Introduction Energy-containing beverages, specifically sugar-sweetened beverages (SSB), may contribute to weight gain and obesity development. Yet, no rapid assessment tools are available which quantify habitual beverage intake (grams, energy) in adults. Objective Determine the factorial validity of a newly developed beverage intake questionnaire (BEVQ) and identify potential to reduce items. Methods Participants from varying economic and educational backgrounds (n=1,596; age 43±12 yrs; BMI 31.5±0.2 kg/m2) completed a 19-item BEVQ (BEVQ-19). Beverages that contributed <10% to total beverage, or SSB, energy and grams were identified for potential removal. Factor analyses identified beverage categories that could potentially be combined. Regression analyses compared BEVQ-19 outcomes with the reduced version’s (BEVQ-15) variables. Inter-item reliability was assessed using Cronbach’s Alpha. Following BEVQ-15 development, a subsequent study (n=70; age 37±2 yrs; BMI 24.5±0.4 kg/m2) evaluated the relative validity of the BEVQ-15 through comparison of three 24-hour dietary recalls’ (FIR) beverage intake. Results Three beverage items were identified for elimination (vegetable juice, meal replacement drinks, mixed alcoholic drinks); beer and light beer were combined into one category. Regression models using BEVQ-15 variables explained 91–99% of variance in the four major outcomes of the BEVQ-19 (all P<0.001). Cronbach’s Alpha ranged 0.97–0.99 for all outcomes. In the follow-up study, BEVQ-15 and FIR variables were significantly correlated with the exception of whole milk; BEVQ-15 SSB (R2=0.69) and total beverage energy (R2=0.59) were more highly correlated with FIR than previously reported for the BEVQ-19. The BEVQ-15 produced a lower readability score of 4.8, which is appropriate for individuals with a fourth grade education or greater. Conclusion The BEVQ-19 can be reduced to a 15-item questionnaire. This brief dietary assessment tool will enable researchers and practitioners to rapidly (administration time of ~2 min) assess habitual beverage intake, and to determine possible associations of beverage consumption with health-related outcomes, such as weight status.

Consumption of energy-containing beverages may lead to weight gain, yet research investigating this issue is limited. An easily-administered beverage intake assessment tool could facilitate research on this topic. The purpose of this cross-sectional investigation was to determine the validity and reliability of a self-administered beverage intake questionnaire (BEVQ), which estimates mean daily intake of beverages consumed (g, kcals) across 19 beverage categories. Participants (n=105; aged 39±2 yrs) underwent assessments of height, weight, body mass index, and dietary intake using 4-day food intake records (FIR) from June, 2008-June, 2009. The BEVQ was completed at two additional visits (BEVQ1, BEVQ2). Urine samples were collected to objectively determine total fluid intake and encourage accurate self-reporting. Validity was assessed by comparing BEVQ1 with FIR results; reliability was assessed by comparing BEVQ1 and BEVQ2. Analyses included descriptive statistics, bivariate correlations, paired samples t-tests, and independent samples t-tests. Self-reported water and total beverage intake (g) were not different between the BEVQ1 and FIR (mean difference: 129±77g [P=0.096] and 61±106g [P=0.567], respectively). Total beverage and sugar-sweetened beverage (SSB) energy intake were significantly different, although mean differences were small (63 and 44 kcal, respectively). Daily consumption (g) of water (r=0.53), total beverages (r=0.46), and SSB (r=0.49) determined by the BEVQ1 were correlated with reported intake determined by the FIR, as was energy from total beverages (r=0.61) and SSB (r=0.59) (all P<0.001). Reliability was demonstrated, with correlations (P<0.001) detected between BEVQ1 and BEVQ2 results. The BEVQ is a valid, reliable, and rapid self-administered dietary assessment tool.

The subjective nature of self-reported dietary intake assessment methods presents numerous challenges to obtaining accurate dietary intake and nutritional status. This limitation can be overcome by the use of dietary biomarkers, which are able to objectively assess dietary consumption (or exposure) without the bias of self-reported dietary intake errors. The need for dietary biomarkers was addressed by the Institute of Medicine, who recognized the lack of nutritional biomarkers as a knowledge gap requiring future research. The purpose of this article is to review existing literature on currently available dietary biomarkers, including novel biomarkers of specific foods and dietary components, and assess the validity, reliability and sensitivity of the markers. This review revealed several biomarkers in need of additional validation research; research is also needed to produce sensitive, specific, cost-effective and noninvasive dietary biomarkers. The emerging field of metabolomics may help to advance the development of food/nutrient biomarkers, yet advances in food metabolome databases are needed. The availability of biomarkers that estimate intake of specific foods and dietary components could greatly enhance nutritional research targeting compliance to national recommendations as well as direct associations with disease outcomes. More research is necessary to refine existing biomarkers by accounting for confounding factors, to establish new indicators of specific food intake, and to develop techniques that are cost-effective, noninvasive, rapid and accurate measures of nutritional status.

Background: Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012-2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmartER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes. Methods: Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes. Results: Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59 %) eligible, 301 (49 %) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93 % Caucasian, 81 % female, 31 % ≤ high-school educated, 43 % < $14,999 household income, and 33 % low health literate. Retention rates (74 %) and program engagement was not statistically different between conditions. Compared to MoveMore, SIPsmartER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmartER participants significantly decreased SSB intake by 227 (95 % CI = −326,−127, p < 0.001) kcals/day from baseline to 6 months when compared to the decrease of 53 (95 % CI = −88,−17, p < 0.01) kcals/day among MoveMore participants (p < 0.001). SIPsmartER participants decreased BMI by 0.21 (95 % CI = −0.35,−0.06; p < 0.01) kg/m

A reliance on self-reported dietary intake measures is a common research limitation, thus the need for dietary biomarkers. Added sugar intake may play a role in the development and progression of obesity and related co-morbidities; common sweeteners include corn and sugar cane derivatives. These plants contain a high amount of 13C, a naturally-occurring stable carbon isotope. Consumption of these sweeteners, of which sugar-sweetened beverages (SSB) are the primary dietary source, may be reflected in the δ13C value of blood. Fingerstick blood represents an ideal substrate for bioassay due to its ease of acquisition. The objective of this investigation was to determine if the δ13C value of fingerstick blood is a potential biomarker of added sugar and SSB intake. Individuals aged ≥21 years (n=60) were recruited to attend three laboratory visits; assessments completed at each visit depended upon a randomly assigned sequence (sequence one or two). The initial visit included assessment of height, weight, and dietary intake (sequence one: beverage intake questionnaire [BEVQ], sequence two: four-day food intake record [FIR]). Sequence one participants completed an FIR at visit two, and non-fasting blood samples were obtained via routine finger sticks at visits one and three. Sequence two participants completed a BEVQ at visit two, and provided fingerstick blood samples at visits two and three. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared to dietary outcomes in all participants, as well as among those in the highest and lowest tertile of added sugar intake. Reported mean added sugar consumption was 66±5g/day, and SSB consumption was 330±53g/day and 134±25 kcal/day. Mean fingerstick δ13C value was −19.94±0.10‰, which differed by BMI status. δ13C value was associated (all p<0.05) with intake of total added sugars (g, r=0.37; kcal, r=0.37), soft drinks (g, r=0.26; kcal, r=0.27), and total SSB (g, r=0.28; kcal, r=0.35). The δ13C value in the lowest and the highest added sugar intake tertiles were significantly different (mean difference = −0.48‰, p=0.028). Even though there are several potential dietary sources for blood carbon, the δ13C value of fingerstick blood shows promise as a non-invasive biomarker of added sugar and SSB intake based on these findings.