–3.02 , ptrend = 0.01 versus non-consumers . In sub-group analyses available for 91 % of the cohort artificially sweetened soft drinks increased HCC risk by 6 % per 1 serving increment ( HR 1.06 , 95 % CI 1.03–1.09 , ncases = 101 ) ; for sugar-sweetened soft drinks , this association was null ( HR 1.00 , 95 % CI 0.95–1.06 ; ncases = 127 , pheterogeneity = 0.07 ) . Juice consumption was not associated with HCC risk , except at very low intakes ( < 1 serving/week : HR 0.60 ; 95 % CI 0.38–0.95 ; ptrend = 0.02 vs. non-consumers ) . Conclusions Daily intake of combined soft drinks is positively associated with HCC , but a differential association between sugar and artificially sweetened can not be discounted . This study provides some insight into possible associations of HCC with sugary drinks intake . Further exploration in other setting s is required The present study examined whether low-fat labeling and caloric information affect food intake , calorie estimates , taste preference , and health perceptions .  Participants included 175 female undergraduate students who were r and omly assigned to one of four experimental conditions . A 2 × 2 between subjects factorial design was used in which the fat content label and caloric information of chocolate c and y was manipulated . The differences in food intake across conditions did not reach statistical significance . However , participants significantly underestimated the calorie content of low-fat-labeled c and y. Participants also rated low-fat-labeled c and y as significantly better tasting when they had caloric information available . Participants endorsed more positive health attributions for low-fat-labeled c and y than for regular-labeled c and y , independent of caloric information . The inclusion of eating attitudes and behaviors as covariates did not alter the results . The study findings may be related to the " health halo " associated with low-fat foods and add to the research base by examining the interaction between low-fat and calorie labeling Sweetened beverages , coffee , and tea are the most consumed non-alcoholic beverages and may have important health consequences . We prospect ively evaluated the consumption of various types of beverages assessed in 1995–1996 in relation to self-reported depression diagnosis after 2000 among 263,923 participants of the NIH-AARP Diet and Health Study .  Odds ratios ( OR ) and 95 % confidence intervals ( CI ) were derived from multivariate logistic regressions . The OR ( 95 % CI ) comparing ≥4 cans/cups per day with none were 1.30 ( 95%CI : 1.17–1.44 ) for soft drinks , 1.38 ( 1.15–1.65 ) for fruit drinks , and 0.91 ( 0.84–0.98 ) for coffee ( all P for trend<0.0001 ) . Null associations were observed for  iced-tea  and hot tea . In stratified analyses by drinkers of primarily diet versus regular beverages , the ORs were 1.31 ( 1.16–1.47 ) for diet versus 1.22 ( 1.03–1.45 ) for regular soft drinks , 1.51 ( 1.18–1.92 ) for diet versus 1.08 ( 0.79–1.46 ) for regular fruit drinks , and 1.25 ( 1.10–1.41 ) for diet versus 0.94 ( 0.83–1.08 ) for regular sweetened iced-tea . Finally , compared to nondrinkers , drinking coffee or tea without any sweetener was associated with a lower risk for depression , adding artificial sweeteners , but not sugar or honey , was associated with higher risks . Frequent consumption of sweetened beverages , especially diet drinks , may increase depression risk among older adults , whereas coffee consumption may lower the risk A case-control study of diet and bladder cancer was conducted during 1979 - 1982 in Edmonton , Calgary , Toronto , and Kingston , Canada . A total of 826 histologically verified cancer cases were individually matched by age , sex , and area of residence to 792 r and omly selected population controls . Subjects were interviewed concerning their histories of exposure to a number of dietary factors , including table-top artificial sweeteners , low calorie foods and drinks , beverages containing caffeine or ethanol , and certain other food items . Also , subjects provided information on their past medical , occupational , and residential histories , in addition to their exposures to tobacco and other life-style factors . For the analysis , conditional logistic regression methods were used . Under adjustment for cumulative lifetime amount of cigarette smoking , the dietary factors , with little exception , were not associated with significant alteration of risk for bladder cancer . In particular , ever regular use of artificial sweeteners did not appear to be associated with increased risk , either among men ( odds ratio = 0.95 , p = 0.70 ) or among women ( odds ratio = 1.15 , p = 0.53 ) . However , daily intake of cholesterol , calculated from reported frequencies of consumption of nine relevant food items , suggested a mild increase in risk ; the odds ratio estimate of trend was 1.07/100 mg average daily intake ( i.e. , 1.07(5.5 ) = 1.45 for 550 mg cholesterol per day , as might be consumed in one egg ; p = 0.009 ) . A history of diabetes mellitus of onset after age 20 years also seemed to be associated with increased risk of bladder cancer ( odds ratio = 1.65 , p = 0.019 ) , but this increase did not appear to be the result of use of insulin or other medications , or use of artificial sweeteners or low calorie foods . Thus , this study tends to confirm reports of a lack of association between use of artificial sweeteners and subsequent risk of bladder cancer Objective : Initial efficacy of a magazine-based discussion group for improving  physical activity ( PA ) , self-worth , and eating behaviors in female college freshmen . Design : R and omized control trial . Setting : A large university in southwestern United States . Participants : Thirty-seven female college freshmen were r and omized to the intervention ( n = 17 ) and control groups ( n = 20 ) in September 2013 . Intervention : Participants completed an 8-week magazine-based discussion group program , Fit Minded College Edition , adapted from Fit Minded , a previously tested theory-based intervention . Education on PA , self-worth , and nutrition was provided using excerpts from women 's health magazines . Participants also had access to a Web site with supplementary health and wellness material . The control group did not attend meetings or have access to the Web site but received the magazines . Interventions focusing on concepts of self-worth with less focus on weight and appearance may promote long term PA participation and healthy eating behaviors in college women . Main Outcome Measures : Self-reported PA , global self-worth , knowledge self-worth , self-efficacy , social support , eating behaviors ( ie , fruit/veggie/junk food/sugar-sweetened beverage consumption ) , satisfaction , and Web site usage . Results : Mean age of participants was 18.11 ( SD = 0.32 ) years . Time × Intervention effects were observed for PA minutes per week ( Partial & eegr;2 = 0.34 ) , knowledge self-worth ( Partial & eegr;2 = 0.02 ) , and daily sugar-sweetened beverage consumption ( Partial & eegr;2 = 0.17 ) ( P < .05 ) , with the intervention group reporting greater increases in PA and knowledge self-worth and greater decreases in sugar-sweetened beverage consumption . Conclusions : A magazine-based discussion group may provide a promising platform to improve health behaviors in female college freshmen
In healthy subjects , appetite and short term food intake , risk of cancer , risk of diabetes , risk of dental caries , weight gain and risk of obesity are the most investigated health outcomes .
Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes .
In subjects with diabetes and hypertension , the evidence regarding health outcomes of NNS use is also inconsistent .
Background Food products containing non-nutritive sweeteners ( NNSs ) instead of sugar have become increasingly popular in the last decades .
Their appeal is obviously related to their calorie-free sweet taste .
However , with the dramatic increase in their consumption , it is reasonable and timely to evaluate their potential health benefits and , more importantly , potential adverse effects .
The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent , range , and nature of research activity in this area .