Excessive intake of sugar-sweetened beverages like soft drinks and fruit juices that offer no nutritional value other than calories to the diet of teenagers can elevate their risk of heart disease in later life, claims a new study. According to health experts, there is growing evidence of the link between excess sugar consumption among youngsters and a number of health conditions such as obesity, hypertension, elevated triglycerides that are considered markers for heart disease. Lead author of the study, Jean Welsh, post-doctoral fellow at Emory University School of Medicine in Atlanta stated, “We need to be aware of sugar consumption. “It’s a significant contributor of calories to our diet and there are these associations that may prove to be very negative. “Sugar-sweetened soft drinks and sodas are the major contributor of added sugar and are a major source of calories without other important nutrients. “Parents and adolescents need to become aware of the amount of added sugar they are consuming and be aware that there may be some negative health implications if not now, then down the line.”
According to the American Heart Association (AHA) recommendations, a teenager who requires 2,200 calories may have an upper limit of 150 calories from added sugar while someone with an energy requirement of 1,800 calories per day should limit added sugar to 100 calories. However, the National Health and Nutrition Survey (NHANES) of 2,157 teenagers aged 12 to 18 years found that the average teenager consumes close to 500 calories added sugars each day. “Adolescents are eating 20 per cent of their daily calories in sugars that provide few if any other nutrients,” said Jean Welsh.
In order to get an insight into the impact of high sugar consumption in adolescence on the risk of cardiovascular disease in later life the researchers studied 646 teenagers. For the purpose of the study, they analyzed the 24-hour dietary recall by teens with data from the US Department of Agriculture on sugar content in foods. It was noted that the teens’ average daily consumption of added sugars was three to five times higher that the limit acceptable by the AHA.
The study found, that teens who consumed 30 percent or more of total calories from added sugars exhibited lower levels of HDL, or “good” cholesterol and higher levels of triglycerides and LDL or “bad” cholesterol, compared to those who ate less than 10 percent of added sugar. In addition, it was observed that obese and overweight teenagers who consumed more sugar also had the most insulin resistance.
Although the study hints at a possible association between added sugar intake and poor cholesterol profiles as well as other heart disease risk factors, researchers feel there is need for more research to substantiate the findings. Welsh stated, “We need controlled studies to really understand the role of added sugars in cardiovascular disease. But it is important to be aware of the added sugar in the foods we all eat.”
The study is published in the American Heart Association (AHA) journal ‘Circulation.’
Teens whose diets include lots of sugary drinks and foods show physical signs that they are at increased risk for heart disease as adults, researchers from Emory University report. Among 2,157 teens who took part in the National Health and Nutrition Examination Survey, the average amount of added sugar eaten in a day was 119 grams (476 calories), which was 21.4 percent of all the calories these teens consumed daily, the researchers noted. “We need to be aware of sugar consumption,” said lead researcher and postdoctoral fellow Jean Welsh. “It's a significant contributor of calories to our diet and there are these associations that may prove to be very negative,” she said. “Sugar-sweetened soft drinks and sodas are the major contributor of added sugar and are a major source of calories without other important nutrients.” Awareness of the negative effects of added sugar may help people, particularly teens, cut down on the amount of sugar they consume, Welsh added. “Parents and adolescents need to become aware of the amount of added sugar they are consuming and be aware that there may be some negative health implications if not now, then down the line,” she said.
The report is published in the Jan. 10 online edition of Circulation.
Welsh's team found that teens who consumed the most added sugar had 9 percent higher LDL (“bad”) cholesterol levels, and 10 percent higher triglyceride levels (another type of blood fat), compared with those who consumed the least added sugar. Teens who took in the highest amount of added sugar also had lower levels of HDL (“good”) cholesterol than those who consumed the least amount of added sugar. In addition, teens who consumed the highest amount of added sugar showed signs of insulin resistance, which can lead to diabetes and its associated risk of heart disease, the researchers found.
The American Heart Association has recommended an upper limit for added sugars intake, based on the number of calories you need. “Most American women [teens included] should consume no more than 100 calories of added sugars per day; most men, no more than 150 calories,” the association states.
One caveat to these findings is that because of the way the study was done it is not clear if added sugars caused the differing cholesterol levels, only that they are linked. In addition, the data are only for one day and may not reflect the teen's usual diet, the researchers noted. Commenting on the study, Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said that “this study does not prove that dietary sugar is a cardiac risk factor in this population, but it strongly suggests it.”
