- Author: Rob Waters, Kaiser Health News
Saira Diaz uses her fingers to count the establishments selling fast food and sweets near the South Los Angeles home she shares with her parents and 13-year-old son. “There's one, two, three, four, five fast-food restaurants,” she says. “And a little mom and pop store that sells snacks and sodas and candy.”
In that low-income, predominantly Latino neighborhood, it's pretty hard for a kid to avoid sugar. Last year, doctors at St. John's Well Child and Family Center, a nonprofit community clinic seven blocks away, became alarmed by the rising weight of Diaz's son, Adrian Mejia. They persuaded him to join an intervention study run by the University of Southern California and Children's Hospital Los Angeles (CHLA) that weans participants off sugar in an effort to reduce the rate of obesity and diabetes among children.
It also targets a third condition fewer people have heard of: fatty liver disease.
Linked both to genetics and diets high in sugar and fat, “fatty liver disease is ripping through the Latino community like a silent tsunami and especially affecting children,” said Dr. Rohit Kohli, chief of gastroenterology, hepatology and nutrition at CHLA.
Recent research shows about 1 in 4 people in the U.S. have fatty liver disease. But among Latinos, especially of Mexican and Central American descent, the rate is significantly higher. One large study in Dallas foThe USC-CHLA study is led by Michael Goran, director of the Diabetes and Obesity Program at CHLA, who last year made an alarming discovery: Sugar from sweetened beverages can be passed in breast milk from mothers to their babies, potentially predisposing infants to obesity and fatty livers.
Called HEROES, for Healthy Eating Through Reduction of Excess Sugar, his program is designed to help children like Adrian, who used to drink four or more sugary drinks a day, shed unhealthy habits that can lead to fatty liver and other diseases.
Fatty liver disease is gaining more attention in the medical community as lawmakers ratchet up pressure to discourage the consumption of sugar-laden drinks. Legislators in Sacramento are mulling proposals to impose a statewide soda tax, put warning labels on sugary drinks and bar beverage companies from offering discount coupons on sweetened drinks.
“I support sugar taxes and warning labels as a way to discourage consumption, but I don't think that alone will do the trick,” Goran said. “We also need public health strategies that limit marketing of sugary beverages, snacks and cereals to infants and children.”
William Dermody, a spokesman for the American Beverage Association said: “We understand that we have a role to play in helping Americans manage consumption of added sugars, which is why we are creating more drinks with less or no sugar.”
In 2016, 45 deaths in Los Angeles County were attributed to fatty liver disease. But that's a “gross underestimate,” because by the time people with the illness die, they often have cirrhosis, and that's what appears on the death certificate, said Dr. Paul Simon, chief science officer at the L.A. County Department of Public Health.
Still, Simon said, it was striking that 53% of the 2016 deaths attributed to fatty liver disease were among Latinos — nearly double their proportion of total deaths in the county.
Medical researchers consider fatty liver disease a manifestation of something called metabolic syndrome — a cluster of conditions that include excess belly fat and elevated blood pressure, blood sugar and cholesterol that can increase the risk of heart disease, stroke and diabetes.
Until 2006, few doctors knew that children could get fatty liver disease. That year Dr. Jeffrey Schwimmer, a professor of pediatrics at the University of California-San Diego, reviewed the autopsies of 742 children and teenagers, ages 2 to 19, who had died in car crashes or from other causes, and he found that 13% of them had fatty liver disease. Among obese kids, 38% had fatty livers.
After Schwimmer's study was released, Goran began using MRIs to diagnose fatty liver in living children.
A 2008 study by another group of researchers nudged Goran further. It showed that a variant of a gene called PNPLA3 significantly increased the risk of the disease. About half of Latinos have one copy of that high-risk gene, and a quarter have two copies, according to Goran.
He began a new study, which showed that among children as young as 8, those who had two copies of the risky gene and consumed high amounts of sugar had three times as much fat in their livers as kids with no copy of the gene. Now, in the USC-CHLA study, he is testing whether reduced consumption of sugar decreases the fatty liver risk in children who have the PNPLA3 gene variant.
