Elsevier

Nutrition

Volume 31, Issue 1, January 2015, Pages 38-44
Nutrition

Review
Substituting sugar-sweetened beverages with water or milk is inversely associated with body fatness development from childhood to adolescence

https://doi.org/10.1016/j.nut.2014.04.017Get rights and content

Abstract

Objective

The aim of this study was to examine the association between different types of beverage intake and substitution of sugar-sweetened beverages (SSBs) by water, milk, or 100% fruit juice in relation to 6-y change in body fatness.

Methods

A cohort of 9-y-old children (N = 358) who participated in the Danish part of the European Youth Heart Study was followed for development of body fatness over 6 y. Multivariate linear regression was used to examine the associations between beverage intake at baseline and change in body fatness (body mass index z score [BMIz]), waist circumference (WC), and sum of four skinfolds (Σ4SF) over 6 y with adjustment for potential confounders. Substitution models were used to evaluate various beverages as alternatives to SSBs.

Results

SSB intake at age 9 y, but not intake of other beverages, was directly associated with subsequent 6-y changes in BMIz (β = 0.05; P = 0.02) and Σ4SF (β = 0.86; P = 0.02). Daily substitution of 100 g water for 100 g SSB was inversely associated with changes in BMIz (β = −0.04; P = 0.02), WC (β =−0.29; P = 0.04), and Σ4SF (β = −0.91; P = 0.02) over 6 y. Daily substitution of 100 g milk for 100 g SSB was also inversely associated with changes in BMIz (β = −0.05; P = 0.02), WC (β = −0.33; P = 0.046), and Σ4SF (β = −0.79; P = 0.06). No effect was observed for substitution of SSB by 100% fruit juice.

Conclusion

Our results suggest that SSB intake is associated with long-term changes in body fatness in children, and replacing SSBs with water or milk, but not 100% fruit juice, is inversely associated with body fatness development.

Introduction

Increased consumption of beverages, particularly sugar-sweetened beverages (SSBs), is thought to play a role in the etiology of obesity [1], [2]. It is assumed that energy consumed in a liquid form is less satiating than energy consumed in a solid form and may lead to an incomplete compensatory reduction in energy from other sources, resulting in excess energy intake and subsequent weight gain [3]. Moreover, shifts in beverage consumption patterns, that is, increases in SSB consumption and decreases in milk consumption particularly in children and adolescents, and the interrelation of beverage consumption with other unhealthy eating patterns also may contribute to weight gain and obesity [4]. The glycemic and metabolic effects of beverages containing rapidly absorbable carbohydrates also are likely to increase body weight and fat gain [4] with regular soft drinks and fruit drinks containing carbohydrate in the form of added sugars (∼10% sucrose or high fructose corn syrup). Conversely, milk contains 4% to 5% lactose as well as protein, fat, and other food components that slow the rate of carbohydrate absorption.

Childhood obesity has become a major public health concern worldwide. Limiting SSB consumption has been acknowledged as one of the primary preventive strategies for combating the childhood obesity epidemic [5], [6]. The replacement of SSBs with low-energy alternatives such as water and diet beverages is likely to benefit weight control [7], [8]. Previous studies, mostly short-term feeding trials and weight loss intervention studies, have documented that the replacement of SSBs with water [9], [10], [11] and diet beverages [12] may promote weight loss and reduce fat accumulation and obesity risk. Energy-containing nutritious beverages such as milk and 100% fruit juice, when consumed in recommended amounts, may be better alternatives than SSBs. Indeed, previous intervention trials have revealed a beneficial effect on lean body mass and growth in children when habitual SSB consumption is replaced with regular milk [13]. However, the effects of replacing SSBs with other beverages revealed by these short-term experimental studies might not extrapolate to the long term. Only a limited number of studies have examined the long-term effects on obesity development of replacing SSBs with other beverages [14], [15].

Considering the elevated public health concern on the influence of SSB consumption in childhood obesity and the emerging debate on the effectiveness of limiting SSB consumption in childhood obesity prevention, we aimed to prospectively examine the association between the intake of different beverage types and subsequent 6-y changes in body fatness as well as the relationship of replacing SSB with water, coffee/tea, milk, or 100% fruit juice to subsequent 6-y changes in body fatness.

Section snippets

Study population

The European Youth Heart Study (EYHS) is an international multicenter study designed to address environmental, personal, lifestyle, and physiological factors that may influence the development of cardiovascular risk factors in children. All study protocols complied with the Declaration of Helsinki and were approved by the scientific ethics committee of the local counties of Vejle and Funen, Denmark (VF 20030067). Written explanations of the study aims and possible hazards, discomfort, and

Results

Descriptive information on anthropometrics, dietary intake, pubertal status, SES, and physical activity is presented in Table 1. The percentages of children consuming each beverage type were as follows: water (92%), milk (97%), SSBs (57%), fruit juice (37%), and coffee/tea (19%). As expected, anthropometric data increased significantly from baseline to follow-up (P < 0.0001).

The prospective associations between each beverage intake at baseline and 6-y change in body fatness measures are

Discussion

Current literature on beverage intake and adiposity has focused mainly on SSBs, and to a lesser extent on milk, fruit juice, and noncaloric beverages. In this cohort of Danish children, we examined the prospective associations between a variety of beverages and changes in body fatness over 6 y. We found SSB intake at age 9 y, but not other beverage types (water, milk, fruit juice, coffee/tea), was directly related to subsequent 6-y changes in body fatness. In particular, BMIz and Σ4SF were

Conclusion

Our findings support the recommendations to reduce SSB consumption. Additionally, replacing SSBs with water and milk was inversely associated with body fatness development from childhood to adolescence. However, well-designed long-term longitudinal studies and randomized controlled trials are needed to further elucidate the effectiveness of substituting water and milk for SSBs on obesity development.

Acknowledgments

The authors acknowledge all those involved with the European Youth Heart Study.

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  • Cited by (0)

    All authors participated sufficiently and approved the content of the manuscript. LBA was responsible for data collection, with exception of the diet data for which BLH was responsible. BLH conceived the hypothesis for the study. MZ analyzed data. MZ, BLH, and AR interpreted the data, wrote the manuscript, and reviewed/edited the manuscript. All authors reviewed and edited the final manuscript. The authors have no conflicts of interest to declare.

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