The paper has three important messages, he said. First, dietary sugar intake in a representative population of teenagers is nearly double the recommended level. Second, the higher the intake of sugar, the greater the signs of cardiac risk, including elevated LDL (“bad”) cholesterol and low HDL (“good”) cholesterol. Third, the apparent harms of excess sugar are greater in overweight than in lean adolescents.
“Sugar is by no means the sole dietary threat to the health of adolescents, or adults,” Katz said. “But we now have evidence it certainly counts among the important threats to both. Reducing sugar intake by adolescents, to prevent them becoming adults with diabetes or heart disease, is a legitimate priority in public health nutrition,” he said.
SOURCES: HealthDay; Jean Welsh, M.P.H., Ph.D., R.N., postdoctoral fellow, Emory University, Atlanta; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Jan. 10, 2011, Circulation, online
Primary school children who don't like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do, according to a study in the December issue of the Journal of Clinical Nursing. Drinking less than 400ml of fluid a day also significantly increases the risk. Dr Moon Fai Chan, assistant professor at the National University of Singapore, teamed up with Yuk Ling Chan, from the Hong Kong Polytechnic University, to study the diet and toileting habits of 383 children aged from eight to ten from a school in Hong Kong. Fifty-one per cent were boys and children who were on regular medication or who paid regular hospital or clinic visits were excluded. Seventy per cent of the children who took part in the study were ten-years-old, 22 per cent were nine and eight per cent were eight.
“A number of studies have suggested that functional constipation – which is due to dietary habits, environmental habits and psychosocial factors rather than a particular health problem – is getting worse among school-age children” says Dr Moon Fai Chan from the Alice Lee Centre for Nursing Study at the University. “It is estimated that functional constipation accounts for 95 per cent of cases of constipation affecting children once they pass infancy. The condition has serious consequences, as it can cause a wide range of distressing emotional and physical problems such as stress, soiling, problems at school, damaged self-confidence and reduced social interaction.”
Key findings of the study included:
- Seven per cent of the children who took part suffered from functional constipation and there were clear dietary differences between the children who did and did not have problems.
- Girls were more likely to have functional constipation than boys (8.2 per cent versus 6.6 per cent) and nine-year-olds were more likely to report problems (13.3 per cent) than eight-year-olds (10 per cent) and ten-year-olds (5.2 per cent).
- Children who only drank 200ml to 400ml of fluid a day were eight times more likely to experience problems than children who drank 600ml to 800ml and 14 times more likely than children who drank a litre or more.
- Children who said they did not like fruit or vegetables were 13 times more likely to suffer from functional constipation than children who did.
- Nine out of ten children refused to use the school toilets for bowel movements and the figure was the same for children with and without constipation.
The biggest problems with school toilets were that children preferred to go at home. They also cited lack of toilet paper and dirty toilets. “When we compared our findings with previous studies we found that the levels of functional constipation among Hong Kong school children was higher than those in the USA and UK, but similar to Italy” says Dr Chan. The authors have made a number of recommendations that they feel would help to tackle the problem. They suggest that:
- Primary schools should work with healthcare professionals to make children more aware of the problem, with regular healthcare education sessions in classrooms and at assemblies.
- Parents need to be educated about functional constipation so that they can spot problems in their children and make sure that their diet provides sufficient fluid, vegetables and fruit. They should also remind their children to pay regular toilet visits at school.
- School tuck-shops should stock high-fibre snacks such as popcorn, fresh food and dried fruit, instead of crisps and sweets.
- Children should be encouraged to drink plain water during lessons and drinking fountains should be installed.
- School toilets should be more user-friendly, private and well stocked with paper so that children feel more comfortable using them.
“We hope that this study will help to raise awareness of functional constipation, which can cause children real physical and emotional distress and seriously affect their quality of life” says Dr Chan.
Source: Investigating factors associated with functional constipation of primary school children in Hong Kong. Chan MF and Chan YL. Journal of Clinical Nursing. 19, pp3390-3400. (December 2010). DOI: 10.1111/j.1365-2702.2010.03366.x
Even young children appear to be consuming more caffeine, so much so that caffeine could be contributing to sleep problems in primary school children, researchers found. Three-quarters of children ages 5 to 12 consumed caffeine on an average day in a survey of parents at routine clinic visits by William J. Warzak, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. The more caffeine children consumed, the fewer hours they slept on average (P=0.02), the researchers reported online in the Journal of Pediatrics, although not drawing a causal link. The average intake was two or three times higher than the 22- to 23-mg daily average reported nearly a decade ago, they noted.
