Background The WHO recommends taxes on sugar sweetened beverages (SSBs) to improve population health. We examined changes in volume of and amount of sugar in purchases of soft drinks according to household income and composition, 19 months following the implementation of the UK soft drinks industry levy.Methods Data were from the Kantar Fast Moving Consumer Goods panel, a market research panel which collects data on weekly household purchases (mean weekly number of households=21 908), March 2014–November 2019. Interrupted time series analysis of volume and sugar purchases was used to estimate absolute and relative differences in the volume and amount of sugar in soft drinks, confectionery and alcohol purchased weekly by household income (<£20 000, £20–50 000 or >£50 000) and composition (presence of children (<16 years) in the household (yes or no)), 19 months after soft drinks industry levy (SDIL) implementation, compared with the counterfactual scenario based on pre-announcement trends and using a control group (toiletries).Results By November 2019, purchased weekly sugar in soft drinks fell by 7.46 g (95% CI: 12.05, 2.87) per household but volumes of drinks purchased remained unchanged, compared with the counterfactual. In low-income households, weekly sugar purchased in soft drinks decreased by 14.0% (95% CI: 12.1, 15.9) compared with the counterfactual but in high-income households increased by 3.4% (1.07, 5.75). Among households with children, sugar purchased decreased by 13.7% (12.1, 15.3) but increased in households without children by 5.0% (3.0, 7.0). Low-income households and those with children also reduced their weekly volume of soft drinks purchased by 5.7% (3.7, 7.7) and 8.5% (6.8, 10.2) respectively. There was no evidence of substitution to confectionary or alcohol.Conclusion In the second year following implementation of the SDIL, effects on sugar purchased were greatest in those with the highest pre-SDIL purchasing levels (low-income households and those with children). The SDIL may contribute to reducing dietary inequalities.Trial registration number ISRCTN18042742. Registered: August 2017.

BackgroundThe UK Soft Drinks Industry Levy (SDIL) was announced in March 2016, became law in April 2017, and was implemented in April 2018. Empirical analyses of commercial responses have not been undertaken to establish the scale, direction or nuance of industry media messaging around fiscal policies. We aimed to develop a detailed understanding of industry reactions to the SDIL in publicly available media, including whether and how these changed from announcement to implementation.MethodsWe searched Factiva to identify articles related to sugar, soft-drinks, and the SDIL, between 16th March 2016-5(th) April 2018. Articles included were UK publications written in English and reporting a quotation from an industry actor in response to the SDIL. We used a longitudinal thematic analysis of public statements by the soft-drinks industry that covered their reactions in relation to key policy milestones.ResultsTwo hundred and ninety-eight articles were included. After the announcement in March 2016, there was strong opposition to the SDIL. After the public consultation, evolving opposition narratives were seen. After the SDIL became law, reactions reflected a shift to adapting to the SDIL. Following the publication of the final regulations, statements sought to emphasise industry opportunities and ensure the perceived profitability of the soft drinks sector. The most significant change in message (from opposition to adapting to the SDIL) occurred when the SDIL was implemented (6(th) April 2018).ConclusionReactions to the SDIL changed over time. Industry modified its media responses from a position of strong opposition to one that appeared to focus on adaptation and maximising perceived profitability after the SDIL became law. This shift suggests that the forces that shape industry media responses to fiscal policies do not remain constant but evolve in response to policy characteristics and the stage of the policy process to maximise beneficial framing.

