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      Reduction of Sugar-Sweetened Beverage Consumption in Elementary School Students Using an Educational Curriculum of Beverage Sugar Content

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          Abstract

          Introduction: Given the known association between sugar-sweetened beverage (SSB) intake and poorer health, we instituted an educational curriculum to reduce student consumption of SSBs. Methods: The program included third- to fifth-grade students. A simple demonstration using teaspoons of sugar or small candies showed students the quantity of added sugar in common beverages. This amount of sugar was compared to the daily limit recommended by the American Heart Association. Key principles were reinforced over a 4-month period. Anonymous beverage recall surveys were distributed to 213 students at baseline and 211 students 6 months after exposure to the curriculum. Primary endpoints included evaluation of SSB, real fruit juice (RFJ), diet soda, and water servings in the last 24 hours. Results: The proportion of children consuming 2 or more beverages daily decreased from 8.9% to 4.3% ( P = .0546) for diet soda, from 70.0% to 58.3% ( P = .0123) for SSB + RFJ, and from 60.1% to 47.4% ( P = .0087) for SSB. At baseline, students reported an average consumption of 3.5 SSB, 4.5 SSB + RFJ, 0.4 diet soda, and 3.3 water servings per day. At 6 months after exposure, the average daily beverage consumption decreased to 2.7 servings per day for SSB ( P = .014), 3.8 for SSB + RFJ ( P = .039), and 0.2 for diet soda ( P = .027). Water consumption increased from 3.3 to 3.6 servings per day ( P = .075). Discussion: Our data suggest grade school students are receptive to information about the adverse effects of SSBs on health. Adding similar educational programs to elementary school curriculum may help reduce long-term SSB consumption.

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          Childhood weight affects adult morbidity and mortality.

          W Dietz (1998)
          Few studies have examined the long-term effects of childhood obesity on adult disease. Nonetheless, obesity present in childhood or adolescence seems to increase the likelihood of adult morbidity and mortality. In men who were obese during adolescence, all-cause mortality and mortality from cardiovascular disease and colon cancer were increased. In both men and women obese during adolescence, rates of cardiovascular disease and diabetes were increased. Among women but not men obese during adolescence, obesity has a variety of adverse psychosocial consequences. These include completion of fewer years of education, higher rates of poverty, and lower rates of marriage and household income. These effects seem related both to the persistence of obesity and to the effects of childhood or adolescent obesity on the quantity and location of body fat deposition. Approximately 50% of obese adolescents with a body mass index at or above the 95th percentile become obese adults. Furthermore, the risk factors for adult disease that are associated with obesity in children and adolescents persist into adulthood or increase in prevalence if weight gain occurs. Although both total body fat and regional fat deposition could account for the association of childhood or adolescent obesity with adult disease, no studies to date have examined cardiovascular risk factors and related them to visceral fat, controlled for total body fat.
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            Projected Impact of Mexico’s Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study

            Background Rates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico. Methods and Findings We used the Cardiovascular Disease Policy Model–Mexico, a state transition model of Mexican adults aged 35–94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation. We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400–218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $769 million–$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35–44 y). This study’s strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups. Conclusions Mexico’s high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico’s SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico’s SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.
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              Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study.

              Overweight in adolescence is considered an important predictor of long-term morbidity and mortality. The impact of adolescent overweight on adult overweight and related multiple cardiovascular risk factors was examined in a biracial (black-white) cohort (N = 783) who participated in two cross-sectional surveys as adolescents aged 13 to 17 years and as young adults aged 27 to 31 years. The cohort was categorized as adolescent-onset adult overweight (N = 110) or lean (N = 81) according to age-, race-, and sex-specific body mass index (BMI) greater than the 75th percentile or between the 25th and 50th percentiles on both surveys. The risk for overweight adolescents to remain overweight as young adults ranged from 52% in black males to 62% in black females. As young adults, the overweight cohort showed adverse levels of body fatness measures, systolic and diastolic blood pressure, lipoprotein cholesterol, insulin, and glucose as compared with the lean cohort (P 75th percentile) for the total cholesterol to high-density lipoprotein (HDL) cholesterol ratio, insulin level, and systolic blood pressure occurred only among the overweight cohort (P < .0001). Thus, excess weight in adolescence persists into young adulthood, and has a strong adverse impact on multiple cardiovascular risk factors, requiring primary prevention early in life.
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                Author and article information

                Journal
                Glob Pediatr Health
                Glob Pediatr Health
                GPH
                spgph
                Global Pediatric Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                2333-794X
                06 June 2017
                2017
                : 4
                : 2333794X17711778
                Affiliations
                [1 ]Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA
                [2 ]The University of Chicago Medical Center, Chicago, IL, USA
                Author notes
                [*]Timothy Sanborn, MD, Evanston Hospital, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201-1613, USA. Email: tsanborn@ 123456northshore.org
                Article
                10.1177_2333794X17711778
                10.1177/2333794X17711778
                5464517
                01d160b1-34fe-4fe4-a636-1986755229a3
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 August 2016
                : 23 February 2017
                : 28 March 2017
                Categories
                Childhood Obesity and Nutrition
                Custom metadata
                January-December 2017

                school age,early lifespan nutrition,obesity,overweight and comorbidities,effecting public policy change

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