A dietary pattern dominated by ultra-processed foods has been associated with non-communicable diseases in several studies. A previous study from 2013 found a high share of ultra-processed foods in Norwegian food sales. This study aimed to investigate the current share of ultra-processed foods in Norway and the development in expenditure on ultra-processed foods from 2013.

A repeated cross-sectional analysis of scanner data from the Consumer Price Index from September 2013 and 2019 and an investigation of the processing degree according to the NOVA classification system.

Food sales in Norway.

Norwegian grocery stores (n 180, for both time periods).

The share of expenditure in 2019 was highest for ultra-processed foods (46·5 %) and minimally or unprocessed foods (36·3 %), followed by processed foods (8·5 %) and processed culinary ingredients (1·3 %). An increasing degree of processing was found for several of the food groups between 2013 and 2019; however, most effect sizes were weak. In 2019, soft drinks became the most frequently purchased food item, surpassing milk and cheese, with the highest expenditure in Norwegian grocery stores. Increases in expenditure on ultra-processed foods were mainly due to increased expenditures on soft drinks, sweets and potato products.

A high share of expenditure on ultra-processed food was found in Norway, which may imply a high consumption of these foods. The change in expenditure of NOVA groups between 2013 and 2019 was small. Carbonated and non-carbonated soft drinks were the most frequently purchased products in Norwegian grocery stores and contributed to most of the expenditures.

Dietary guidelines on pure fruit juice differ between countries regarding the question whether pure fruit juice (without added sugars) is an acceptable substitute for fruit or should be avoided because of its comparable sugar content with that of sugar-sweetened beverages (SSB). We modelled whether substituting pure fruit juice for fruit or SSB was associated with cardiometabolic risk.

Prospective cohort study.

Based on a validated FFQ at baseline, we calculated the relative contribution of pure fruit juice to total consumption of fruit and pure fruit juice ( ${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{fruit}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$ ) and to total consumption of SSB and pure fruit juice ( ${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{SSBs}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$ ). In multivariate analyses (Cox regression), we assessed associations with incidence of type 2 diabetes, CVD, CHD and stroke after an average follow-up of 14·6 years.

About 35 000 participants from the EPIC-NL study, aged 20–70 years at enrolment.

Substitution of pure fruit juice for SSB was associated with lower risk of all endpoints. For type 2 diabetes and CHD, for example, drinking 75–100 % (as compared with 0–<25 %) of total SSB + pure fruit juice as pure fruit juice showed hazard ratio (95 % CI) of 0·74 (95 % CI 0·64, 0·85) and 0·85 (95 % CI 0·76, 0·96), respectively. Substitution of pure fruit juice for fruit was not associated with the risk of type 2 diabetes, CVD, CHD and stroke.

Substituting pure fruit juice for SSB was associated with lower cardiometabolic risk, whereas substituting pure fruit juice for fruit was not associated with cardiometabolic risk.

To evaluate the impact of changes in import tariffs on sweetened beverages.

Interrupted time series analysis was used to examine sweetened beverage tariff increases of 40–60 % in 2008 and to 75 % in 2012, and an approximately 11 % decrease in 2014 when an excise tax replaced the tariff. Post-tax trends were compared with a counterfactual modelled on the pre-tax trend for: quarterly price of an indicator beverage, monthly beverage import volumes (both 2001–2017) and quarterly sales volumes (2012–2017). In a controlled analysis, taxed beverage imports were compared with a sugary snacks control.

Cook Islands.

NA.

In the first year, after the 2008 tariff increase the price of the selected indicator soft drink increased by 7·3 % (95 % CI 6·3 %, 8·3 %) but after the 2012 tariff increase it decreased by 13·9 % (95 % CI –14·9 %, –12·8 %). At the same time, the import volumes of taxed beverages decreased by 13·2 % (95 % CI –38·1 %, 17·8 %) and 2·9 % (95 % CI –41·6 %, 72·5 %), respectively, and decreased by 24·8 % (95 % CI –36·9, –9·8) and 10·2 % (95 % CI –37·1, 37·5) in the controlled analysis. After the 2014 tax decrease, the price of the indicator soft drink decreased by 23·6 % (95 % CI –26·0 %, –21·1 %), sweetened beverage imports increased by 4·5 % (95 % CI –39·5 %, 156·0 %) and sales of full-sugar soft drinks increased by 31 % (95 % CI –21 %, 243 %).

The increased import tariffs on sweetened beverages appeared to be effective for reducing import volumes, but this was partly reversed by the reduced tax/tariff in 2014.

To compare the sugar content of items at four multinational fast-food chains, across three countries.

Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey–Kramer adjustments.

USA, Germany and Australia.

Burger King™ (Hungry Jack’s™), Kentucky Fried Chicken™, McDonald’s™ and Subway™.

Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories.

Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.

