Commercially available fruit snacks

 

While eating a piece of fresh fruit is undoubtedly the healthiest option, 80% of the U.S.  population does not consume the daily amount of fruit servings (five) recommended by federal dietary guidelines. So, one strategy for consumers to increase fruit in their diet is to choose nutrient-dense fruit snacks. 

 

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ALISSA NOLDEN IS AN ASSISTANT PROFESSOR OF FOOD SCIENCE AT UMASS AMHERST. 

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CREDIT: UMASS AMHERST

Next time you’re packing lunch for your kid or reaching for a healthy afternoon bite, consider this: only three types of fruit snacks – dried fruit, fruit puree and canned fruit with juice – meet the latest recommendations for high-nutrition snacks set by federal dietary guidelines, according to research by University of Massachusetts Amherst food scientists.

Of all the commercially available fruit snacks, defined by the USDA as “products made with fruit and fruit juices, which may or may not contain added sugar, artificial colors and flavors, and preservatives,” the UMass Amherst team found that dried fruit has the best overall nutritional profile – the highest nutrient density and fiber content, and the lowest added sugar. 

Conversely, fruit-flavored snacks such as gummies have the lowest nutrient density and fiber content and the highest amount of added sugar. Other fruit snack options with low nutrient density include canned fruit packed in something other than juice, and dried flavored fruit, both of which contain higher amounts of added sugar. The food comparison study, led by food scientists Amanda Kinchla, extension professor, and Alissa Nolden, assistant professor, was published recently in the journal Nutrients.

“It’s not fresh fruit but the snacking products that people are more customarily consuming,” Kinchla says. 

The researchers decided to investigate which fruit snacks are the most nutritious – the first time this type of study was undertaken. They collected and analyzed nutritional content for 1,497 fruit snacks, using the Mintel Global New Products Database, accessed through UMass Libraries. For their study, the team defined fruit snacks as “non-frozen, non-beverage food products mainly made with fruit ingredients.”

They used the Nutrient Rich Foods (NRF) Index, which calculates an overall nutrition quality score based on the nutrient profile of foods, to compare the healthfulness of fruit snacks. This model considers nutrients that are desirable – protein, dietary fiber, potassium, vitamin D, calcium, iron – as well as those that are recommended to be limited in the diet – saturated fat, cholesterol, added sugar and sodium – to assess the overall nutrient quality of each fruit snack.

“We were trying to connect the dots between all the nutrients, which is the advantage of the NRF – to be able to look at multiple nutrients at the same time,” Nolden says. 

The team classified the fruit snacks into nine different categories: dried fruit, fruit-based bar, dried flavored fruit, canned fruit, fruit-flavored snack, fruit puree, fruit chips, formed fruit and canned fruit with juice.

In addition, they looked not only at the nutritional value per serving size but also calculated added sugar and fiber content based on the FDA’s Reference Amount Customarily Consumed (RACC) per eating occasion to balance the serving variability among different fruit snack categories.

Their goal was to determine the healthfulness of fruit snacks and see where improvements could be made. 

“With Alissa’s consumer insight and understanding of perceptions and sensory analysis, we can try to understand consumers’ acceptance and limitations and then design foods that would better cater to that, so that we can then bolster health and wellness platforms,” Kinchla says.

The paper concludes, “Reformulation of fruit snacks is needed… Formed fruit and fruit-based bars could be lower in added sugar to become a more nutritious fruit snack option. Canned fruit [with added sugar] and fruit-flavored snacks need more reformulation, as they are low in nutrient density and fiber content and high in added sugar. Improving the nutritional quality of fruit snacks can facilitate smart snacking choices.

“Future direction for the fruit snack category should consider decreasing added sugar content, increasing fiber content and enhancing sensory profile to improve the overall nutrient density.”

Even low levels of leisure time physical activity help to lower stroke risk

Even people whose physical activity levels fall short of recommended guidelines, but who manage to do some during their leisure time, are likely to have a lower risk of stroke than their sedentary peers, suggests a pooled data analysis of the available evidence, published online in the Journal of Neurology Neurosurgery & Psychiatry.

