ReviewSubstituting sugar-sweetened beverages with water or milk is inversely associated with body fatness development from childhood to adolescence
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.
References (46)
- et al.
Liquid calories, sugar, and body weight
Am J Clin Nutr
(2007) - et al.
Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children
Am J Clin Nutr
(2008) Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Health Study)
Lancet
(2006)Normal growth and techniques of growth assessment
Clin Endocrinol Metab
(1986)- et al.
Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence
Am J Clin Nutr
(2009) - et al.
Correlates of beverage intake in adolescent girls: the National Heart, Lung, and Blood Institute Growth and Health Study
J Pediatr
(2006) - et al.
Is sugar sweetened beverage consumption associated with increased fatness in children?
Nutition
(2007) - et al.
Adolescent beverage habits and changes in weight over time: findings from Project EAT
Am J Clin Nutr
(2009) - et al.
Validation of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group
J Am Diet Assoc
(1993) Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases
Obes Rev
(2013)
Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments
Obes Rev
Is there an association between sweetened beverages and adiposity?
Nutr Rev
Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation
Recommendations for prevention of childhood obesity
Pediatrics
Impact of water intake on energy intake and weight status: a systematic review
Nutr Rev
Diet beverages and the risk of obesity, diabetes, and cardiovascular disease: a review of the evidence
Nutr Rev
Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial
Pediatrics
Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults
Obesity (Silver Spring)
A randomized trial of sugar-sweetened beverages and adolescent body weight
N Eng J Med
A trial of sugar-free or sugar-sweetened beverages and body weight in children
N Eng J Med
Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies
Int J Obes (Lond)
Impact of change in sweetened caloric beverage consumption on energy intake among children and adolescents
Arch Pediatr Adolesc Med
The European Youth Heart Study-Cardiovascular Disease Risk Factor in Children: rationale, aims, study design, and validation of method
J Phys Act Health
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.