Eight- to 12-year-olds in Warzak's study averaged 109 mg of caffeine — the equivalent of nearly three 12-oz cans of soda each day. But even the 52 mg of caffeine consumed by 5- to 7-year-olds on an typical day was well above the level known to have a physiologic effect on adults, the researchers noted. “There's really no role for caffeine in kids,” Marcie Schneider, MD, of the Albert Einstein College of Medicine in New York City, emphasized in commenting on the study. “We know that caffeine raises your blood pressure, raises your heart rate, and can be addictive.” Unlike older teens who are likely drinking coffee to wake up in the mornings for school, the assumption is that younger kids are getting most of their caffeine from soda, noted Schneider, who serves as a member of the American Academy of Pediatrics Committee on Nutrition.
She urged pediatricians to raise parents' awareness of the issue, perhaps as part of the yearly checkup. “We routinely ask kids what they're eating and drinking,” “It may be something that is worth pediatricians pointing out to parents that this kid does not need caffeine in their life partially because it does some things that are negative.”
Warzak's group surveyed parents of 228 children seen at an urban outpatient pediatric clinic during routine visits about the children's average daily consumption of drinks and snacks with an emphasis on caffeine-containing items. None of the children had a known sleep disorder or medical condition that might cause bedwetting. Illustrated depictions were provided to help parents accurately estimate serving sizes.
Nearly all of the caffeine intake was consumed through beverages. Few children got a meaningful amount of caffeine from food. “Caffeine's diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis,” the researchers noted. However, they found that intake didn't correlate with the number of nights a child wet the bed (P=0.49). Overall, enuresis was actually less likely in children who consumed caffeine.
The researchers cautioned that interpretation of these results may be complicated by cultural differences in reporting children's behavioral health concerns and that their study could not draw any causal conclusions. Schneider also noted the use of parental reports and the relatively small sample as limitations. Although the findings offered no support for removing caffeine from children's diets on the basis of bedwetting, Warzak's group concluded in the paper that “given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.”
Source: Warzak WJ, et al “Caffeine consumption in young children” J Pediatr 2011; DOI: 10.1016/j.jpeds.2010.11.022.
Bouhlal and co workers reported that salt had an impact on intake but fat did not. They found that in general food intake increased with salt level, noting that compared with the 'normal' salt levels, a suppression of salt induced a 25 per cent decrease in green bean intake, whereas an addition of salt induced a 15 per cent increase in pasta intake. Contrarily to initial beliefs, the researchers observed no increase in food intake with increasing added sugar level. They said the findings indicate that two to three year old children's food intake may not be affected by its added sugar content.
The study data also showed that preschool children with a higher BMI score consumed more pasta when fat level was higher. The authors said this finding may confirm previous results which highlight fatter children prefer high-fat foods. The researcher said their results imply that fat and sugar addition could be avoided in foods for children without having an impact on palatability, allowing the energy density of children's diet to be limited.
“Furthermore, these findings suggest that there is no need to add salt to pasta which is consumed anyway. On the contrary, salt suppression in vegetables, whose intake is to be promoted, should be considered cautiously,” they said.
Source: British Journal of Nutrition
Published online ahead of print, doi: 10.1017/S0007114510003752
“The impact of salt, fat and sugar levels on toddler food intake”
Authors: S. Bouhlal, S. Issanchou, S. Nicklaus
With his bulging biceps and vegetarian diet, Popeye is credited with urging millions of youngsters to eat spinach since the 1930s. But now the cartoon sailor man's impact on children's eating habits has been recognised by scientific research. Experts found that children who regularly watched Popeye scoffing spinach before his animated bouts with his arch-rival Bluto, doubled their vegetable intake. The youngsters, aged four and five, ate four portions of vegetables a day after watching the cartoon hero compared to two before the study.
Professor Chutima Sirikulchayanonta, who led the research at Mahidol University in Bangkok, said: “We got the children planting vegetable seeds, taking part in fruit and vegetable tasting parties, cooking vegetable soup, and watching Popeye cartoons.”
Researchers said that the experiment, which also encouraged children to plant their own vegetables, led to the 26 volunteers taking more interest in eating healthily.
Prof Sirikulchayanonta added that Popeye did not influence an increase in the children's fruit consumption, but that this was possibly because they already enjoyed plenty of fruit in their diet.
The findings of the study are published in journal Nutrition & Dietetics.