 

The effects are independent of age and sex, the findings show, prompting the authors to suggest that everyone should be encouraged to do whatever level of physical activity they can manage in their leisure time.

There’s no doubt that moderate to high levels of leisure-time physical activity curb stroke risk. But it’s not clear if even modest amounts confer protection, and if any such effects depend on age and sex, explain the authors.

While international guidelines recommend 150 minutes or more a week of moderate intensity physical activity or 75 minutes or more of vigorous intensity activity to lower the risk of cardiovascular disease, including stroke, not many adults achieve this, say the researchers.

To find out if lower levels of physical activity might still confer protection, the authors trawled research databases for relevant studies. They pooled the results of 15, involving 752,050 adults whose health had been monitored for an average of 10.5 years. 

Each study assessed the potential impact of between 3—none, below target, and ideal—and 5—none, insufficient, low, moderate and intense— levels of leisure time physical activity on stroke risk.

The pooled data analysis of 5 studies assessing 3 levels of leisure time physical activity showed that, compared with no physical activity, the highest ‘ideal’ amount cut the risk of stroke by 29%, but that some ‘below target’ activity still reduced the risk by 18%.

Similar findings emerged for the pooled data analysis of the six studies reporting on 4, and the two reporting on 5 levels of leisure time physical activity. Compared with none, a moderate level of physical activity cut the risk of stroke by between 27% and 29%.

These effects were independent of sex and age, the analysis showed.

The authors acknowledge several limitations to their findings, chief among which were the variable definitions of different levels of activity used in the included studies and the reliance on subjectively assessed levels of physical activity.

Nevertheless, the authors conclude that recreational physical activity, even in small amounts could help ward off stroke in the long term.

“According to our results, all levels of [leisure time physical activity] can be beneficial for stroke prevention, including levels currently regarded as low or insufficient,” they write. “People should be encouraged to be physically active even at the lowest levels.”

Daily step count of 9,000 to 10,000 may counteract risk of death and cardiovascular disease in highly sedentary people

 In good news for office workers, a new study from the University of Sydney’s Charles Perkins Centre (Australia) has found increasing your step count may counteract the health consequences of too much sedentary time each day.

The study of over 72,000 people, published in the British Journal of Sports Medicine, found every additional step up to around 10,000 steps a day was linked to reduced risk of death (39 percent) and cardiovascular disease (21 percent) regardless of how much remaining time was spent sedentary.

Previous studies have shown an association between greater daily step count and lower levels of death and CVD, and separate studies have linked high levels of sedentary behaviour with increased risks of CVD and death. However, this is the first to objectively measure, via wrist-worn wearables, if daily steps could offset the health risks of high sedentary behaviour.

Lead author and research fellow, Dr Matthew Ahmadi said: “This is by no means a get out of jail card for people who are sedentary for excessive periods of time, however, it does hold an important public health message that all movement matters and that people can and should try to offset the health consequences of unavoidable sedentary time by upping their daily step count.”

Senior author Professor Emmanuel Stamatakis, Director of the Mackenzie Wearables Research Hub at the Charles Perkins Centre, said this growing body of physical activity research using device-based measurement provided huge opportunities for public health.

“Step count is a tangible and easily understood measure of physical activity that can help people in the community, and indeed health professionals, accurately monitor physical activity. We hope this evidence will inform the first generation of device-based physical activity and sedentary behaviour guidelines, which should include key recommendations on daily stepping,” said Professor Stamatakis.

How was the study conducted?

Researchers used data on 72,174 individuals (average age 61; 58% female) from the UK Biobank study - a major biomedical database - who had worn an accelerometer device on their wrist for seven days to measure their physical activity. The accelerometer data were used to estimate daily step count and time spent sedentary, that is sitting or lying down while awake.

The research team then followed the health trajectory of the participants by linking hospitalisation data and death records.

The median daily step count for participants was 6222 steps/day, and 2200 steps/day (the lowest 5 percent of daily steps among all participants) was taken as the comparator for assessing the impact on death and CVD events of increasing step count.

