Sweetened Beverages -A Big Problem for Little Kids

Many times we may look at a study and think that the results could easily have been anticipated.  Yet, there are many examples when our assumptions are flat-out wrong.

A recent study (Pediatrics 2013; 132: 413-20 -thanks to Jeff Lewis for this reference) helps solidify what we think we already knew, namely that sugar-sweetened beverages (SSB) contribute to weight gain in young children.  This study showed that 2-5 year-olds, followed in the Early Childhood Longitudinal Survey–Birth Cohort (n=9600), who had more frequent SSB consumption had higher BMI z scores by age four (P < .05) than infrequent/nondrinkers of SSB.  This study, for the first time, shows this effect in this younger population.

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Will salt intake make you fat?

Maybe.  According to a recent study (Pediatrics 2013; 131: 14-20), salt intake is associated with consumption of sugar-sweetened beverages (SSB); hence, it might make you fat.

This cross-sectional study used data (4283 participants, ages 2-16 years) from the 2007 Australian National Children’s Nutrition and Physical Activity Survey.  Calculation of dietary intake (salt, fluid, sugary beverages) was determined by looking at two 24-hour dietary recalls.

Each gram of salt was associated with a 46 gram intake of fluid.  Of those who took SSB (n=2571), salt intake was associated with increased consumption of SSB; each gram of salt was associated with a 17 gram increased intake of SSB.  Participants with SSB intake of more than 1 serving (≥250 g), in turn, were 26% more likely to be overweight/obese (odds ratio 1.26).

Study limitations included the following:

  • 24-hour dietary recalls which likely underrepresented salt intake
  • Salt intake may be clustered with other ‘unhealthy’ dietary habits.  Thus, it may be a marker for undesirable diet rather than a causal factor.

Conclusion: Besides lowering blood pressure and lowering the risk of kidney stones, reducing salt intake may help with obesity prevention.

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Eliminating sweetened beverages to help obesity

For every difficult problem there’s a solution that’s simple, neat and wrong.–HL Mencken

Two studies from the New England Journal of Medicine, thus far (at the time of writing) published only online, shed some light on the difficult problem of consumption of sugar-sweetened beverages and its relationship to obesity:

  • A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children. Janne C. de Ruyter, M.Sc., et al. September 21, 2012DOI:  10.1056/NEJMoa1203034

  • A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight. Cara B. Ebbeling, Ph.D., et al,  September 21, 2012DOI:  10.1056/NEJMoa1203388

The first study was an 18-month double-blind, randomized, controlled trial with 641 primarily normal-weight children between 4-12 years of age; patients were recruited from elementary schools.  Patients either received a sugar-free artificially sweetened beverage or a similar sugar-containing beverage, 8 oz per day at school.  At 18 months, 74% continued consuming these beverages; among those remaining in the program, on average, they consumed 83% of the assigned 7 cans each week.  Another marker of adherence was increased urinary sucralose in the sugar-free group (6.7 mg/L compared with 0.1 mg/L in the sugar group). Weight gain was less in the sugar-free group: 6.35 kg compared with 7.37 kg.  Other measures of weight gain were less as well, including skinfold-thickness, waist-to-height ratio, and fat mass. It is also noted that in the U.S. the average consumption of sweetened beverages is three times the amount noted in this Dutch study.

The second study examined 224 overweight and obese adolescents who were randomly assigned into experimental and control groups.  The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages; they were followed for an additional year afterwards.  Retention rates were good: 93% at 2 years. To support the experimental group, sugar-free beverages were delivered to  the house and the families received monthly motivational calls. In addition, patients had three check-in visits and written materials. The consumption of sugar-sweetened beverages declined in the experimental group from a baseline of 1.7 servings per day to nearly 0 at 1 year & remained lower at 2 years than the control group.  The primary outcome, BMI, did not differ significantly between the two groups at 2 years nor did change in body fat percentage.  (BMI did improve at 1 year, -0.57.)  In the small number of Hispanic participants (n=27 in experimental group), there was a significant change in BMI at both 1 and 2 years.

While consumption of sugar-sweetened beverages have been considered to be more fattening than solid foods because they do not lead to a sense of satiety, it appears that restriction of these beverages by itself will not make a major dent in the problem of obesity.

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