Obesity: Popkin BM

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00019. · Instituto Nacional de Salud Pública, Cuemrnavaca, Morelos, México. · Gac Med Mex. · Pubmed #19043956 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00004. · Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #18372998 links to  free full text

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Mattes RD, Popkin BM. · Department of Foods and Nutrition, Purdue University, West Lafayette, IN, USA. · Am J Clin Nutr. · Pubmed #19056571 links to  free full text

Abstract: Nonnutritive sweeteners (NNS) are ecologically novel chemosensory signaling compounds that influence ingestive processes and behavior. Only about 15% of the US population aged >2 y ingest NNS, but the incidence is increasing. These sweeteners have the potential to moderate sugar and energy intakes while maintaining diet palatability, but their use has increased in concert with BMI in the population. This association may be coincidental or causal, and either mode of directionality is plausible. A critical review of the literature suggests that the addition of NNS to non-energy-yielding products may heighten appetite, but this is not observed under the more common condition in which NNS is ingested in conjunction with other energy sources. Substitution of NNS for a nutritive sweetener generally elicits incomplete energy compensation, but evidence of long-term efficacy for weight management is not available. The addition of NNS to diets poses no benefit for weight loss or reduced weight gain without energy restriction. There are long-standing and recent concerns that inclusion of NNS in the diet promotes energy intake and contributes to obesity. Most of the purported mechanisms by which this occurs are not supported by the available evidence, although some warrant further consideration. Resolution of this important issue will require long-term randomized controlled trials.

Popkin BM. · Interdisciplinary Obesity Center, Department of Nutrition, School of Public Health, University of North Carolina, Carolina Population Center, 123 West Franklin Street, Chapel Hill, North Carolina 27516-3997, USA. · Nat Rev Cancer. · Pubmed #17186019 No free full text.

Abstract: As we look to understand future forces that will affect cancer risk, poor dietary patterns, overweight and obesity are significant concerns. In the past two decades these factors have shifted from issues that face higher-income countries to a global pandemic, and are rapidly becoming less a problem of affluence and more a problem of poverty. Rapid shifts in food systems, food pricing and marketing are the causes that underlie this trend. It is imperative to understand these factors and implement global interventions to slow this pandemic. The alternative is an acceleration of the incidence of the main nutrition-related cancers, primarily in developing countries.

Popkin BM, Kim S, Rusev ER, Du S, Zizza C. · Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. · Obes Rev. · Pubmed #16866975 No free full text.

Abstract: Most studies that have focused on the costs of obesity have ignored the direct effects of obesity-related patterns of diet and physical activity. This study reviews the full effects of each component--poor dietary and physical activity patterns and obesity--on morbidity, mortality and productivity. The direct healthcare costs are based on a review of the effects of these factors on key diseases and the related medical care costs of each disease. The indirect costs on reduced disability, mortality and sickness during the period of active labour force participation prior to retirement are also examined. A case study is prepared for China to provide some guidance in the utilization of this review for economic analysis of obesity. The case study shows that the indirect costs are often far more important than the direct medical care costs. The Chinese case study found that the indirect effects of obesity and obesity-related dietary and physical activity patterns range between 3.58% and 8.73% of gross national product (GNP) in 2000 and 2025 respectively.

Popkin BM, Duffey K, Gordon-Larsen P. · Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill 27516-3997, United States. · Physiol Behav. · Pubmed #16246381 No free full text.

Abstract: In this paper, the environment is defined as the macro- and community-level factors, including physical, legal and policy factors, that influence household and individual decisions. Thus, environment is conceived as the external context in which household and individual decisions are made. This paper reviews the literature on the ways the environment affects diet, physical activity, and obesity. Other key environmental factors discussed include economic, legal, and policy factors. Behind the major changes in diet and physical activity in the US and globally lie large shifts in food production, processing, and distribution systems as well as food shopping and eating options, resulting in the increase in availability of energy-dense foods. Similarly, the ways we move at home, work, leisure, and travel have shifted markedly, resulting in substantial reductions in energy expenditure. Many small area studies have linked environmental shifts with diet and activity changes. This paper begins with a review of environmental influences on diet and physical activity, and includes the discussion of two case studies on environmental influences on physical activity in a nationally representative sample of US adolescents. The case studies illustrate the important role of physical activity resources and the inequitable distribution of such activity-related facilities and resources, with high minority, low educated populations at strong disadvantage. Further, the research shows a significant association of such facilities with individual-level health behavior. The inequity in environmental supports for physical activity may underlie health disparities in the US population.