The median time spent sedentary was 10.6 hours/day, so study participants sedentary for 10.5 hours/day or more were considered to have high sedentary time while those who spent less than 10.5 hours/day sedentary were classified as low sedentary time.

Adjustments were made to eliminate biases, such as excluding participants with poor health, who were underweight or had a health event within two years of follow-up. Researchers also took into account factors such as age, sex, ethnicity, education, smoking status, alcohol consumption, diet and parental history of CVD and cancer.

What did they find?

Over an average 6.9 years follow up, 1633 deaths and 6190 CVD events occurred.

After taking account of other potential influences, the authors calculated that the optimal number of steps per day to counteract high sedentary time was between 9000 to 10000 steps/day, which lowered mortality risk by 39 percent and incident CVD risk by 21 percent.

In both cases, 50 percent of the benefit was achieved at between 4000 and 4500 steps a day.

Study limitations

This is an observational study so can’t establish direct cause and effect. And although the large sample size and long follow-up allowed the risk of bias to be reduced, the authors acknowledge the possibility that other unmeasured factors could affect results. As steps and sedentary time were obtained in a single time point, this could also lead to bias, they add.

Nevertheless, they conclude, “Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing between 9000 and 10,000 steps a day optimally lowered the risk of mortality and incident CVD among highly sedentary participants.”

Sweetened drinks linked to atrial fibrillation risk

Drinking sugar- or artificially sweetened beverages was associated with increased risk of irregular heart rhythms, finds a study in Circulation: Arrhythmia and ElectrophysiologyResearch Highlights:

• An analysis of health data in the UK Biobank found a 20% higher risk of irregular heart rhythm, known as atrial fibrillation, among people who said they drank two liters or more per week (about 67 ounces) of artificially sweetened drinks. The risk was 10% higher among people who said they drank similar amounts of sugar-sweetened beverages.
• Drinking one liter (about 34 ounces) or less of pure juice per week, such as 100% orange or vegetable juice, was associated with an 8% lower risk of atrial fibrillation.
• The observational study could not confirm that sweetened drinks cause  irregular heart rhythms.

Adults who reported drinking two liters (about 67 ounces) or more of sugar- or artificially sweetened drinks per week had a higher risk of an irregular heart rhythm known as atrial fibrillation compared with adults who drank fewer such beverages, according to new research published today in Circulation: Arrhythmia and Electrophysiology, a peer-reviewed journal of the American Heart Association.

The study also found that drinking one liter (about 34 ounces) or less per week of pure, unsweetened juice, such as orange or vegetable juice, was associated with a lower risk of atrial fibrillation (AFib). However, the study could not confirm whether the sweetened drinks caused AFib, yet the association remained after accounting for a person’s genetic susceptibility to the condition.

Consuming sweetened drinks has been linked to Type 2 diabetes and obesity in previous research. This large study of health data in the UK Biobank is among the first to assess a possible link between sugar- or artificially sweetened beverages and AFib. Atrial fibrillation is a condition in which the heart beats irregularly, increasing the risk of stroke by five-fold. More than 12 million people are expected to have AFib by 2030, according to the American Heart Association’s 2024 Heart Disease and Stroke Statistics.

“Our study's findings cannot definitively conclude that one beverage poses more health risk than another due to the complexity of our diets and because some people may drink more than one type of beverage,” said lead study author Ningjian Wang, M.D., Ph.D., a researcher at the Shanghai Ninth People's Hospital and Shanghai Jiao Tong University School of Medicine in Shanghai, China. “However, based on these findings, we recommend that people reduce or even avoid artificially sweetened and sugar-sweetened beverages whenever possible. Do not take it for granted that drinking low-sugar and low-calorie artificially sweetened beverages is healthy, it may pose potential health risks.”

Researchers reviewed data from dietary questionnaires and genetic data for more than 200,000 adults free of AFib at the time they enrolled in the UK Biobank, between 2006 and 2010. During the nearly 10-year follow-up period, there were 9,362 cases of AFib among the study participants.

