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      Association between household socioeconomic level and consumption of fast food and soft drinks: a cross-sectional assessment of the Young Lives cohort in Peru Translated title: Asociación entre el nivel socioeconómico de la vivienda y el consumo de comida rápida y bebidas azucaradas: análisis transversal de la cohorte Niños del Milenio en Perú

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          ABSTRACT Introduction The consumption of fast food and soft drinks is a risk factor for developing overweight and obesity. This study aimed at assessing if there is association between household socioeconomic level and the consumption of fast food and soft drinks among children. Material and Methods A cross-sectional assessment of the data from the third round (2009-2010) of the youngest cohort of the Young Lives study in Peru was conducted. Sampling was conducted in three stages: in the first one, the country was divided into equal geographical regions, excluding the 5% of the richest district; in the second stage, 20 sentinel sites were chosen and an area within each sentinel site was selected. Finally, in the third stage, eligible children were selected. Outcomes were the self-reported consumption of fast food and soft drinks (never, sometimes, and always), whereas the exposure was household socioeconomic status (in quintiles). Crude and adjusted models were created between variables of interest using Poisson regression models, with robust variance, to report prevalence ratios (PR) and 95% confidence intervals (95% CI). Results Data of 1901 children, of which 942 (49.6%) were girls, with a mean age of 7.5 (SD: 0.5) was analyzed. A total of 24.1% (95%CI: 22.2%-26.1%) reported always consuming fast food, whilst this number was 22.4% (20.5%-24.3%) for soft drinks. Compared to the lowest socioeconomic quintile, those who were in higher socioeconomic status had more probability of consuming fast food and soft drinks (Chi-squared for trends <0.001). The highest socioeconomic quintile had a greater probability to always consume fast food (PR=1.42; 95%CI: 1.08-1.88) and soft drinks (PR=1.71; 95%CI: 1.24-2.37). Conclusions This study shows that there is a significant association between the household socioeconomic level and the consumption of soft drinks and fast food.

          Translated abstract

          RESUMEN Introducción El consumo de comida rápida y bebidas azucaradas es un factor de riesgo para el desarrollo de sobrepeso y obesidad. Este estudio evaluó si existe asociación entre el nivel socioeconómico de la vivienda y el consumo de comida rápida y bebidas azucaradas en niños. Material y Métodos Evaluación transversal de los datos de la tercera ronda (2009-2010) de la cohorte más joven del estudio Niños de Milenio en Perú. El muestreo fue realizado en tres fases: en la primera, el país fue dividido en regiones geográficas iguales excluyendo al 5% de los distritos con mejor nivel económico; mientras que en la segunda fase se escogieron 20 sitios de vigilancia y un área dentro de ellas. Finalmente, en la tercera fase, se escogieron a los niños elegibles. Las variables fueron el autorreporte del consumo de comida rápida y bebidas azucaradas (nunca, algunas veces y siempre), mientras que la exposición fue el nivel socioeconómico de la vivienda (dividido en quintiles). Se crearon modelos crudos y ajustados entre las variables de interés usando modelos de regresión de Poisson, con varianza robusta, para reportar razones de prevalencia (RP) y sus intervalos de confianza al 95% (IC 95%). Resultados Los datos de 1901 niños, de los cuales 942 (49,6%) fueron mujeres, con una media de edad de 7,5 (DE: 0,5), fueron analizados. Un total de 24,1% (IC95%: 22,2%-26,1%) reportó siempre consumir comida rápida, y de este número fue 22,4% (IC95%: 20,5%-24,3%) para bebidas azucaradas. Comparado con el nivel socioeconómico más bajo, aquellos niños en el nivel socioeconómico más alto tuvieron mayor probabilidad de consumir comida rápida y bebidas azucaradas (Chi cuadrado de tendencias <0,001). El más alto quintil socioeconómico tuvo mayor probabilidad de consumir comida rápida (RP=1,42; IC95%: 1,08-1,88) y bebidas azucaradas (RP=1,71; IC95%: 1,24-2,37). Conclusiones Este estudio muestra que existe una asociación significativa entre el nivel socioeconómico de la vivienda y el consumo de comida rápida y bebidas azucaradas en niños.

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          Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

          Summary Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.
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            Sugar consumption, metabolic disease and obesity: The state of the controversy.