Popkin BM. · Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, NC 27516, USA. · Public Health Nutr. · Pubmed #16236207 No free full text.

Abstract: OBJECTIVE: To focus on factors that play a major role in our rapid, global nutritional changes. DESIGN: A range of studies are summarised: these show how an understanding of social, economic and technological change at the global, national and community levels affects diet, activity, and body composition patterns and trends. These studies are used to demonstrate the value of the key global, national, community, household and individual factors that should define the field of nutrition. SETTING: The focus is global. RESULT: Large shifts have occurred in diet and in physical activity patterns--particularly in the last one or two decades of the twentieth century. These changes are reflected in nutritional outcomes such as changes in average stature, body composition and morbidity. Understanding the rapidity of these changes and the underlying factors at the global, national and community levels is critical for creating a science of nutrition that can prevent disease and sustain the health and integrity of humans. CONCLUSION: The vision of the nutrition field is one where scholars who work on many levels will intersect; equal weight in the nutrition profession will be provided to all dimensions as they are welcomed into the field of nutrition--particularly those that will directly or indirectly affect dietary patterns, physical activity patterns, and energetics. This vision of the nutrition field is one where scholars from a range of disciplines and perspectives meet to work together with the goal being a focus on improving nutritional status and the human condition.

Popkin BM. · Carolina Population Center, University of North Carolina at Chapel Hill, 27516-3997, USA. · Forum Nutr. · Pubmed #15806892 No free full text.

This publication has no abstract.

Monteiro CA, Moura EC, Conde WL, Popkin BM. · Department of Nutrition, School of Public Health, and Center for Epidemiological Studies in Health and Nutrition, Avenue Dr. Arnaldo 715, São Paulo 01246-904, Brazil. · Bull World Health Organ. · Pubmed #15654409 links to  free full text

Abstract: A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004.

Bray GA, Paeratakul S, Popkin BM. · Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA. · Physiol Behav. · Pubmed #15621059 No free full text.

Abstract: The First Law of Thermodynamics provides a framework for understanding the imbalance between energy intake and expenditure that produces obesity, but it does not help understand the role of genetics, the regulation of food intake, the distribution of body fat, the mechanisms by which diets work or the mechanism by which portion control has gotten out of control. In animals, increasing dietary fat increases body fat, and it is unlikely that humans escape this important biological rule. In epidemiological studies, increasing dietary fat is associated with increased prevalence of obesity probably by increasing the intake of energy dense foods. In the National Weight Loss Registry, three things were associated with weight loss: continued monitoring of food intake, lowering dietary fat intake, and increased exercise. The relation of dietary fat is most evident when physical activity is low. The speed of adaptation to dietary fat is increased by exercise. When dietary fat is reduced, weight is lost, but weight loss eventually plateaus. The rate of weight loss during the initial phase is about 1.6 g/day for each 1% decrease in fat intake. When dietary fat is replaced with olestra to reduce fat intake from 33% to 25% in obese men, weight loss continues for about 9 months reaching a maximum of nearly 6% of body weight and a loss of 18% of initial body fat. In the control group with a 25% reduced-fat diet, weight loss stopped after 3 months and was regained over the next 6 months, indicating the difficulty of adhering to a conventional low-fat diet. Thus, dietary fat is an important contributor to obesity in some people.

Popkin BM, Gordon-Larsen P. · Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. · Int J Obes Relat Metab Disord. · Pubmed #15543214 No free full text.

Abstract: OBJECTIVE: This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. DESIGN: Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. SUBJECTS: Youth and adults from a range of countries around the world. MEASUREMENTS: The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. RESULTS: The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. CONCLUSION: The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.

Popkin BM. · Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. · Nutr Rev. · Pubmed #15387480 No free full text.