The analysis found:

• Compared to people who did not consume any sweetened drinks, there was a 20% increased risk of atrial fibrillation among people who said they drank more than 2 liters per week (about 67 ounces or more, or roughly one 12-ounce drink 6 days a week) of artificially sweetened beverages; and a 10% increased risk among participants who reported drinking 2 liters per week or more of sugar-sweetened beverages.
• People who said they drank 1 liter (about 34 ounces) or less of pure fruit juice each week had an 8% lower risk of atrial fibrillation.
• Participants who consumed more artificially sweetened beverages were more likely to be female, younger, have a higher body mass index and a higher prevalence of Type 2 diabetes.
• Participants who consumed more sugar-sweetened beverages were more likely to be male, younger, have a higher body mass index, a higher prevalence of heart disease and lower socioeconomic status.
• Those who drank sugar-sweetened beverages and pure juice were more likely to have a higher intake of total sugar than those who drank artificially sweetened drinks.
• Smoking may have also affected risk, with smokers who drank more than two liters per week of sugar-sweetened beverages having a 31% higher risk of AFib, whereas no significant increase risk was noted for former smokers or people who never smoked.

“These novel findings on the relationships among atrial fibrillation risk and sugar- and artificially sweetened beverages and pure juice may prompt the development of new prevention strategies by considering decreasing sweetened drinks to help improve heart health,” Wang said.

Researchers also evaluated whether a genetic susceptibility to AFib was a factor in the association with sweetened beverages. The analysis found the AFib risk was high with the consumption of more than 2 liters of artificially sweetened drinks per week regardless of genetic susceptibility.

“Although the mechanisms linking sweetened beverages and atrial fibrillation risk are still unclear, there are several possible explanations, including insulin resistance and the body’s response to different sweeteners,” Wang said. “Artificial sweeteners in food and beverages mainly include sucralose, aspartame, saccharin and acesulfame.”

A 2018 science advisory from the American Heart Association noted that there is a scarcity of large, long-term, randomized trials on the efficacy and safety of artificial sweeteners. The writing group advised against prolonged consumption of low-calorie sweetened beverages by children; however, they noted artificially sweetened drinks may be a useful replacement strategy to reduce consumption of sugar-sweetened beverages among adults who habitually drink a high number of sugar-sweetened drinks.

American Heart Association nutrition committee member Penny M. Kris-Etherton, Ph.D., R.D., FAHA, said these findings on artificially sweetened beverages are surprising “given that two liters of artificially sweetened beverages a week is equivalent to about one 12-ounce diet soda a day.”

Kris-Etherton, an emeritus professor of nutritional sciences at Penn State University, was a co-author of the association’s science advisory on artificial sweeteners.

“This is the first study to report an association between no- and low-calorie sweeteners and also sugar-sweetened beverages and increased risk of atrial fibrillation,” she said. “While there is robust evidence about the adverse effects of sugar-sweetened beverages and cardiovascular disease risk, there is less evidence about adverse health consequences of artificial sweeteners.

“We still need more research on these beverages to confirm these findings and to fully understand all the health consequences on heart disease and other health conditions. In the meantime, water is the best choice, and, based on this study, no- and low-calorie sweetened beverages should be limited or avoided.”

The American Heart Association’s 2016 dietary guidelines align with the U.S.D.A.’s 2020-2025 Dietary Guidelines for Americans in suggesting sugar-sweetened beverage consumption be minimized; they also note there is unclear evidence of the role of no- and low-calorie sweeteners on many health outcomes. The American Heart Association recommends limited intake of sugar-sweetened beverages, such as such as soft drinks, fruit drinks, sports drinks, energy drinks, sweetened teas and coffee drinks. Healthy beverage options noted are water and fat-free or low-fat milk, while unsweetened fresh, frozen or packaged fruit juice is recommended instead of fruit juice with added sugar. A half cup of pure juice (such as orange juice or grapefruit juice) is recognized as one fruit serving.

Study background and details:

• The UK Biobank is a large, biomedical database with health records for about 500,000 adults — enrolled from 2006 until 2010 — who lived in the U.K. and received health care through the U.K.’s National Health Service.
• Data was reviewed for 201,856 participants of the U.K. Biobank, ranging in age from 37 to 73 years old, and 45% were male.
• Participants were followed for an average of nearly 10 years.
• Blood samples were collected to measure genetic risk for AFib, and participants answered more than one 24-hour questionnaire about their diet on five repeated occasions between April 2009 and June 2012.

