A touch of sugar : a multimedia case study to facilitate student dietitians learning about the clinical management of diabetes

This paper describes the development, implementation and evaluation of a multimedia case study on dietetic case management of diabetes. A multimedia web-based program was developed to use the interactive capacity of the web-based environment to enable student dietitians to develop the skills of clinical reasoning and to trigger their learning about the nutritional management of diabetes. A case study of a person with diabetes was developed using a simulated medical history, video clips and sound clips. The students were asked to manage the patient online by responding to the patient's questions, attending a team meeting and outpatient clinic, attending to food service tasks and responding to visual cues. Tutors were able to access the student's responses to submissions online. Evaluation of the program was by questionnaire, which gathered quantitative and qualitative data on the student's perceptions of their experiences in using the web-based case. The students rated the content and the interactive parts of the case highly but experienced technical difficulties and found the case took too much time to complete.

The 'caffeine-sweetness' effect; potential reduction of energy in caffeinated sugar-sweetened soft drinks

Background – Excessive consumption of sugar sweetened beverages (SSB) is a contributing factor in the occurrence of overweight and obesity. The high energy intake, low satiation, high glycemic index, and intense marketing are all thought to contribute to their over consumption. In addition, the role of the mildly-addictive chemical caffeine in SSB has been questioned (Griffiths and Vernotica, 2000, Keast and Riddell, 2007). We have previously shown that low concentrations of caffeine may decrease sweetness of sugars and thereby result in excess energy in SSB formulations (Ebbeling et al., 2006).
Objective – Without noticeably affecting flavour, to determine potential energy reduction when decreasing sucrose concentration from caffeinated and de-caffeinated SSB.
Design – Human psychophysical taste evaluations in water, sucrose and model SSB. Triangle forced-choice ascending method of limits was used to determine caffeine taste threshold in water and sucrose (n= 62). Directional paired comparison tests to determine 1/ the influence of caffeine on sweetness of sucrose (n= 23), and 2/ the nonperceivable difference when decreasing the sucrose and caffeine concentrations in a model SSB (n= 30).
Outcomes – Caffeine, at sub-threshold concentrations in common SSB (0.67mM) can be perceived in sucrose solutions because it significantly inhibits sweetness (p<0.001), the ‘caffeine sweetness effect’. Presumably coremoval of caffeine and sucrose could be achieved without affecting the sweetness of the SSB. Removing caffeine from the model SSB allowed an energy reduction of 137.4 KJ per 500 ml serving (12.6% sucrose reduction) without noticeably affecting flavour for 80% of the population. The energy reduction possible without co-removal of caffeine was a more modest 32 KJ per 500 ml serving (3.5% sucrose reduction).
Conclusion – Sub-threshold concentrations of caffeine suppress sweetness resulting in higher concentrations of sugars in SSB. Excessive consumption of SSB is linked to the obesity epidemic, and we suggest the removal of caffeine and subsequent removal of 137.4 KJ energy will have long term public health benefits.

The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children

Objective: To model the health benefits and cost-effectiveness of banning television (TV) advertisements in Australia for energy-dense, nutrient-poor food and beverages during children's peak viewing times.

Methods: Benefits were modelled as changes in body mass index (BMI) and disability-adjusted life years (DALYs) saved. Intervention costs (AUD$) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions. Changes in BMI were assumed to be maintained through to adulthood. The comparator was current practice, the reference year was 2001, and the discount rate for costs and benefits was 3%. The impact of the withdrawal of non-core food and beverage advertisements on children's actual food consumption was drawn from the best available evidence (a randomized controlled trial of advertisement exposure and food consumption). Supporting evidence was found in ecological relationships between TV advertising and childhood obesity, and from the effects of marketing bans on other products. A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of 'strength of evidence', 'equity', 'acceptability to stakeholders', 'feasibility of implementation', 'sustainability' and 'side-effects'.

Results: The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 (95% uncertainty interval (UI) $2.40, $7.70) per DALY. Total DALYs saved were 37 000 (95% UI 16 000, 59 000). When the present value of potential savings in future health-care costs was considered (AUD$ 300m (95% UI $130m, $480m), the intervention was 'dominant', because it resulted in both a health gain and a cost offset compared with current practice.