Abstract: This paper examines the speed of change in diet, activity, and obesity in the developing world, and notes potential exacerbating biological relationships that contribute to differences in the rates of change. The focus is on lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. These dietary, physical activity, and body composition changes are occurring at great speed and at earlier stages of these countries' economic and social development. There are some unique issues that relate to body composition and potential genetic factors that are also explored, including potential differences in body mass index (BMI)--disease relationships and added risks posed by high levels of poor fetal and infant growth patterns. In addition there is an important dynamic occurring--the shift in the burden of poor diets, inactivity and obesity from the rich to the poor. The developing world needs to give far greater emphasis to addressing the prevention of the adverse health consequences of this shift to the nutrition transition stage of the degenerative diseases.

Bray GA, Nielsen SJ, Popkin BM. · Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA. · Am J Clin Nutr. · Pubmed #15051594 links to  free full text

Abstract: Obesity is a major epidemic, but its causes are still unclear. In this article, we investigate the relation between the intake of high-fructose corn syrup (HFCS) and the development of obesity. We analyzed food consumption patterns by using US Department of Agriculture food consumption tables from 1967 to 2000. The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States. Our most conservative estimate of the consumption of HFCS indicates a daily average of 132 kcal for all Americans aged > or = 2 y, and the top 20% of consumers of caloric sweeteners ingest 316 kcal from HFCS/d. The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis. In addition, unlike glucose, fructose does not stimulate insulin secretion or enhance leptin production. Because insulin and leptin act as key afferent signals in the regulation of food intake and body weight, this suggests that dietary fructose may contribute to increased energy intake and weight gain. Furthermore, calorically sweetened beverages may enhance caloric overconsumption. Thus, the increase in consumption of HFCS has a temporal relation to the epidemic of obesity, and the overconsumption of HFCS in calorically sweetened beverages may play a role in the epidemic of obesity.

Zhai F, Fu D, Du S, Ge K, Chen C, Popkin BM. · Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing, People's Republic of China. · Public Health Nutr. · Pubmed #12027294 No free full text.

Abstract: OBJECTIVE: To review the nutrition policies and efforts related to nutrition transition in China. DESIGN AND SETTING: This paper reviews the nutrition policy and activities of China to prevent and control diet-related non-communicable diseases (DR-NCDs). Data came from the Ministry of Health, the Ministry of Agriculture, the State Council and some cross-sectional surveys. RESULTS: China is undergoing a remarkable, but undesirable, rapid transition towards a stage of the nutrition transition characterised by high rates of DR-NCDs in a very short time. Some public sector Chinese organisations have combined their efforts to create the initial stages of systematic attempts to reduce these problems. These efforts, which focus on both under- and overnutrition, include the new Dietary Guidelines for Chinese Residents and the Chinese Pagoda and The National Plan of Action for Nutrition in China, issued by the highest body of the government, the State Council. There are selected agricultural sector activities that are laudable and few other systematic efforts that are impacting behaviour yet. In the health sector, efforts related to reducing hypertension and diabetes are becoming more widespread, but there is limited work in the nutrition sector. This paper points to some unique strengths from past Chinese efforts and to an agenda for the next several decades. CONCLUSIONS: China is trying in its efforts to prevent and control the development of DR-NCDs but effects are limited. Systematic multi-sector co-operation is needed to effectively prevent and control DR-NCDs inside and outside the health sector.

Popkin BM, Horton S, Kim S, Mahal A, Shuigao J. · Department of Nutrition, University of North Carolina, Chapel Hill 27516-3997, USA. · Nutr Rev. · Pubmed #11766908 No free full text.

Abstract: Undernutrition is being rapidly reduced in India and China. In both countries the diet is shifting toward higher fat and lower carbohydrate content. Distinct features are high intakes of foods from animal sources and edible oils in China, and high intakes of dairy and added sugar in India. The proportion of overweight is increasing very rapidly in China among all adults; in India the shift is most pronounced among urban residents and high-income rural residents. Hypertension and stroke are relatively higher in China and adult-onset diabetes is relatively higher in India. Established economic techniques were used to measure and project the costs of undernutrition and diet-related noncommunicable diseases in 1995 and 2025. Current WHO mortality projections of diet-related noncommunicable diseases, dietary and body composition survey data, and national data sets of hospital costs for healthcare, are used for the economic analyses. In 1995, China's costs of undernutrition and costs of diet-related noncommunicable diseases were of similar magnitude, but there will be a rapid increase in the costs and prevalence of diet-related noncommunicable diseases by 2025. By contrast with China, India's costs of undernutrition will continue to decline, but undernutrition costs did surpass overnutrition diet-related noncommunicable disease costs in 1995. India's rapid increase in diet-related noncommunicable diseases and their costs projects similar economic costs of undernutrition and overnutrition by 2025.

