evidenceupdate:medialiteracy&theeﬀectsof...

Evidence Update: Media Literacy & the Effects of Added Sugar and Salt in Children’s Diets

Mary Anne Smith, PhD, RD January 20th, 2015

Acknowledgements

Project Objec+ves

Using a semi-‐systemaLc approach,

identify,

critically appraise & summarize

the highest quality, most recent evidence.

Research QuesLons

1.  What is the effecLveness of media literacy programs targeted to children to protect them from the harms of unhealthy food and beverage adverLsing?

2.  What are the health effects of added sugars in children’s diets?

3.  What are the health effects of high salt in children’s diets?

QuesLon #1


2.  What are the health effects of added sugar in children’s diets?


Media Literacy Background

•  Food and beverage adverLsing can negaLvely affect children’s food preferences, choices, and intakes1-‐3

•  Canadian children view 3.7 food/beverage ads per hour of television watched4

Media Literacy Background

Media Literacy: ability to access, analyze, evaluate, and communicate messages in a

variety of forms5

Adver+sing Literacy

Media Literacy Methods

•  Databases searched: Trip, PubMed, CINAHL. Also Google scholar, Journal of Media Literacy EducaLon

•  Focuses: adverLsing of less healthy foods and beverages, ≤ 17 years, English, secondary research, prioriLzaLon of arLcles published since 2009

•  Reviewed: 5 secondary and 9 primary research arLcles

1.  The literature base suffers from unsubstan+ated assump+ons. Namely: •  ê adverLsing literacy = é suscepLbility to adverLsing6

•  Younger children = More suscepLble

•  Media literacy in an intervening variable between exposure and effects7

•  Media influence can be raLonally controlled7

•  Food and beverage adverLsing literacy is pregy much the same as other types of media literacy3

Media Literacy Results

Exposure Literacy Effects

Media Literacy Results 2.  Media literacy intervenLons are more successful at

improving media-‐literacy related outcomes than changing ahtudes or behaviours •  A counter-‐adverLsement for front-‐of-‐package promoLons helped children understand the adverLsement, but did not change children’s desire for the product8

•  An online adverLsing literacy game helped children interpret advergames as a form of adverLsing, but did not change brand ahtudes or purchase intension for the product9

Media Literacy Results 3.  Media literacy has been shown to be effecLve

across a wide variety of other contexts •  A systemaLc review and meta-‐analysis of 51 media literacy intervenLons found a posiLve and significant intervenLon effect (weighted mean effect = 0.37, 95%CI 0.27, 0.47)10

•  Smoking prevenLon11, 12; alcohol prevenLon13; eaLng disorder risk14

•  Again, intervenLons were more successful at improving media understanding than in changing behaviours

Media Literacy Conclusions

•  May help children understand adverLsing, but may not influence food preferences or purchasing decisions

•  “May not be a strong opLon for agenuaLng the effects of food adverLsing directed to children”3

QuesLon #2




Sugar Background

•  Sugar intake in Canadian children 9-‐18 years: (CCHS, 2.211)

•  ~25% of energy intake from natural and added sugars •  Sor drinks accounted for 14.3% of total sugar intake

•  Controversy over added sugar recommendaLons: •  DRIs: ≤ 25% of total energy intake • World Health Organiza+on, Heart and Stroke Founda+on of Canada: ≤ 10% of total energy intake

Sugar Methods •  Databases: Cochrane,

PubMed, CINAHL

•  Focuses: Human studies, ≤ 18 years, English, secondary research, prioriLzaLon of arLcles published since 2009

•  Reviewed: 15 secondary and 9 primary research arLcles

Hunger/SaLety Energy intake Hypoglycemia Cough/Cold

Obesity MalnutriLon Diabetes

Dental Caries Hypertension Dyslipidemia

HyperacLvity Learning CogniLon

AddicLon Substance Abuse

AuLsm Alzheimer's

Short-‐Term Long-‐Term

Physical

Mental

Good evidence that added sugars:

éEnergy intake16 ?é Obesity16, 18-‐25 ??? Diet Adequacy17 éDental Caries*26-‐27

≠HyperacLvity28 ≠Learning28 ≠CogniLon28


Physical

Mental

•  Evidence from secondary research

é = direct relaLonship ê = indirect relaLonship ??? = unclear relaLonship ≠ = no relaLonship