Research earlier this year found that sales of tinned spinach, like the kind eaten by Popeye, rose by 24 per cent last year to become one of Britain's fastest selling canned vegetables.
Popeye, who was created by Elzie Crisler Segar for the Thimble Theatre comic strip and first appeared on screen in 1933, is credited with helping save the US spinach industry in the 1930s.
His influence in boosting sales among children was recognised by the spinach-growing community in Crystal City, Texas, who erected a statue of the fictional sailor in 1937.
Popeye has not regularly been seen on British television since The Popeye Show – the most recent incarnation of the cartoon – ended its run in 2004. The cartoons are still aired in Asia.
Do foods sold with cartoon characters on the package taste better? In a Yale study, children preferred cartoon-endorsed foods to identical products in different packages.
Forty New Haven, Conn., four- to six-year olds participated in the study. They tried two samples of three different snack foods—graham crackers, fruit snacks, and carrots. Unbeknownst to the children, products within each group were identical foods in different packaging.
When asked which of each sample tasted better, more than half of the children chose the snacks in cartoon-endorsed packaging. This number jumped to about 85 percent when asked which snacks they preferred.
Christina Roberto, a post-graduate student at Yale University and lead author of the study, says this is no accident. Companies use cartoons to push kids to choose their products. Seems innocent enough, right? Wrong. One of the major concerns is when companies use characters to promote junk food rather than health food, which can lead to weight problems and poorer nutrition.
“The food industry spends $1.6 billion on youth-targeted marketing and, of that, 13 percent is dedicated to character licensing and cross-promoting,” Roberto said. “For the most part, these foods are of poor nutritional quality.”
The authors used survey data from Project EAT (Eating Among Teens), in which two groups of adolescents (1608 middle school and 3074 high school students) completed surveys in 1999 and 2004 regarding eating habits, parental styles, and various socioeconomic variables.
Cross-sectional results for adolescent girls indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For adolescent boys, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals five years later, but only between mothers and sons or between fathers and daughters.
The paper directly compared findings from two separate studies: 'The Diets of British Schoolchildren' conducted by the Department of health (DH) in 1983 (Department of Health 1989); and the National Diet and Nutrition Survey (NDNS) from 1997 (Gregory & Lowe, 2000).
Gibson's analysis found that total sugar intake averaged at 115g/day in 1983, compared with 113g/day in 1997. Allowing for exclusions of low and high energy reporters, intake levels were 122g/day (1983) and 127g/day (1997), showing a marginal and insignificant increase over the study period. Contrastingly, mean body weight increased significantly during the period of the DH and NDNS surveys, showing a rise of 1.9kg for 10-11 year olds and 3.4kg among 14-15 year olds. BMI increased from 17.9 to 18.6 units in the younger group, and 20.2 to 21.3 units in the older group. According to these calculations, the prevalence of being overweight (plus obesity), as defined by the International Obesity Taskforce (IOTF) cut-offs (91st percentile) rose from 13% to 21-22% between surveys. Gibson concluded that the slight increase in consumption of total sugars did not account for the significant increase in BMI, equivalent to 2-3 kg over the review period.
During the same period, Gibson found that mean energy intake (EI) was 3% lower in 1997 than in 1983, mainly as a result of lower fat intake. This change in overall energy consumption meant that sugars represented a higher proportion of daily energy intake in 1997 (23.6% versus 22.3%), despite total sugar consumption remaining relatively static in comparison. The review surmises that the most likely cause for the increased BMI is a decline in energy expenditure.
In addition, Gibson's paper found that basal metabolic rate (BMR) increased by approximately 3% between surveys as a result of higher body weights, and it is estimated that EI in relation to basal requirements was even lower at 6%. Gibson found that the paradox of rising BMI, despite a 2-3% rise in BMR and an EI that is static or falling, pointed to declining energy expenditure as an important factor in the change.
The Gibson analysis showed that the key sources of sugars in the diet have changed with a marked shift away from table sugar and smaller falls in consumption of sugars through milk, biscuits and cakes, counterbalanced by a significant increase in sugars consumed in soft drinks and, to a lesser extent, fruit juice and breakfast cereals.
A conclusion of Gibson's reanalysis of data from the DH and NDNS studies, that consumption of total sugars remained relatively static during the period, providing an estimated 22% of energy, is supported by findings from a repeated cross sectional study of children's food and drink intake, conducted in Northumberland in 1989, 1990 and 2000 which looked at trends in children's food and drink intake.