OBJECTIVE:To determine changes in household purchases of drinks 1 year after implementation of the UK soft drinks industry levy (SDIL).DESIGN:Controlled interrupted time series.PARTICIPANTS:Households reporting their purchasing to a market research company (average weekly n=22 091), March 2014 to March 2019.INTERVENTION:A two-tiered tax levied on soft drinks manufacturers, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g sugar/100 mL (high tier) are taxed at £0.24/L, drinks with ≥5 to <8 g sugar/100 mL (low tier) are taxed at £0.18/L.MAIN OUTCOME MEASURES:Absolute and relative differences in the volume of, and amount of sugar in, soft drinks categories, all soft drinks combined, alcohol and confectionery purchased per household per week 1 year after implementation.RESULTS:In March 2019, compared with the counterfactual, purchased volume of high tier drinks decreased by 140.8 mL (95% CI 104.3 to 177.3 mL) per household per week, equivalent to 37.8% (28.0% to 47.6%), and sugar purchased in these drinks decreased by 16.2 g (13.5 to 18.8 g), or 42.6% (35.6% to 49.6%). Purchases of low tier drinks decreased by 170.5 mL (154.5 to 186.5 mL) or 85.8% (77.8% to 93.9%), with an 11.5 g (9.1 to 13.9 g) reduction in sugar in these drinks, equivalent to 87.8% (69.2% to 106.4%). When all soft drinks were combined irrespective of levy tier or eligibility, the volume of drinks purchased increased by 188.8 mL (30.7 to 346.9 mL) per household per week, or 2.6% (0.4% to 4.7%), but sugar decreased by 8.0 g (2.4 to 13.6 g), or 2.7% (0.8% to 4.5%). Purchases of confectionery and alcoholic drinks did not increase.CONCLUSIONS:Compared with trends before the SDIL was announced, 1 year after implementation, volume of all soft drinks purchased combined increased by 189 mL, or 2.6% per household per week. The amount of sugar in those drinks was 8 g, or 2.7%, lower per household per week. Further studies should determine whether and how apparently small effect sizes translate into health outcomes.TRIAL REGISTRATION NUMBER:ISRCTN18042742.

Objectives To examine changes in volume of and amount of sugar in purchases of soft drinks according to household income and composition, at 19 months following the implementation of the UK Soft drinks industry levy (SDIL). Design: Controlled interrupted time series analysis Setting: Representative households (mean weekly number of households =21,908) across Great Britain Participants: Members of the Kantar Fast Moving Consumer Goods panel, a market research panel which collects data on weekly household purchases (eg: drinks, confectionery etc) between March 2014 to November 2019. Interventions: The SDIL, is a two-tiered tax (announced in March 2016 and implemented in April 2018) on manufacturers of soft drinks. Drinks containing ≥8g sugar /100mls and ≥5 to <8g sugar/ 100mls are taxed at 0.24 GBP/litre and 18 GBP/litre, respectively. Soft drinks containing <5g sugar/100ml are not subject to the levy. Levy exempt drinks, irrespective of sugar content, include milk and milk-based drinks, no-added-sugar fruit juice and powder used to make drinks. Main Outcome measures: Absolute and relative differences in the volume of and amount of sugar in non-alcoholic soft drinks, confectionery and alcohol purchased weekly by household income (<20,000, 20-50,000 or >50,000 GBP) and composition (presence of children [<16years] in the household (yes or no), 19 months after SDIL-implementation, compared to the counterfactual scenario based on pre-announcement trends and using a control group (toiletries). Results: By November 2019, overall purchased weekly sugar in soft drinks fell by 7.46g (95%CI: 12.05, 2.87) per household but volumes of drinks purchased remained unchanged, compared to the counterfactual based on pre-announcement trends. In low-income households, weekly sugar purchased in soft drinks decreased by 14.0% (95%CI: 12.1,15.9) compared to the counterfactual but in high income households increased by 3.4% (1.07,5.75). Similarly, among households with children, sugar purchased decreased by 13.7% (12.1, 15.3) compared to the counterfactual but increased in households without children by 5.0% (3.0,7.0). Low-income households and those with children also reduced their weekly volume of soft drinks purchased by 5.7% (3.7, 7.7) and 8.5% (6.8, 10.2) respectively. There was no evidence of substitution to confectionary or alcohol. Conclusion: In the second year following implementation of the SDIL, there were sustained reductions in sugar derived from soft drink purchases, but no change in volume of soft drinks purchased. Effects on sugar purchased were greatest in those with the highest pre-SDIL purchasing levels (low-income households and those with children). The SDIL may contribute to reducing dietary inequalities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding: NR, MW, and JA were supported by the Medical Research Council (grant Nos MC\_UU\_00006/7). This project was funded by the NIHR Public Health Research programme (grant Nos 16/49/01 and 16/130/01). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. NR had full access to all the data in the study and had final responsibility for the decision to submit for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data sharing: Kantar Fast Moving Consumer Goods panel data are not publicly available but can be purchased from Kantar Worldpanel (http://www.kantarworldpanel.com). The authors are not legally permitted to share the data used for this study however interested parties can contact Kantar WorldPanel representative Sean Cannon (Sean.Cannon@kantar.com) to inquire about accessing this proprietary data.

