Added Sugar Beverages Research Articles

Energy-Dense and Low-Fiber Dietary Pattern May Be a Key Contributor to the Rising Obesity Rates in Brazil.

Hybrid methods are a suitable option for extracting dietary patterns associated with health outcomes. This study aimed to identify the dietary patterns of Brazilian adults (20-59 years old; n = 28,153) related to dietary components associated with the risk of obesity. Data from the 2017-2018 Brazilian National Dietary Survey were analyzed. Food consumption was obtained through 24 h recall. Dietary patterns were extracted using partial least squares regression, using energy density (ED), percentage of total fat (%TF), and fiber density (FD) as response variables. In addition, 32 food groups were established as predictor variables in the model. The first dietary pattern, named as energy-dense and low-fiber (ED-LF), included with the positive factor loadings solid fats, breads, added-sugar beverages, fast foods, sauces, pasta, and cheeses, and negative factor loadings rice, beans, vegetables, water, and fruits (≥|0.15|). Higher adherence to the ED-LF dietary pattern was observed for individuals >40 years old from urban areas, in the highest income level, who were not on a diet, reported away-from-home food consumption, and having ≥1 snack/day. The dietary pattern characterized by a low intake of fruits, vegetables, and staple foods and a high intake of fast foods and sugar-sweetened beverages may contribute to the obesity scenario in Brazil.

Associations between household food environment and daily intake of regular and diet soft drinks per BMI status of European children: Feel4Diabetes Study.

The objective of this study was to investigate how the availability of food in the household environment is associated with a daily intake of regular and diet soft drinks in European children, considering BMI status. This cross-sectional study utilised baseline data from 12 211 schoolchildren participating in the Feel4Diabetes European lifestyle modification intervention. Sociodemographics, soft drink intake and household food availability data were collected using parent-completed questionnaires. Anthropometry was recorded, and children were classified into BMI categories according to the International Obesity Task Force cut-offs. In the multivariate logistic regression analysis controlled for children's sex, mother's BMI, and educational level, frequent household availability of fruit juice (sugar added), regular soft drinks and salty snacks compared to less frequent were positively associated with daily regular soft drink intake in children, regardless of BMI group (ORs range 1.59-6.69). Conversely, frequent availability of fruit juice (no added sugar) was inversely related to regular soft drink intake in both BMI groups, as was the availability of fresh fruit in the overweight/obesity group, and the availability of diet soft drinks in the underweight/normal-weight (ORs range 0.31-0.54). In conclusion, habitual household availability of selected energy-dense foods/beverages was positively associated with a daily intake of regular soft drinks in European children, regardless of BMI status. Contrastingly, household availability of fresh fruit, fruit juice (no added sugar) and diet soft drinks were inversely associated with regular soft drink intake. Programmes focusing on reducing children's soft drink intake should consider reducing the availability of sugar-added beverages in the household food environment and encouraging water consumption, as a practical, healthier alternative suggestion.

Human exposure to organophosphate esters in water and packed beverages

Drinks are an essential part of human diet, which makes them a source of human exposure to plasticizers such as organophosphate esters (OPEs). The current study provides new information about sixteen OPE levels in 75 different samples (tap water, packed water, cola drinks, juice, wine and hot drinks). Tap water mean levels (40.9 ng/L) were statistically higher than packed water mean levels (4.82 ng/L), mainly due to the contribution of tris(2-chloroisopropyl) phosphate (TCIPP) and tris(2-butoxyethyl) phosphate (TBOEP) that may come from PVC water pipes. Over 90% of samples presented at least one OPE, where regular cola drinks had the highest mean concentrations (2876 ng/L). There was a significantly higher presence of OPEs in added sugar beverages than sugar free drinks, especially for 2-ethylhexyl diphenyl phosphate (EHDPP), which might be related not only to packaging materials but to the added sugar content. Estimated daily intakes (EDIs) in normal and high-exposure scenarios were 2.52 ng/kg bw/day and 7.43 ng/kg bw/day, respectively. Human risk associated with beverages ingestion showed regular cola drinks, juice and tap water as the groups with the highest hazard quotients (HQs). Although OPE exposure was below to safety limits, it should be noted that EHDPP values for regular cola group must be cause of concern, and other routes of exposure such as food ingestion or air inhalation should be also considered.