            The impact of sugar consumption on health continues to be a controversial topic. The objective of this review is to discuss the evidence and lack of evidence that allows the controversy to continue, and why resolution of the controversy is important. There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly. The direct pathway involves the unregulated hepatic uptake and metabolism of fructose, leading to liver lipid accumulation, dyslipidemia, decreased insulin sensitivity and increased uric acid levels. The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars. Consumption of added sugar is associated with development and/or prevalence of fatty liver, dyslipidemia, insulin resistance, hyperuricemia, CVD and T2DM, often independent of body weight gain or total energy intake. There are diet intervention studies in which human subjects exhibited increased circulating lipids and decreased insulin sensitivity when consuming high sugar compared with control diets. Most recently, our group has reported that supplementing the ad libitum diets of young adults with beverages containing 0%, 10%, 17.5% or 25% of daily energy requirement (Ereq) as HFCS increased lipid/lipoprotein risk factors for CVD and uric acid in a dose-response manner. However, un-confounded studies conducted in healthy humans under a controlled, energy-balanced diet protocol that enables determination of the effects of sugar with diets that do not allow for body weight gain are lacking. Furthermore, recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS, and the conclusions from several meta-analyses suggest that fructose has no specific adverse effects relative to any other carbohydrate. Consumption of excess sugar may also promote the development of CVD and T2DM indirectly by causing increased body weight and fat gain, but this is also a topic of controversy. Mechanistically, it is plausible that fructose consumption causes increased energy intake and reduced energy expenditure due to its failure to stimulate leptin production. Functional magnetic resonance imaging (fMRI) of the brain demonstrates that the brain responds differently to fructose or fructose-containing sugars compared with glucose or aspartame. Some epidemiological studies show that sugar consumption is associated with body weight gain, and there are intervention studies in which consumption of ad libitum high-sugar diets promoted increased body weight gain compared with consumption of ad libitum low- sugar diets. However, there are no studies in which energy intake and weight gain were compared in subjects consuming high or low sugar, blinded, ad libitum diets formulated to ensure both groups consumed a comparable macronutrient distribution and the same amounts of fiber. There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain. It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed. Yet, filling these evidence gaps may be necessary for supporting the policy changes that will help to turn the food environment into one that does not promote the development of obesity and metabolic disease.
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              A systematic review of fast food access studies.

              The frequent consumption of energy-dense fast food is associated with increased body mass index. This systematic review aims to examine the methodology and current evidence on fast food access and its associations with outcomes. Six databases were searched using terms relating to fast food. Only peer-reviewed studies published in English during a 10-year period, with data collection and analysis regarding fast food access were included. Forty articles met the aforementioned criteria. Nearly half of the studies (n = 16) used their own set of features to define fast food. Studies predominantly examined the relationship between fast food access and socioeconomic factors (n = 21) and 76% indicated fast food restaurants were more prevalent in low-income areas compared with middle- to higher-income areas. Ten of 12 studies found fast food restaurants were more prevalent in areas with higher concentrations of ethnic minority groups in comparison with Caucasians. Six adult studies found higher body mass index was associated with living in areas with increased exposure to fast food; four studies, however, did not find associations. Further work is needed to understand if and how fast food access impacts dietary intake and health outcomes; and if fast food access has disparate socioeconomic, race/ethnicity and age associations. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.
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                Author and article information

                Journal
                renhyd
                Revista Española de Nutrición Humana y Dietética
                Rev Esp Nutr Hum Diet
                Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )
                2173-1292
                2174-5145
                March 2020
                : 24
                : 1
                : 68-77
                Affiliations
                [2] Lima Lima orgnameUniversidad Peruana Cayetano Heredia Peru
                [3] Lima Lima orgnameUniversidad Científica del Sur Peru
                [1] Lima Lima orgnameUniversidad Peruana de Ciencias Aplicadas Peru
                Article
                S2174-51452020000100008 S2174-5145(20)02400100008
                10.14306/renhyd.24.1.824
                1325e33a-b8a3-4bce-89cf-2b88e6d18fa6

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 02 July 2019
                : 27 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 36, Pages: 10
                Product

                SciELO Spain

                Categories
                Investigations

                Clase Social,Sugar-Sweetened Beverages,Fast Foods,Obesidad,Bebidas Azucaradas,Comida Rápida,Social Class,Obesity

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