ObjectivesTo determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation.DesignRepeat cross-sectional online survey.SettingThe UK.ParticipantsUK respondents to the International Food Policy Study aged 18–64 years who provided information on all variables of interest in November–December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284).Outcome measuresSelf-reported support for, and perceived effectiveness of, the SDIL.ResultsThe adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar.ConclusionsWe found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.

BackgroundDespite a growing body of evidence suggesting that short sleep duration may be linked to adverse metabolic outcomes, how these associations differ between age groups remains unclear. We use eight years of data from the UK National Diet and Nutritional Survey (NDNS) (2008-2016) to analyse cross-sectional relationships between sleep duration and metabolic risk in participants aged 11-70 years.MethodsParticipants (n = 2008) who provided both metabolic risk and sleep duration data were included. Self-reported sleep duration was standardised by age, to account for differences in age-related sleep requirements. A standardised metabolic risk score was constructed, comprising: waist circumference, blood pressure, serum triglycerides, serum high-density lipoprotein cholesterol, and fasting plasma glucose. Regression models were constructed across four age groups from adolescents to older adults.ResultsOverall, decreased sleep duration (hrs) was associated with an increased metabolic risk (standard deviations) with significant quadratic (B:0.028 [95%CI: 0.007, 0.050]) and linear (B:-0.061 [95%CI: -0.111, -0.011]) sleep duration coefficients. When separated by age group, stronger associations were seen among mid-aged adults (36-50y) (quadratic coefficient: 0.038 [95%CI: 0.002, 0.074]) compared to other age groups (e.g. adolescents (11-18y), quadratic coefficient: -0.009 [95%CI: -0.042, 0.025]). An increased difference between weekend and weekday sleep was only associated with increased metabolic risk in adults aged 51-70 years (B:0.18 [95%CI: 0.005, 0.348]).ConclusionsOur results indicate that sleep duration is linked to adverse metabolic risk and suggest heterogeneity between age groups. Longitudinal studies with larger sample sizes are required to explore long-term effects of abnormal sleep and potential remedial benefits.

Background Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The UK Soft Drinks Industry Levy (SDIL) is a two tiered tax, announced in March 2016 and implemented in April 2018. Drinks with ≥8g of sugar per 100ml (higher levy tier) are taxed at £0.24 per litre, drinks with ≥5-<8g of sugar per 100ml (lower levy tier) are taxed at £0.18 per litre, and drinks with <5g sugar per 100ml (no levy) are not taxed. Milk-based drinks, pure fruit juices, drinks sold as powder and drinks with >1.2% alcohol by volume are exempt. We aimed to determine whether the announcement of the SDIL was associated with anticipatory changes in purchases of soft drinks prior to implementation of the SDIL in April 2018. We explored differences in the volume of, and amount of sugar in, household purchases of drinks in each levy tier at two years post-announcement. Methods and findings We used controlled interrupted time series to compare observed changes associated with the announcement of the SDIL to the counterfactual scenario of no announcement. We used data from Kantar Worldpanel, a commercial household purchasing panel with approximately 30,000 British members that includes linked nutritional data on purchases. We conducted separate analyses for drinks liable for the SDIL in the higher, lower and no levy tiers, and all liable and exempt soft drinks combined, controlling with household purchase volumes of toiletries. At two years post-announcement against a backdrop of marked ongoing declines, there was a 41.3ml (95%CI 19.0 to 63.7ml) increase in volume of and a 5.1g (95%CI 2.0 to 8.1g) increase in sugar from, purchases of higher levy tier drinks compared to the counterfactual of no announcement (equivalent to 9.1% and 10.2% respectively). In contrast, a reversal of the existing upward trend in volume of, and amount of sugar in, purchases of lower levy tier drinks was seen. These changes led to a 68.1ml (95% CI: 54.9 to 81.1) reduction in volume and 4.4g (95% CI: 2.6 to 6.3) reduction in sugar purchased in these drinks per household per week compared to the counterfactual—a 38% reduction in both cases. There was a 10% increase in volume of and 69% increase in sugar in household purchases of no levy drinks. At two years post-announcement, these changes led to a 165.5 ml (95%CI 100.1 to 230.9 ml) and 5.7 g (95% CI 4.0 to 7.3) increase in volume and sugar purchased in these drinks per household per week respectively, compared to the counterfactual. There was no evidence that total volume of purchases of all drinks combined was different from the counterfactual, but there was evidence of a small increase in sugar purchased from all drinks. This is an observational study and changes other than the SDIL may have been responsible for the results reported. Purchases consumed outside of the home were not accounted for. Conclusions The announcement of the UK SDIL was associated with reductions in volume and sugar purchased in lower levy tier drinks before implementation. These were offset by increases in purchasing of higher-levy and no levy drinks. These findings may reflect reformulation of drinks from the lower to no levy tier with removal of some, but not, all sugar, alongside changes in consumer attitudes, beliefs and purchasing behaviours. Trial registration ISRCTN Registry ISRCTN18042742 .