The limitations of this study include that the findings were observational and cannot prove causation between consumption of certain types of beverages and AFib risk. In addition, the findings relied on participants to recall their own diets, so there may have been memory errors or bias. It is also unknown if the sugar- and artificially sweetened drinks contained caffeine.

Latest booster reduces adults’ risk of moderate or severe COVID by more than half

 The most recent COVID-19 booster shot reduces adults’ risk of moderate or severe COVID by more than half, according to a new nationwide data study from September 2023 through January 2024, a period of JN.1 variant dominance.

The new study is one of the first to evaluate protection provided by the updated shot against COVID-19-associated emergency department and urgent care visits (markers for moderate disease) and against hospitalizations (a marker for severe disease), in individuals 18 and older, due to JN.1, the most recently predominant strain of COVID.

“Halving your risk of needing to visit an E.D. or urgent care center or to be treated in the hospital for COVID is significant,” said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute vice president for data and analytics and a professor at Indiana University School of Medicine. “As an informatician I want to highlight that the data we analyzed came from different populations and geographic locations, adults of all ages and the most recent COVID strain. This analysis strongly supports the benefit of getting a booster shot and as a clinician, I encourage my patients to do so.”

“These are encouraging findings,” said study co-author Brian Dixon, PhD, MPA, interim director of Regenstrief Institute’s Clem McDonald Center for Biomedical Informatics and professor at Indiana University Richard M. Fairbanks School of Public Health. “These estimates of vaccine effectiveness are what we would expect for an annual booster designed for an endemic virus that continues to evolve. We looked at a longer time period than similar studies in Europe, and we found good performance. Yet we do need to be alert to the presumed waning of the updated booster’s effectiveness, which we have seen in earlier COVID-19 vaccines. Americans should expect the CDC to recommend future boosters, likely on an annual schedule.”

These findings of protection against moderate and severe disease provided by the booster in this large study are consistent with those of an earlier, small scale study of individuals seen for testing at a pharmacy. That study did not include hospitalized patients.

The authors of the new study, co-authored by Drs. Grannis and Dixon, concluded, “In this analysis of updated COVID-19 VE [vaccine effectiveness], receipt of an updated COVID-19 vaccine dose provided protection against COVID-19-associated ED/UC [emergency department/critical care] visits and hospitalizations among immunocompetent adults. CDC will continue monitoring VE of updated COVID-19 vaccines. All adults should stay up to date with recommended COVID-19 vaccines, including receiving a dose of updated vaccine.”

Refrigerate lettuce to reduce risk of E. coli contamination

 Leafy green vegetables are important sources of dietary fiber and nutrients, but they can harbor harmful pathogens. In particular, lettuce has often been involved in outbreaks of foodborne illness across the U.S. A new study from the University of Illinois Urbana-Champaign examines factors that affect E. coli contamination on five different leafy greens – romaine lettuce, green-leaf lettuce, spinach, kale, and collards. 

“We are seeing a lot of outbreaks on lettuce, but not so much on kale and other brassica vegetables. We wanted to learn more about the susceptibility of different leafy greens,” said lead author Mengyi Dong, now a postdoctoral research associate at Duke University. Dong conducted the research as a doctoral student in the Department of Food Science and Human Nutrition (FSHN), part of the College of Agricultural, Consumer and Environmental Sciences (ACES) at the U. of I.

The researchers infected whole leaves from each of the five vegetables with E. coli O157:H7 and observed what happened after storage at 4° C (39° F), 20° C (68° F), and 37° C (98.6° F). Overall, they found that susceptibility was determined by a combination of temperature and leaf surface properties such as roughness and the natural wax coating.

“At room temperature or higher, E. coli grows very fast on lettuce, but if lettuce is refrigerated at 4° C (39° F), we see a sharp decline in the E. coli population. However, for waxy greens like kale and collard, we get the opposite results. On these vegetables, E. coli grows slower under warmer temperatures, but if it is already present, it can survive longer under refrigeration.”