Carbonated beverage consumption is associated with various adverse health conditions such as obesity, type 2 diabetes and CVD. Pakistan has a high burden of these health conditions. At the same time, the carbonated beverage industry is rapidly growing in Pakistan. In this context, we analyse the trends and socioeconomic factors associated with carbonated beverage consumption in Pakistan.

We use six waves of the cross-sectional household surveys from 2005–2006 to 2015–2016 to analyse carbonated beverage consumption. We examine the trends in carbonated beverage consumption-prevalence for different economic groups categorised by per capita household consumption quintiles. We estimate the expenditure elasticity of carbonated beverages for these groups using a two-stage budgeting system framework. We also construct concentration curves of carbonated beverage expenditure share to analyse the burden of expenditure across households of different economic status.

Pakistan.

Nationally representative sample of households in respective survey waves.

We find that the wealthier the household, the higher is the prevalence of carbonated beverage consumption, and the prevalence has increased for all household groups over time. From the expenditure elasticity analysis, we observe that carbonated beverages are becoming an essential part of food consumption particularly for wealthier households. And, lastly, poorer households are bearing a larger share of carbonated beverage expenditure in 2014–2016 than that in 2006–2008.

Carbonated beverages are becoming an increasingly essential part of household food consumption in Pakistan. Concerns about added sugar intake can prompt consideration of public health approaches to reduce dietary causes of the disease burden in Pakistan.

To analyse trends in sweetened beverages consumption among adults in Brazil between 2007 and 2016.

A time-series analysis, with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). The prevalence of regular consumption (≥5 d/week), the average daily consumption (millilitres) and the prevalence of non-consumption of these beverages were analysed. The temporal variations of the indicators were calculated by linear regression. The analyses were performed for the complete set of the evaluated population and stratified by sociodemographic characteristics.

Brazilian capitals and Federal District.

Brazilian adults aged ≥18 years (n 519 641).

There was a reduction in both regular and average daily consumption of sugar- and artificially sweetened beverages (−1·28 percentage points (pp)/year, P=0·001 and −9·63 ml/year, P=0·001, respectively). The same result regarding regular consumption was found when only sugar-sweetened beverages were analysed (−1·11 pp/year, P=0·011). Similar trends were identified in the stratified analyses, with a greater magnitude of reduction among males, young adults, those with higher schooling and residents of more developed regions. Coincidentally, there was an increase in the prevalence of adults who did not consume sweetened beverages (1·54 pp/year, P=0·005).

The consumption of sweetened beverages decreased during the period. However, a significant portion of the population still referred a daily consumption of these beverages.

To examine the relationships between objectively measured sleep patterns (sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage (SSB) consumption (regular soft drinks, energy drinks, sports drinks and fruit juice) among children from all inhabited continents of the world.

Multinational, cross-sectional study.

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

Children (n 5873) 9–11 years of age.

Sleep duration was 12 min per night shorter in children who reported consuming regular soft drinks ‘at least once a day’ compared with those who reported consuming ‘never’ or ‘less than once a week’. Children were more likely to sleep the recommended 9–11 h/night if they reported lower regular soft drink consumption or higher sports drinks consumption. Children who reported consuming energy drinks ‘once a week or more’ reported a 25-min earlier bedtime than those who reported never consuming energy drinks. Children who reported consuming sports drinks ‘2–4 d a week or more’ also reported a 25-min earlier bedtime compared with those who reported never consuming sports drinks. The associations between sleep efficiency and SSB consumption were not significant. Similar associations between sleep patterns and SSB consumption were observed across all twelve study sites.

Shorter sleep duration was associated with higher intake of regular soft drinks, while earlier bedtimes were associated with lower intake of regular soft drinks and higher intake of energy drinks and sports drinks in this international study of children. Future work is needed to establish causality and to investigate underlying mechanisms.

To examine whether the association between soft drinks consumption and child behaviour problems differs by food security status and sleep patterns in young children.

Cross-sectional observational data from the Fragile Families and Child Wellbeing Study (FFCWS), which collected information on food insecurity, soft drinks consumption, sleep patterns and child behaviour problems. Bivariate and multivariate ordinary least-squares regression analyses predicting child behaviour problems and accounting for socio-economic factors and household characteristics were performed.

Twenty urban cities in the USA with a population of 200 000 or more.

Parental interviews of 2829 children who were about 5 years old.

Soft drinks consumption was associated with aggressive behaviours, withdrawn and attention problems for children aged 5 years. However, the association differed by food security status. The association was mostly statistically insignificant among food-secure children after accounting for socio-economic and demographic characteristics. On the other hand, soft drinks consumption was associated with behaviour problems for food-insecure children even after accounting for these factors. However, after accounting for child sleep patterns, the association between soft drinks consumption and child behaviour problems became statistically insignificant for food-insecure children.