Tudor-Locke C, Ainsworth BE, Popkin BM. · Prevention Research Center, Norman J. Arnold School of Public Health, University of South Carolina, Columbia 29206, USA. · Sports Med. · Pubmed #11347681 No free full text.

Abstract: The assessment and promotion of childrens' healthful physical activity is important: (i) to combat the international obesity epidemic that extends to childhood; and (ii) to establish an early habit of lifestyle physical activity that can be sustained into adolescence and adulthood. The primary focus of both assessment and promotion efforts has been on in-school physical education classes and, to a lesser extent, out-of-school structured exercise, sport and play. A potential source of continuous moderate activity, active commuting to school by means of walking or by bicycle, has been largely ignored in surveys of physical activity. Suggestive evidence of steep declines in the amount of childrens' destination walking can be gleaned from national transportation surveys. At the same time, there has been a dramatic increase in the reported use of motorised vehicles, including the use for chauffeuring children. There is very little evidence to support or refute active commuting to school as an important source of childrens' physical activity; however, this is largely because it has been overlooked in the stampede to assess time in more vigorous activities. The promotion of active commuting to school must be considered in the context of parents' real and perceived concerns for their children's personal and pedestrian safety. We certainly do not have a full understanding at this time of all the factors related to decisions about transportation mode, whether by child, parent, community, or school. Such information is necessary if successful and sustainable interventions can be implemented, important transport policy decisions can be made, and community and school designs can be modified. Practice rarely waits for research, however, and there are numerous examples of innovative programming, policies and environmental designs occurring internationally that can serve as natural experiments for enterprising researchers willing to push the envelope of our understanding of active commuting and childrens' physical activity. Since we know so little, there is much to learn.

Popkin BM. · Department of Nutrition and the Carolina Population Center, University of North Carolina at Chapel Hill, CB #8120 University Square, 123 West Franklin Street, Chapel Hill, NC 27516-3997, USA. · J Nutr. · Pubmed #11238777 links to  free full text

Abstract: Changes in diet and activity patterns are fueling the obesity epidemic. These rapid changes in the levels and composition of dietary and activity/inactivity patterns in transitional societies are related to a number of socioeconomic and demographic changes. Using data mainly from large nationally representative and nationwide surveys, such as the 1989, 1991, 1993 and 1997 China Health and Nutrition Surveys, in combination with comparative analysis across the regions of the world, we examine these factors. First, we show the shifts in diet and activity are consistent with the rapid changes in child and adult obesity and in some cases have been causally linked. We then provide a few examples of the rapid changes in the structure of diet and activity, in particular associated with increased income. Cross-country and in-depth analysis of the China study are used to explore these relationships. People living in urban areas consume diets distinctly different from those of their rural counterparts. One of the more profound effects is the accelerated change in the structure of diet, only partially explained by economic factors. A second is the emergence of a large proportion of families with both currently malnourished and overweight members as is shown by comparative analysis of a number of Asian and Latin American countries.

Kim S, Moon S, Popkin BM. · Department of Nutrition, University of North Carolina at Chapel Hill, and the Department of Food and Nutrition, Yonsei University, Seoul, South Korea. · Am J Clin Nutr. · Pubmed #10617945 links to  free full text

Abstract: BACKGROUND: An accelerating shift from infectious to noncommunicable diseases and concurrent shifts in diet, activity, and body composition are universal trends but are especially apparent in middle- and lower-income countries. A unique nutrition transition has occurred in South Korea, a country that modernized earlier than most Asian countries did. OBJECTIVE: The purpose of this analysis was to describe the South Korean nutrition transition, focusing on specific features that other countries might follow to retain the healthful elements of their traditional diets. DESIGN: We used secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). RESULTS: The structure of South Korea's economy, along with the country's dietary and disease patterns, began an accelerated shift in the 1970s. Major dietary changes included a large increase in the consumption of animal food products and a fall in total cereal intake. Uniquely, the amount and rate of increase in fat intake have remained low in South Korea. South Korea also has a relatively low prevalence of obesity compared with other Asian countries with similar or much lower incomes. CONCLUSIONS: The nutrition transition in South Korea is unique. National efforts to retain elements of the traditional diet are thought to have shaped this transition in South Korea in the midst of rapid economic growth and the introduction of Western culture.

