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Trends in prevalence (95% CI) of daily consumers of diet soft drinks, by country and by Family Affluence Scale (FAS) category in European countries (↑ = increase in socioeconomic differences over time between the 20% most affluent vs. the 20% least affluent adolescents; interaction terms FAS × time: *P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001, multilevel logistic models adjusted for sex, age groups, survey years and FAS categories)
Source publication
Purpose
To assess country-level trends in the prevalence of daily consumption of sugary (2002–2018) and diet (2006–2018) soft drinks among European adolescents, overall and by family material affluence.
Methods
We used 2002, 2006, 2010, 2014 and 2018 data from the ‘Health Behaviour in School-aged Children’ survey. Nationally representative samples...
Citations
... 1990s [16][17][18][19], with some signs of a reduction in Europe [20,21]. In the United States, 48% of adults reported consuming at least one food or beverage containing LCSs in 2-d dietary assessments performed from 2007 to 2012 [22]. ...
Low-calorie sweeteners (LCSs) and LCS-containing beverages have been proposed as appropriate substitutes for caloric sugars in recent years. In this Perspective, we highlight the recent findings from observational and interventional studies, focusing on obesity, gut microbiome, and cardiometabolic health. We provide public health actors and health care professionals with an insightful overview of recent evidence to bridge the gap between research and practice.
... Several diet quality indices, like the Alternative Healthy Eating Index 2010 (AHEI-2010) [11] and the Dietary Approaches to Stop Hypertension (DASH) score [10], have been developed to quantify adherence to recommended dietary patterns. Studies have consistently shown that many adolescents follow a poor diet [12][13][14][15]. Adolescents' poor eating habits implicate present and future diet-related diseases [16][17][18][19]. ...
... Although lower diet quality among adolescents is known from several studies [12][13][14][15], implicating present and future diet-related diseases like micronutrient deficiencies, obesity, or diabetes [16][17][18][19], our results help to identify subgroups that are particularly in need of timely interventions and to shape interventions programs focusing on different dietary components and including education programs. Previous studies evaluated intervention programs focusing on micronutrient supplementation and nutrition education to prevent deficiencies or obesity among adolescents [68][69][70]. ...
(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.
... Its association with weight gain and obesity and the risk of dental caries has been clearly documented and underlined as particularly worrisome [1]. Despite declines in most high-income countries, levels of consumption remain too high overall [2]. Substitution to water consumption, and not to artificially sweetened beverages (also included in sweetened beverages (SB)), is a topical issue to decrease sugar-liking. ...
... In Belgium, SB consumption is particularly high in the general population including children [37], putting this country in the top five of the European countries with the highest prevalence of daily consumers [38]. After a decrease until the early 2000s, a plateau in daily consumption has been reported since [2]. In addition, social inequalities in SB consumption tend to increase in Trial registration ISRCTN Registry ISRCTN99843102. ...
Background
Effectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age).
Methods
Forty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child’s beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires.
Discussion
Multicomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024–2025.
Trial registration
ISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021
... It also makes it possible to look for their determinants within the individual and social realms of teenagers' lives, such as in the trend analysis of life satisfaction among European and North American adolescents completed by Cavallo et al. [32]. Other HBSC data analyses presented trends in subjective complaints, physical activity, eating behaviours, and the occurrence of risk behaviours [33][34][35][36][37]. Analyses of changes in the quality of life, as measured by Cantril's ladder and the prevalence of repeated psychological complaints, are the most thematically consistent with this publication [32,38]. ...
Introduction and objective:
Health-related quality of life (HRQL) should be used more extensively in monitoring the health of school-aged children. The presented study aimed to evaluate trends in KIDSCREEN-10 indices, considering mean scores and the level of social inequalities.
Material and methods:
3,937 children aged 13 participated in three Health Behavior in School-aged Children (HBSC) cross-sectional surveys conducted in Poland between 2010-2018. Subgroups were distinguished according to gender, health status, and three social factors (family affluence, neighbourhood social capital, and local deprivation).
Results:
The average KIDSCREEN-10 index value was equal to: 22.36±4.54; 25.41±6.75; and 24.74±6.53 in 2010, 2014, and 2018,respectively. However, in 2018 no deterioration was recorded in boys, in poorer families or in regions with high social capital. The improvement in HRQL in 2014 was accompanied by an increase in disparities in health status and family wealth, as well as a decrease in disparities in local deprivation. An especially high increase in Glass index values was recorded for neighbourhood social capital (increasing from 0.542 in 2010 to 0.938 in 2018). The multivariate general linear model revealed the main effect of the year of the study, gender, chronic disease status, and the three social factors, as well as six significant 2-way interactions.