*RelaLonship mediated by several variables

≠ SaLety29

éUric Acid30, TG31 êHDL-‐C31

?é Systolic BP30, 31 ≠ LDL-‐C31, Diastolic BP30 éFasLng Insulin31

êInsulin SensiLvity31, 32


Physical

Mental

Some evidence that added sugars:

•  Evidence from primary research


No evidence that added sugars:

•  No research studies met the inclusion criteria

Hypoglycemia Cough/Cold

AddicLon Substance Abuse

AuLsm Alzheimer's


Physical

Mental

Sugar LimitaLons

•  Majority of the research in this area used cross-‐secLonal designs

•  Cannot be used to determine causality

•  Discrepancies in how ‘added sugars’ are defined

•  Difficult to isolate effect of a single nutrient source from other diet/lifestyle factors

Sugar Conclusions •  Higher-‐quality primary research needed to elucidate many of the relaLonships

•  Diets high in sugar can contribute to increased energy intake (and weight gain) and dental caries without proper oral care

•  No relaLonship between sugar intake and hyperacLvity in children

QuesLon #3




Salt Background

•  Salt intake in Canadian children 9-‐18 years: (CCHS, 2.233)

•  ~97% of boys and ~82% of girls exceed the tolerable upper limit for sodium

•  EsLmates do not include salt added during cooking or at the table

•  In adults, salt intake linked to: – Hypertension –  Cardiovascular disease –  Renal disease –  Kidney Stones –  Stomach Cancer

Salt Methods •  Databases: Cochrane,

PubMed, CINAHL, TRIP

•  Focuses: Human studies, ≤ 18 years, English, secondary research, prioriLzaLon of arLcles published since 2009

•  Reviewed: 5 secondary and 16 primary research dd arLcles

Muscle Cramps Dizziness Electrolyte Disturbances DehydraLon

Nausea VomiLng/Diarrhea Asthma Symptoms

High Blood Pressure Cardiovascular Disease

Kidney Damage Kidney Stones

Obesity Edema

Stomach Cancer Osteoporosis

Stress OvereaLng

Depression Anxiety

Alzheimer's


Physical

Mental

Good evidence that high salt diets:

éBlood Pressure34 ≠Asthma*35


Physical

Mental

•  Evidence from secondary research


*Mostly based on adult data

??? Asthma38, 39 éCalcium ExcreLon36 ≠ Bone Turnover36 ≠ Potassium ExcreLon37 ≠ HydraLon40-‐43 éSSB intake41-‐43

??? Blood Pressure44-‐49

éBMI50, 51 éBody Fat %50

éWaist Circumference51


Physical

Mental

Some evidence that high salt diets:

•  Evidence from primary research


No evidence that high salt diets:

•  No research studies met the inclusion criteria

Muscle Cramps Dizziness Nausea

VomiLng/Diarrhea

Cardiovascular Disease

Kidney Damage Kidney Stones

Edema Stomach Cancer Osteoporosis

Stress OvereaLng

Depression Anxiety

Alzheimer's


Physical

Mental

Salt LimitaLons •  Majority of the research in this area used cross-‐secLonal designs

•  Cannot be used to determine causality

•  Differences in how sodium is measured •  Dietary intake vs. urinary excreLon

•  As with sugar, difficult to isolate effect of a single nutrient source from other diet/lifestyle factors

Salt Conclusions •  More research is needed – parLcularly research that can determine causality

•  Diets high in salt likely contribute to increased blood pressure, and may negaLvely affect calcium retenLon, BMI, body fat %, and waist circumference

•  Likely no relaLonship between salt intake and hydraLon status or bone turnover in children

Take Home Messages

Media Literacy: 1.  Media literacy intervenLons (in any area) are

typically beger at educaLng rather than changing ahtudes or behaviours

2.  “May not be a strong opLon for agenuaLng the effects of food adverLsing directed to children”3

Take Home Messages

Added Sugars: 1.  Need higher quality research in children that

standardizes ‘sugar’ 2.  Sugar is not associated with hyperacLvity or

behaviour problems in children, but is associated with increased energy intake (possibly leading to weight gain) and dental caries when oral care is inadequate

Take Home Messages

Salt: 1.  Need research that can determine causality and

more research in children 2.  Salt is not associated with hydraLon status, but

may be associated with blood pressure, sugar-‐sweetened beverage intake, weight status, and calcium excreLon

QuesLons?

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