The negative association between soft drinks consumption and child behaviour problems could be explained by sleep problems for food-insecure children. Since about 21 % of households with children are food insecure, targeted efforts to reduce food insecurity would help improve dietary (reduce soft drinks consumption) and health behaviours (improve sleep) and reduce child behaviour problems.

The prevalence of asthma is rising, presenting serious public health challenges. Recent data suggest that sugar-sweetened beverage (SSB) consumption plays a role in asthma aetiology. The purpose of the present study was to determine whether SSB consumption is linked to post-exercise airway narrowing (predictor of asthma development) across puberty.

Participants completed pulmonary function tests, physical activity and dietary habit questionnaires, and an exercise test to exhaustion.

Community in Manhattan, Kansas, USA.

We recruited ten boys and ten girls from an original cohort of forty participants tested in our laboratory approximately 5 years prior. Participants were aged 9·7 (sd 0·9) years at baseline and 14·7 (sd 0·9) years at follow-up.

Pre-puberty, boys consumed 6·8 (sd 4·8) servings/week and girls consumed 6·9 (sd 3·7) servings/week, while post-puberty boys consumed 11·5 (sd 5·3) servings/week and girls consumed 7·7 (sd 4·3) servings/week. Using Pearson correlation, SSB consumption was not significantly related to post-exercise airway narrowing at pre-puberty (r=−0·35, P=0·130). In linear regression analyses, SSB consumption was significantly related to post-exercise airway narrowing post-puberty before (standardized β=−0·60, P=0·005) but not after (standardized β=−0·33, P=0·211) adjustment for confounders. Change in SSB consumption from pre- to post-puberty was significantly associated with post-exercise airway narrowing post-puberty (r=−0·61, P=0·010) and change in post-exercise airway narrowing from pre- to post-puberty (r=−0·45, P=0·048) when assessed via Pearson correlations.

These findings suggest a possible link between SSB consumption and asthma development during maturation. Reduced SSB intake may be a possible public health avenue for blunting rising asthma prevalence.

To elucidate the association between the intake of soft drinks and periodontal disease (PD) among Taiwanese middle-aged adults.

The cross-sectional design was employed to assess a dose–response relationship between the intake of soft drinks and PD after controlling for relevant confounding factors, with adjusted odds ratios obtained from a multivariate logistic regression model.

Keelung Community-based Integrated Screening (KCIS) programme, Keelung, Taiwan.

Participants (n 10 213) aged 35–44 years who had undergone oral checks for PD between 2005 and 2009.

A dose–response relationship between the intake of soft drinks and elevated risk for PD defined by community periodontal index ≥3 (the current status of PD) was noted (P=0·02 by trend test). Compared with infrequent intake of soft drinks (≤2 times/week), the adjusted OR increased from 1·05 (95 % CI 0·92, 1·20) for the frequency of 3–4 times/week to 1·17 (95 % CI 1·03, 1·34) for the frequency of ≥5 times/week. A similar trend (P<0·01) was also observed for PD defined by loss of attachment ≥1 (representing the long-term cumulative gum damage due to PD).

A dose–response relationship between the intake frequency of soft drinks and PD was observed in Taiwanese middle-aged adults. Such evidence could be used in health promotion to support reductions in soft drink intake.

To assess the association between the consumption of sugar-sweetened carbonated beverages (SSCB) and obesity in children and adolescents from Navarra (Spain).

We used a matched case–control study design. The exposure, SSCB consumption (1 serving: 200 ml), was measured with a previously validated FFQ. Anthropometrical measures were taken using standardized protocols. The outcome, obesity, was defined as BMI above the age- and sex-specific 97th percentile according to the Spanish reference charts. In the analysis we used conditional logistic regression. Potential confounders were controlled using a multivariable model.

Subjects were recruited in the paediatric departments of the Universidad de Navarra Clinic and the Navarra Hospital Complex, and in three primary health centres of Navarra. Controls were recruited when attending for a routine medical examination or vaccination.

One hundred and seventy-four obese children and 174 individually sex- and age-matched controls, 52·87 % boys, with a mean age of 11·6 years. Exclusion criteria were dietary interventions, exposure to hormone treatment, development of secondary obesity due to endocrinopathy and serious intercurrent illness.

Independently of other factors, high consumption of SSCB (>4 servings/week) was significantly associated with obesity (OR = 3·46; 95 % CI 1·24, 9·62; P = 0·01). Besides, each additional daily serving of SSCB was associated with a 69 % relative increase in the risk of obesity (OR = 1·69; 95 % CI 1·04, 2·73; P = 0·03).

We found a strong and significant association between SSCB consumption and obesity risk. Our results suggest a monotonic dose–response linear shape for this association in children and adolescents (P for trend = 0·02).

To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka.

A cross-sectional study where the data were collected by means of a self-administered questionnaire.

Government, private and international schools in the Colombo district of Sri Lanka.

Adolescents aged 17 years attending sixty-five schools.

Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks.

The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.