Conclusions: Although recognizing the limitations of the available evidence, restricting TV food advertising to children would be one of the most cost-effective population-based interventions available to governments today. Despite its economic credentials from a public health perspective, the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government.

Fiji’s sugar, tourism and garment industries : a survey of performance, problems and potentials

Sugar, tourism and garment industries are three of Fiji’s major industries. These industries have been undergoing some serious problems during the past decade. This paper analyses the performance of these industries, examines the problems besieging them, and looks at the potentials these industries have for the country. The paper also offers some suggestions which policy makers in Fiji could consider in order to ensure that these industries continue to benefit Fiji.

The relationship between Fiji Sugar Corporation's profitability and sugarcane production: an empirical assessment

The Fiji Government's inability to resolve the differences over land leases is widely seen as a major contributor to the difficulties experienced by the sugar industry. In this paper, however, a different perspective is provided on the industry's problems. In examining the relationship between the profitability of the Fiji Sugar Corporation and sugarcane production, it is found that profitability has had a statistically significant negative effect on sugarcane production, leading to the conclusion that the Fiji Sugar Corporation has been inefficient in the management of the mills, the rail transport system, and sugarcane research.

Sweet preferences and sugar consumption of 4- and 5-year-old children : role of parents

We investigated the relationships in children between rules that restrict consumption of mono- and disaccharides (MDS), consumption of MDS and preferences for sucrose-containing orangeade. The background ideas of restriction rules we also investigated. To this end, 44 children (5.1 ^ 0.5 years) performed a rank-order and paired-comparison test of preference for five orangeades, which differed in sucrose concentration (0.14, 0.20, 0.29, 0.42, 0.61 M sucrose). Parents filled out a questionnaire concerning restriction rules and their children’s consumption of MDS-containing foods. Stronger restriction rules were related to a lower consumption of beverages that contained MDS and to a lower consumption of MDS-containing foods during breakfast and lunch. The most freedom to choose foods that contain MDS was given during the afternoon. Fifty-five percent of the children who were highly restricted showed a preference for the highest concentration of sucrose in orangeade. None of these children preferred the orangeade with the lowest concentration of sucrose. While 19% of the children who were little restricted preferred the beverage with the lowest concentration of sucrose, 33% preferred the beverage with the highest concentration. These parents generally believed that sugar has a bad effect on health and had similar background ideas concerning restriction
rules.

Sugar

An intercultural dance project in the port cities of Marseilles and Liverpool. Commissioned by the Liverpool Culture Company, Sugar is a ground-breaking collaboration between dance, rap and graffiti artists from Liverpool and Marseilles merging their talents to create an urban story of contemporary street life. Sugar's unique dance fusion uses break-dance, contemporary dance and hip hop where echoes of the slave trade reverberate with every beat.

Reduction in sugar-sweetened beverages is not associated with more water or diet drinks

Objective The Dutch Obesity Intervention in Teenagers (DOiT) is a school-based randomised controlled trial that was effective in decreasing the consumption of sugar-sweetened beverages among adolescents. The present study examined, using mediation analysis, whether this decrease in consumption of sugar-sweetened beverages could be explained by an increase in the consumption of water or diet drinks.

Design Participants completed a questionnaire about their beverage consumption at baseline and at 8 months (immediately post-intervention), 12- and 20-month follow-ups. A series of multi-level linear regression analyses were performed to examine water and diet drink consumption as potential mediators of the intervention effect on the consumption of sugar-sweetened beverages.

Setting Eighteen Dutch secondary schools.

Subjects A total of 747 adolescents (mean age: 12·7 years).

Results In addition to the DoiT intervention effect of a reduction in the consumption of sugar-sweetened beverages at 8 months (−284 ml/d; 95 % CI −420, −148) and 12 months (−260 ml/d; 95 % CI −360, −160), there was also a significant reduction in diet drinks at 8 months (−52 ml/d; 95 % CI −89, −16). There was no significant difference in water consumption at any follow-up. The decrease in sugar-sweetened beverage consumption could not be explained by an increase in water or diet drink consumption at any time point.

Conclusions Interventions aimed at reducing sugar-sweetened beverage consumption may be effective without changing consumption of other beverages. Reducing sugar-sweetened beverages was, however, a main message of the DOiT intervention. It is possible that a concomitant promotion of water may have resulted in a greater increase in water intake and replacement of sugar-sweetened beverages with water.