Popkin BM. · Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, NC 27516-3997, USA. · Nutr Rev. · Pubmed #19453685 No free full text.

Abstract: As a result of the rapid shift in dietary and activity patterns, the world is facing a pandemic of obesity. This new global pandemic is rapidly becoming a problem of the poor. Extensive work has been undertaken to document the changes in weight and, to a much lesser extent, in diet, energy expenditures, and activity patterns. Broad-based creative public health actions are needed to offset these larger forces that promote energy imbalance, poor diets, and reduced physical activity. Inaction will result in an acceleration of morbidity, disability, and deaths from major nutrition-related noncommunicable diseases - primarily in developing countries.

Popkin BM. · University of North Carolina, Chapel Hill, NC, USA. · Nestle Nutr Workshop Ser Pediatr Program. · Pubmed #19346763 No free full text.

Abstract: The nutrition transition relates to broad patterns of diet, activity and body composition that have defined our nutritional status in various stages of history. The world is rapidly shifting from a dietary period in which the higher income countries were dominated by patterns of nutrition-related non-communicable diseases (NR-NCDs; while the lower and middle world were dominated by receding famine) to one in which the world is increasingly being dominated by NR-NCDs. Dietary changes appear to be shifting universally toward a diet dominated by higher intakes of caloric sweeteners, animal source foods, and edible oils. Activity patterns at work, leisure, travel, and in the home are equally shifting rapidly toward reduced energy expenditure. Large-scale declines in food prices (e.g., beef prices), increased access to supermarkets, and urbanization of urban and rural areas are key underlying factors.

Duffey KJ, Popkin BM. · Department of Nutrition, University of North Carolina, Chapel Hill, NC 27516, USA. · Am J Clin Nutr. · Pubmed #19064537 No free full text.

Abstract: BACKGROUND: Research on trends in consumption of added sugar and high-fructose corn syrup (HFCS) in the United States has largely focused on calorically sweetened beverages and ignored other sources. OBJECTIVE: We aimed to examine US consumption of added sugar and HFCS to determine long-term trends in availability and intake from beverages and foods. DESIGN: We used 2 estimation techniques and data from the Nationwide Food Consumption Surveys (1965 and 1977), Continuing Survey of Food Intake by Individuals (1989-1991), and the National Health and Nutrition Examination Surveys (1999-2000, 2001-2002, and 2003-2004) to examine trends in HFCS and added sugar both overall and within certain food and beverage groups. RESULTS: Availability and consumption of HFCS and added sugar increased over time until a slight decline between 2000 and 2004. By 2004, HFCS provided roughly 8% of total energy intake compared with total added sugar of 377 kcal x person(-1) x d(-1), accounting for 17% of total energy intake. Although food and beverage trends were similar, soft drinks and fruit drinks provided the most HFCS (158 and 40 kcal x person(-1) x d(-1) in 2004, respectively). Moreover, among the top 20% of individuals, 896 kcal x person(-1) x d(-1) of added sugar was consumed compared with 505 kcal x person(-1) x d(-1) of HFCS. Among consumers, sweetened tea and desserts also represented major contributors of calories from added sugar (>100 kcal x person(-1) x d(-1)). CONCLUSION: Although increased intake of calories from HFCS is important to examine, the health effect of overall trends in added caloric sweeteners should not be overlooked.

Gordon-Larsen P, Hou N, Sidney S, Sternfeld B, Lewis CE, Jacobs DR, Popkin BM. · Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. · Am J Clin Nutr. · Pubmed #19056560 No free full text.