In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.

Objectives To answer four questions: What are attitudes, knowledge and social norms around sugar-sweetened beverages (SSBs)? What are current levels of trust in messages on SSBs? What is current support for, and perceived effectiveness of, the UK soft drinks industry levy (SDIL)? What is the association between attitudes, knowledge, social norms, trust, SSB consumption and sociodemographic factors; and support for, and perceived effectiveness of, the SDIL? Design Cross-sectional online survey. Setting UK. Participants UK respondents to the 2017 International Food Policy Study aged 18–64 years who provided information on all variables of interest (n=3104). Outcome measures Self-reported perceived effectiveness of, and support for, the SDIL. Results Most participants supported the SDIL (70%), believed it would be effective (71%), had a positive attitude to SSBs (62%), had knowledge of the link between SSBs and obesity (90%), and trusted messages from health experts (61%), but not those from the food and beverage industry (73%). Nearly half (46%) had negative social norms about drinking SSBs. In adjusted models, older age, non-consumption of SSBs, social norms to not drinks SSBs, knowledge of the link between SSBs and obesity and trust in health expert messages were associated with greater support for the SDIL, whereas having dependent children and trusting messages from the food and beverage industry were associated with less support. In adjusted models, older age was associated with lower perceived effectiveness of the SDIL, whereas social norms to not drink SSBs, negative attitudes to SSBs and trusting messages from health experts and the food and beverage industry were associated with greater perceived effectiveness. Conclusions There was strong support for the SDIL and belief that it would be effective. Those with more ‘public health’ orientated norms and trust were generally more likely to support the SDIL or believe that it would be effective.

Objective: The current paper describes Diet In Nutrients Out (DINO), an integrated dietary assessment system incorporating dietary data entry and nutritional analysis within one platform for use in dietary assessment in small-scale intervention studies to national surveys.Design: DINO contains > 6000 food items, mostly aggregated composites of branded foods, across thirty-one main food groups divided into 151 subsidiary groups for detailed reporting requirements, with fifty-three core nutrient fields.Setting: MRC Human Nutrition Research (HNR), Cambridge, UK and MRC Keneba, Gambia.Subjects: DINO is used across dietary assessment projects at HNR and MRC Keneba.Results: DINO contains macro-and micronutrients as well as additional variables of current research and policy interest, such as caffeine, whole grains, vitamin K and added sugars. Disaggregated data are available for fruit, vegetables, meat, fish and cheese in composite foods, enabling greater accuracy when reporting food consumption or assessing adherence to dietary recommendations. Portion sizes are categorised in metric and imperial weights, with standardised portion sizes for each age group. Regular reviews are undertaken for portion sizes and food composition to ensure contemporary relevance. A training programme and a checking schedule are adhered to for quality assurance purposes, covering users and data. Eating context questions are integrated to record where and with whom the respondent is eating, allowing examination between these factors and the foods consumed.Conclusions: An up-to-date quality-assured system for dietary assessment is crucial for nutritional surveillance and research, but needs to have the flexibility to be tailored to address specific research questions.

Caffeine occurs naturally in the leaves and seeds of many plants and is artificially added to some beverages. Consumption of caffeine has been linked to both positive and adverse health outcomes. We incorporated estimates of caffeine content (mg/100 g or ml) of foods and drinks, taken from the published literature, to provide a preliminary estimate of caffeine intake for the UK population, based on data collected in the National Diet and Nutrition Survey 2008–10. Among consumers mean total caffeine intakes of adult men 19+ y were significantly greater than intakes by boys 4–10 y and 11–18 y (p < 0.05), with the same age-related differences seen for females. 4.1% of men 19+ y and 3.8% of women 19+ y had caffeine intakes in excess of 300 mg/d. The addition of caffeine to UK food composition databases will allow more detailed study of the health effects of caffeine consumption.