At the start of the study, he tests kids to see if they have the PNPLA3 gene, uses an MRI to measure their liver fat and catalogs their sugar intake. A dietitian on his team educates the family about the impact of sugar. Then, after four months, they measure liver fat again to assess the impact of the intervention. Goran expects to have results from the study in about a year.
More recently, Goran has been investigating the transmission of sugar from mothers to their babies. He showed last year that in nursing mothers who drank beverages sweetened with high-fructose corn syrup — the primary sweetener in standard formulations of Coca-Cola, Pepsi and other sodas — the fructose level in their breast milk rose and stayed elevated for several hours, ensuring that the baby ingested it.
This early exposure to sugar could be contributing to obesity, diabetes and fatty livers, based on previous research that showed fructose can enhance the fat storage capacity of cells, Goran said.
In neighborhoods like South Los Angeles, where Saira Diaz and Adrian Mejia live, a lack of full-service markets and fresh produce makes it harder to eat healthily. “Access to unhealthy food options — which are usually cheaper — is very high in this city,” Derek Steele, director of health equity programs at the Social Justice Learning Institute in Inglewood, Calif., told Kaiser Health News.
The institute has started farmers markets, helped convert two corner stores into markets with healthier food options and created 109 community gardens on public and private lands in South L.A. and neighboring Inglewood, which has 125 liquor and convenience stores and 150 fast-food outlets.
At Torrance Memorial Medical Center, 10 miles down the road, Dr. Karl Fukunaga, a gastroenterologist with Digestive Care Consultants, said he and his colleagues are seeing so many patients with fatty liver disease that they plan to start a clinic to address it. He urges his patients to avoid sugar and cut down on carbohydrates.
Adrian Mejia and his mother received similar advice from a dietitian in the HEROES program. Adrian gave up sugary beverages, and his liver fat dropped 43%. Two months ago, he joined a soccer league.
“Before, I weighed a lot and it was hard to run,” he said. “If I kept going at the pace I was going, probably later in my life I would be like my [diabetic] grandma. I don't want that to happen.”
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
Source: Published originally on USAToday.com, Fatty liver disease strikes Latino children like a ‘silent tsunami', by Rob Waters, Kaiser Health News, April 19th , 2019.
- Author: ABCNews.com
They say their report confirms what public health experts have suspected for years — that advertisers of junk foods find a lucrative audience among minorities.
And the researchers who wrote the report say it helps explain why black and Hispanic kids are more likely to be obese than their white peers.
The report finds that African-American children and teens see 70 percent more food-related TV advertising than white kids do. They also see twice as many TV ads for candy, sugary drinks, and snacks, according to the team at the Rudd Center for Food Policy & Obesity at the University of Connecticut, the African-American Collaborative Obesity Research Network and the University of Texas Health Science Center at San Antonio.
Study after study shows that Americans — and people in most other countries, too — are getting fatter.
And blacks and Hispanics are far more likely than whites or Asians to be overweight.
While it's hard to demonstrate that advertising directly causes people to eat too much unhealthy food, the way companies advertise certainly reflects and reinforces preferences, the research team said.
"Previous research has shown that black and Hispanic youth receive a 'double dose' of food marketing that promotes products high in sugar, saturated fat, and sodium," they wrote.
"Compared to white non-Hispanic youth, they are exposed to more food advertising in the media, as well as more marketing messages in their communities."
The team did an in-depth analysis, looking at 26 restaurant, food, and beverage companies, including all companies with $100 million or more in advertising spending in 2013. They also examined the companies taking part in the voluntary Children's Food and Beverage Advertising Initiative industry self-regulatory program.
"Systematic searches of marketing trade press and reports, companies' annual reports, and press releases from 2012 to 2014 identified statements about their targeted marketing practices," the report reads.
"To identify brands with TV advertising targeted to black and Hispanic audiences, we utilized syndicated market research data from Nielsen."