Sigrid Gibson, the paper's author, said: “There are very few studies that have assessed trends in sugar intake over time and particularly over such an extended period. The findings of the reanalysis strongly contradict widespread assumptions that sugar levels in the diet are responsible for rising obesity levels. With dietary sugar intakes relatively static, and overall energy consumption showing decline, increased BMI levels cannot be attributed to sugar consumption.”
Let’s look at some examples:
You eat 2 waffles for breakfast
- One serving from the Food Guide Pyramid is equal to 1 waffle.
- So that means if you ate 2 waffles, you also ate 2 servings from the grains group.
Here are some other common portions and their respective Food Guide Pyramid serving sizes:
|Common portions that people eat
||Food Guide Pyramid Serving Size
||Total servings per Food Guide Pyramid
||= 2 servings
|1 English Muffin
||½ English muffin
||= 2 servings
|1 Hamburger bun
||= 2 servings
|1 cup cooked rice
||½ cup cooked rice
||= 2 servings
|1 cups cooked pasta
||½ cup cooked pasta
||= 2 servings
In each food group, look at these different Food Guide Pyramid examples indicating 1 serving each. How do these compare with what your portions look like?
- 1 slice bread, waffle or pancake
- ½ bagel, hamburger bun, or English muffin
- ½ cup cooked rice, pasta or cereal
- 1 cup ready to eat cereal
- ¾ cup (6 fluid ounces) 100% vegetable juice
- 1 cup raw, leafy vegetables or salad
- ½ cup cooked or canned vegetables
- 1 medium apple, orange or banana
- ½ cup fruit (canned, cooked or raw)
- ½ cup (4 fluid ounces) 100% fruit juice
- ¼ cup dried fruit (raisins, apricots or prunes)
- 1 cup milk or yogurt
- 2 ounces processed cheese (American)
- 1 ½ ounces natural cheese (cheddar)
- Meat and Beans
- 1 tablespoons of peanut butter counts as 1 ounce
- ¼ cup nuts or 20-24 almonds
- 1 medium size egg
- 2-3 ounces of poultry, meat or fish (2-3 servings)
- ¼ cup of beans
Tips on how to visually estimate 1 serving size
|1 oz. bread or 1 slice of bread
|10 French fries
||Deck of cards
|½ cup cooked rice or pasta
|1 cup raw leafy vegetables
|½ cup vegetables
|1 medium fruit such as an apple or an orange
||Tennis ball or the size of your fist
|¾ cup juice
||6 ounce juice can (1 ½ servings)
|½ cup chopped or canned fruit
|Milk and Milk Products Group
|1 ounce cheese
||Pair of dice or the size of your thumb
|1 ½ ounces cheddar cheese
||2 (9-volt) batteries
|1 cup of milk
||8 ounce carton of milk
|8 ounces yogurt
||Baseball or tennis ball
|Meat & Beans Group
|3 ounces of meat, fish or poultry
||Deck of cards (3 servings)
|2 tablespoons of peanut butter
||Ping–pong ball (2 servings)
|½ cup cooked beans
||Baseball (2 servings)
Try these ideas to help control portions at home:
- When your child is hungry and looking for a snack take the amount of food that is equal to one serving (refer to the Nutrition Facts label) and have your child eat it off a plate instead of eating it out of the box or bag.
- Don’t be tempted to finish off leftover dinner the next day. Freeze leftovers as single servings so that you can pull it out of the freezer when you need a quick, healthy meal for your family.
- Be prepared and have emergency snacks on hand if your family is running late and needs a quick snack. Make your own snack bags for traveling by reading the Nutrition Facts label and placing a single serving size into plastic bags.
- Have your child measure out a single serving of food before sitting in front of the television or doing other activities that can distract him/her from realizing how much food is being consumed. This way your child will know exactly how much he or she is eating!
Serving sizes on food labels are sometimes different from the Food Guide Pyramid servings. For example, the serving size for beverages is measured in cups or fluid ounces. Whether it is milk, juice, or soda the nutrition facts labeling guidelines is 1 cup or 8 fluid ounces, which equals 1 serving size. However, the Food Guide Pyramid serving size for milk is 1 cup, but for juice it is ¾ cup.
So, even though the amount of 1 serving on nutrition facts labels and the Food Guide Pyramid may be slightly different it is still a great tool to help you and your child decide if you are getting enough or too much food each day. Encourage your child to get familiar with the serving sizes because smart eating is an essential part of growing and staying healthy!
Source: Nourish Interactive.