Abstract: BACKGROUND: Although walking is the most popular leisure-time activity for adults, few long-term, longitudinal studies have examined the association between walking, an affordable and accessible form of physical activity, and weight gain. OBJECTIVE: The objective was to evaluate the association between changes in leisure-time walking and weight gain over a 15-y period. DESIGN: Prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study of 4,995 men and women aged 18-30 y at baseline (1985-1986) from 4 US cities and reexamined 2, 5, 7, 10, and 15 y later. Sex-stratified, repeated-measures, conditional regression modeling with data from all 6 examination periods (n = 23,633 observations) was used to examine associations between walking and annualized 15-y weight change, with control for 15-y nonwalking physical activity, baseline weight (and their interaction), marital status, education, smoking, calorie intake, and baseline age, race, and field center. RESULTS: Mean (+/- SE) baseline weights were 77.0 +/- 0.3 kg (men) and 66.2 +/- 0.3 kg (women), weight gain was approximately 1 kg/y, and the mean duration of walking at baseline was <15 min/d. After accounting for nonwalking physical activity, calorie intake, and other covariates, we found a substantial association between walking and annualized weight change; the greatest association was for those with a larger baseline weight. For example, for women at the 75th percentile of baseline weight, 0.5 h of walking/d was associated with 8 kg less weight gain over 15 y compared with women with no leisure time walking. CONCLUSION: Walking throughout adulthood may attenuate the long-term weight gain that occurs in most adults.

Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng SW, Rivera JA, Popkin BM. · Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico. · J Nutr. · Pubmed #19022972 No free full text.

Abstract: Little is understood about the patterns and trends in adolescent and adult beverage intake in Mexico or most other countries. Here, we used nationally representative dietary intake, income, and food expenditure surveys, which included 416 adolescents (aged 12-18 y) and 2180 adults (aged >or=19 y) from the 1999 Mexican Nutrition Survey and 7464 adolescents and 21,113 adults from the 2006 Mexican Health and Nutrition Survey. We measured the volume and energy per day contributed by all beverages consumed by the sample subjects. In 2006, Mexican adolescents and adults obtained 20.1 and 22.3%, respectively, of their energy intake from energy-containing beverages. Whole milk, carbonated and noncarbonated sugar-sweetened beverages, fruit juice with various sugar and water combinations added, and alcohol represented the 4 major categories of beverage intake. The trends from the dietary intake surveys showed very large increases in the intake of energy-containing beverages among adolescents and adults between 1999 and 2006. Income elasticities showed a high likelihood that intakes will increase as Mexican incomes continue to rise. Whereas the own-price elasticities for whole milk and sodas were both modest, intakes of these were increasing and higher than those for all other food groups. Energy intake trends and current levels of beverage intakes in Mexico are the highest recorded in a nationally representative survey and present major challenges for public health authorities.

Scharoun-Lee M, Kaufman JS, Popkin BM, Gordon-Larsen P. · Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. · J Epidemiol Community Health. · Pubmed #18977809 No free full text.

Abstract: BACKGROUND: Differences in the association of socioeconomic status (SES) with obesity may underlie the racial/ethnic disparities in obesity that increase dramatically across the transition to adulthood in the United States. The aim of this study was to examine racial/ethnic differences in the influence of life course SES on longitudinal obesity patterns from adolescence to adulthood. METHODS: Latent class analysis was used on a nationally representative, diverse sample of 12 940 adolescents followed into young adulthood (mean age = 21.7 years) to identify life course SES group profiles based on SES data in adolescence and young adulthood. Gender-stratified multinomial logistic regression models estimated the association of SES groups with obesity incidence and persistence versus staying non-obese. RESULTS: No significant interactions with race/ethnicity were observed, although racial/ethnic minorities had the highest obesity risk across SES groups. Racial/ethnic-pooled associations between disadvantaged SES exposure and higher obesity risk were strong but differed by gender. Males with a disadvantaged background who experienced early transitions into the labour force, marriage and residential independence had the highest risk of obesity incidence (relative risk ratio (RRR) = 1.64; 95% confidence interval (CI) 1.12 to 2.40), while females exposed to persistent adversity were at highest risk (RRR = 3.01, 95% CI 1.95 to 4.66). In general, SES group membership had a stronger relationship with obesity persistence than incidence. CONCLUSIONS: The relationship between SES and obesity patterns is similar across race/ethnicity and differs by gender during the transition to adulthood. However, stronger associations with obesity persistence and enduring racial/ethnic disparities in obesity risk across SES groups suggest that these social factors play a larger role in disparities earlier in the life course.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC. · Instituto Nacional de Salud Pública, Cuernavaca, Mor. · Rev Invest Clin. · Pubmed #18637573 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.