They found three brands advertised heavily on Spanish-language television and not at all on English-language broadcasts: 7 Up, Kraft Mayonnaise, and Fuze Iced Tea.
"Black children and teens saw at least twice as many ads for gum/mints, soda, and other sugary drinks compared with white children and teens, and black children saw 2.1 times as many candy and regular soda ads and 2.3 times as many gum/mint ads," the report says.
They're careful not to blame companies doing what they need to do to stay afloat — advertise and try to sell products.
"In evaluating companies' targeted marketing practices, it is important to recognize that food and beverage marketing designed to appeal directly to Hispanic and black consumers is not problematic in and of itself," the researchers write.
"Hispanic consumers spend more than an estimated $1 trillion per year, and they represent one of the largest and fastest growing demographic groups in the United States. Hispanic households also tend to be larger and younger than other households, making them an especially attractive market for consumer goods, including food."
It does make good business sense, the researchers noted.
"However, this research demonstrates that racial-ethnic targeted food marketing likely contributes to health disparities," they added.
None of the companies contacted by NBC News responded. Nor did the American Beverage Association, which represents soft drink makers.
"This research confirms public health concerns about food and beverage marketing targeted to black and Hispanic consumers, especially children and adolescents," the researchers concluded.
"Due to their greater exposure to media and food marketing, proposals to reduce unhealthy food marketing to youth and/or increase marketing of nutritious foods would also greatly benefit black and Hispanic youth. In addition, industry pledges to increase marketing of healthy products must include expansion of advertising in black- and Hispanic-targeted media, where healthier categories are currently significantly underrepresented."
"In 2014, on average, children ages 2 to 11 viewed 12.8 food and beverage ads per day on TV alone - almost 4,700 ads per year - and adolescents ages 12 to 17 viewed 15.2 ads per day," they wrote.
Source: Published originally on ABCNews.com as Black, Hispanic kids targeted by ads for soda and high-calorie drinks, August 11, 2015.
- Author: Quartz.com by Matt Phillips
But a new paper, recently published in Contemporary Economic Policy (pdf), sheds light on the reasons why—and why this disparity matters.
Analysts polled a representative group of more than 1,000 participants in 2009, asking a number of questions about water consumption as well as attributes of bottled water in terms of taste, safety and convenience. Researchers confirmed that Black and Hispanic respondents were much more likely to drink bottled water and believe it was safer.
“The preferences of these minority groups are not driven by concerns about convenience, but rather perceptions about water quality,” the study said.
The economists then included data from the US Environmental Protection Agency on water quality violations for states, and found that people who lived in states with more water quality violations were indeed more likely to drink bottled water. The authors then presented indirect evidence in the form of previous research from the American Housing Survey (tables) that said Blacks and Hispanics are overrepresented as a share of those living with unsafe drinking water. They wrote:
For owner-occupied units, the percentage of housing units with unsafe drinking water from their primary source is 6% for the population overall, 9% for Blacks, and 16% for Hispanics. For renter-occupied units, the corresponding percentages are even higher—11% overall, 11% for Blacks, and 21% for Hispanics.
These findings are consistent with previous studies. For instance, a 2011 study published in JAMA Pediatricsfound African-American and Latino parents were more likely to give their children mostly bottled water. And a separate paper published in 2007found that many Latino families don't drink tap water because of concerns that it could cause illness.
“We now have an understanding of why people do this,” said Joel Huber, a marketing professor at Duke University's Fuqua School of Business, a co-author on the paper.
Of course, these results are based on broad aggregates, which mean they may not hold true for any individual. Still, such findings matter.
For instance, if policy makers want to use taxes to discourage bottled water consumption for environmental reasons, it means the tax would fall hardest on Blacks and Latinos.
There might also be public health implications, not so much related to bottled water consumption, but to aversions to cheaper tap water. Some studies have linked mistrust of tap water to lower consumption of water, and increased consumption of sugary drinks.
Source: Published originally on Quartz.com as Blacks and Hispanics drink more bottled water. Economists now know why, by Matt Phillips, June 29, 2015.