Conclusions:
Changes in the well-being of adolescents should be tracked over time using HRQL indices with proven psychometric properties. The level of social inequalities faced by young people should be included in policies and when designing interventions. The relevant initiatives should be targeted at different populations in order to properly address the needs of different groups of children and adolescents.
... Adolescent consumption of SSBs and sodas has been on the decline since 2000-2010s in Western Europe [37]. Therefore, when comparing pretax and posttax soda consumption, having a comparison group, namely, a population with similar socioeconomic conditions and living in a near geographic zone but not exposed to the tax, is needed. ...
... Multiple reasons could explain this phenomenon, such as: 1) youth might be less sensitive to taxes than adults, as shown in 2 different US cities, where tax rates were above 20% [27,28], 2] adolescents, who are not the main household shoppers, do not habitually face a price rise, and 3) taxes have a limited health risk "signaling effect" on adolescents [50]. We expanded on these matters [21] and the possible reasons why there is an overall declining trend in soda consumption in Western Europe [37] in our previous studies. ...
Background:
The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear.
Objectives:
We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence.
Methods:
Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently.
Results:
Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (Pinteractions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (ORlower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (Pinteractions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (Pinteractions ≤ 0.08, increased inequalities).
Conclusions:
Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.
... Moreover, there is evidence that socio-economic status and parents' educational level are relevant factors in predicting children's overweight and obesity status, although they can have different and even opposite effects based on context (e.g., high-income countries vs. middle-income countries) [20]. Studies indicated that adolescents from low socio-economic status families show a higher prevalence of obesity and soft drink consumption [23][24][25][26]. Adolescents and children with lower-educated mothers were exposed to more fast-food outlets, although this did not affect Body Mass Index (BMI), according to a study from The Netherlands [27]. ...
... Socio-economic status was successfully associated with fruit and vegetable consumption, as well as breakfast consumption frequency: students from more affluent families were more likely to report healthy food intake. These results seem to reflect the social inequalities' patterns found in the literature, although no relation was found with ultra-processed foods [20,[23][24][25][26]. Parents' education level was positively associated with fruit and vegetable consumption and negatively associated with soft drink consumption, indicating a social inequality for students with lower-educated parents. ...
Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent’s education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.
... As young people spend a large part of the day at school, restricting physical access to SSBs in school premises (e.g., ban on vending machines, standards for healthy school meals) is, for instance, an effective measure to reduce SSB intake (48) . School food policies, nutrition education programs, and other population-based interventions, such as media campaigns and traffic-light-labelling, could have together partly contributed to the overall downward trend in SSB consumption observed in Europe since 2000-2010s (1,10,49) . ...
Objective
To examine changes in the proportions of daily, weekly, and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001/02 and 2017/18, and in neighbouring comparison countries (without a tax)
Design
Repeated cross-sectional surveys
Setting
Health Behaviour in School-aged Children study, spanning five survey years (school years 2001/02 to 2017/18)
Participants
Nationally-representative samples of 13y- and 15y-old adolescents (N=236,623, 51.0% girls)
Results
Tax sizes (€0.02/L to €0.22/L) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17.9 to 11.9%, P=0.01), Finland (4.2 to 2.5%, P=0.001), Belgium (35.1 to 27.8%, P<0.001), Portugal (17.4 to 14.9%, P=0.02), but not in Hungary (29.8 to 31.3%, P=0.47), or France (29.4 to 28.2%, P=0.27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (P interaction <0.001). Prevalence of weekly soda consumption remained stable (Finland, Hungary, France) or increased (Latvia, Belgium); only Portugal experienced a decline (P<0.001), which was larger than in the comparison country (P interaction <0.001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France, nor Belgium, or the rise was similar to the comparison country in Portugal (P interaction =0.15).
Conclusions
Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.
Artificial sweeteners are consumed by many adults and children living in geographically and ethnically diverse regions of the world. Their use is more frequent among women than men and among older and more highly-educated individuals. Reports of increased risk of bladder cancer when very high doses were administered to laboratory rats led to banning of saccharine and/or cyclamate from few countries, but large epidemiologic studies have not observed increased risks of bladder cancer in humans consuming foods and beverages containing these or other artificial sweeteners. Nor has evidence emerged of increased risks of other cancers, with the possible exception of liver cancer with aspartame. Conversely, artificial sweeteners have been shown in randomized trials to have short-term benefits on body weight, blood sugar levels, and blood pressure, especially in overweight and obese adults. Xylitol-sweetened gum and candies have also been convincingly shown to reduce the risk of dental plaque, a well-established precursor of caries (cavities). A population-wide shift from artificial sweeteners to sugar, a possible consequence of a recent review by the World Health Organization, seems likely to do more harm than good.