Even so, kale and collard are overall less susceptible to E. coli contamination than lettuce. Furthermore, these vegetables are usually cooked – which kills or inactivates E. coli – while lettuce is consumed raw. Rinsing lettuce does help, Dong said, but doesn’t remove all the bacteria because of their tight attachment to the leaf.  

The researchers also inoculated cut leaves with E. coli O157:H7 to compare the intact surface of a whole leaf to the damaged surface of a cut leaf.

“Whole leaves and freshly cut leaves present different situations. When the leaf is cut, it releases vegetable juice, which contains nutrients that stimulate bacterial growth,” Dong explained. However, the researchers found that spinach, kale, and collard juice actually exhibited antimicrobial properties that protect against E. coli.

To further explore these findings, they isolated juice (lysate) from kale and collards and applied the liquid to lettuce leaves, finding that it can be used as a natural antimicrobial agent. The potential applications could include antimicrobial spray or coating to control foodborne pathogen contaminations at both pre-harvest and post-harvest stages, the researchers said.

“We can’t completely avoid pathogens in food. Vegetables are grown in soil, not in a sterile environment, and they will be exposed to bacteria,” said co-author Pratik Banerjee, associate professor in FSHN and Illinois Extension specialist.

“It’s a complex problem to solve, but we can embrace best practices in the food industry and food supply chain. There's a lot of interest from the research community and federal agencies to address these issues, and the USDA imposes high standards for food production, so overall the U.S. food supply is quite safe.”

Banerjee and Dong emphasize they do not want to discourage people from eating fresh fruit and vegetables; they are part of a healthy diet. Just follow food safety guidelines, wash your lettuce thoroughly, store it in the refrigerator, and pay attention to any food safety recalls in your area, they conclude.

Loneliness increases the risk of health deterioration in older adults

The loneliness often experienced by older people in our society has a negative effect on their physical health, according to researchers from Amsterdam UMC and the University of Glasgow. Emiel Hoogendijk, epidemiologist at Amsterdam Public Health, analysed research results from more than 130 studies and found that loneliness led to an increase in physical frailty, which in turn increases the risk of adverse health outcomes such as depression, falls and cognitive decline. These results are published today in The Lancet Healthy Longevity.  

"Recently, and especially during the COVID-19 pandemic, there is more attention for the potential harmful effects of loneliness and social isolation on the health of older people. We wanted to see how far these effects went and saw that all kinds of reduced social functioning, such as loneliness, social isolation and lack of social support, were associated with physical decline in older adults," says Hoogendijk.  

Led by Peter Hanlon, clinical research fellow at the University of Glasgow, along with researchers from Amsterdam UMC, Canada, Australia and Sweden, researchers analysed the relationship between social functioning and physical frailty in older adults. "Frailty refers to a lot of different forms of physical deterioration, such as weight loss, reduced walking speed and decrease in muscle strength. These can all then have an effect on, for example, how likely you are to fall," says Hanlon.  

Previous research has already indicated that frailty can lead to a decrease in social contact, "In some cases, physical vulnerability can also cause people to lose social contacts or become lonelier, for example because they become less mobile," says Hoogendijk. This research shows that this relationship can also be reversed, with a decrease in social contact leading to frailty.  
 
Impaired social functioning can have harmful effects on health, with the US Surgeon General claiming last year that loneliness is just as harmful as smoking 15 cigarettes per day. "We know that people with feelings of loneliness or with a lack of social contacts have a higher risk of, amongst others, depression and various chronic diseases. For example, a lack of social contact can have a direct effect on the immune system, but it can also have an indirect effect on health, for example through an unhealthier lifestyle. We want to do more research into this in the coming period," says Hoogendijk. 

Impaired social and physical functioning often occur at the same time. "Older people who are physically vulnerable often also have to deal with a decline in both social and mental functioning. As we are caring for older adults, we need to pay attention to all of these aspects," says Hanlon. He concludes: "Loneliness, for example, is not an easy problem to solve. However, there is more and more knowledge available about possible effective interventions, including activities that support older people to increase their social connections."