Potencial para alimentação saudável no ambiente alimentar de uma universidade pública brasileira

ABSTRACT Objective To identify the food environment healthy eating potential in the authorized food services on the campus of a Brazilian university. Methods This is an observational study carried out between March and April 2014 on a campus of a public university in Rio de Janeiro, Brazil. The elements of the food environment were evaluated using an audit instrument, containing 86 questions: availability (amount of food services and types of food offered), convenience (days and hours of operation), incentives and barriers to healthy eating (nutrition information, payment strategies and food advertisements). Preparations based on whole grains and fresh or minimally processed products were considered healthy foods; and, preparations with high caloric density, sugar-sweetened beverages, sweets, desserts, cookies, and savory snacks were considered unhealthy food. The questionnaire allowed us to calculate a score for each service, which could range from 0 to 36 points, and indicates the potential for promoting healthy eating in the establishment, with higher scores indicating a greater presence of elements that contribute to healthy eating. The different types of food service facilities were compared based on the scores (p<0.05 for statistical significance). Results Among the establishments evaluated, 24% were snack bars/cafeterias, 26%, restaurants, and 50% offered mixed services. Healthy food items were scarcely available in the establishments (fruits: 24%; vegetables: 20%; brown rice: 15%); while added-sugar beverages (98%), sweets and treats (76%) were widely offered. There was a higher frequency of advertising encouraging consumption of unhealthy items than that aimed at healthy foods (44% vs 30%). In general, the score was 13,2 points (SD=3.3) and the mean score for snack bars/cafeterias (9.3 points) was lower (p<0,05) than that of restaurants and mixed establishments (14,4 points). Conclusion On the campus assessed, the food environment had limited potential for healthy eating, since elements that did not favor healthy food choices were more frequent.

Effect of Front-of-Package Information, Fruit Imagery, and High–Added Sugar Warning Labels on Parent Beverage Choices for Children

Fruit drinks are widely consumed by young children, and many parents mistakenly believe that these drinks are healthy, potentially due to front-of-package claims and imagery. Research is needed on the influence of this marketing and how labeling regulations could change behavior. To assess the effects of a front-of-package 100% vitamin C claim, fruit imagery, percentage juice and teaspoons of added sugar disclosures, and high-added sugar warnings on parents' choices, knowledge, and perceptions of beverages. This randomized clinical trial was conducted May to July 2021 as a single-exposure (no follow-up) online survey of primary caregivers of children ages 0 to 5 years throughout the US. Participants were shown no-, low-, and high-added sugar beverages and asked to choose 1 for their child. Participants were randomized to see high-added sugar beverages with 1 of 7 front-of-package conditions: (1) claim and imagery (control); (2) no claim; (3) no imagery; (4) no claim or imagery; (5) claim, imagery, and percentage juice disclosure; (6) claim, imagery, and warning; or (7) claim, imagery, warning, and teaspoons of added sugar disclosure. Primary outcomes were type of beverage chosen (eg, high-added sugar beverage) and resulting calories and added sugar (in grams). Secondary outcomes were fruit drink knowledge (added sugar and percent juice) and perceptions. There were 5005 participants included in the final analysis (mean [SD] age, 31.5 [8.3] years; 3587 female participants [71.7%]), including 714 participants in group 1, 717 participants in group 2, 710 participants in group 3, 717 participants in group 4, 708 participants in group 5, 729 participants in group 6, and 710 participants in group 7. Compared with participants in the control group, who had a mean (standard error [SE]) of 9.4 (0.5) g of added sugar and 81.9 (1.6) kcal in chosen beverages, only participants who saw warnings with teaspoons of added sugar disclosures had significantly reduced added sugar (-1.3 g; 95% CI, -2.6 to -0.1 g [-14.2%; 95% CI, -26.7% to -1.8%]; P = .04) and calories (-5.3 kcal; 95% CI, -9.8 to -0.9 kcal [-6.5%; 95% CI, -11.8% to -1.3%]; P = .02) in selected beverages. In warning conditions (ie, 6 and 7) compared with the control group (mean [SE] 41.0% [1.8%]), the proportion of participants choosing high-added sugar beverages was significantly reduced, by 5.5 percentage points (95% CI, 0.5 to 10.5 percentage points [13.4%; 95% CI, 1.2% to 25.6%]; P = .03) and 6.4 percentage points (95% CI, 1.4 to 11.4 percentage points [15.6%; 95% CI, 3.3% to 27.8%]; P = .01), respectively. The no claim or imagery condition (4) significantly reduced the proportion of parents choosing high-added sugar beverages (-7.6 percentage points; 95% CI, -12.6 to -2.6 percentage points [-18.4%; 95% CI, -30.6% to -6.3%]; P = .003). Percentage juice disclosures did not affect beverage choice. These findings suggest that added sugar warnings and prohibitions of front-of-package claims and imagery may reduce parents' purchases of high-added sugar beverages for their young children but that percentage juice disclosures may not change behavior. ClinicalTrials.gov Identifier: NCT04811690.

The association between daily beverage consumption and risk of chronic disease among adult women in Turkey

Introduction: It has been shown that the contribution of beverage energy to total energy intake may increase the risk of diseases in various countries. The aim of this study is to evaluate the relationship between the consumption of added sugar from beverages and nutritional status, anthropometric measurements and biochemical blood parameters in adults.
 Materials and Methods: This study was designed as an analytical and cross-sectional study and conducted on 100 adult females aged 18-65 who applied to the private diet outpatient clinic in Istanbul/Turkey between November 2020 and April 2021. The demographic characteristics of the individuals were applied to the participants using the food frequency questionnaire, eating habits, physical activity habits and beverage consumption frequency questionnaires.
 Results: The mean age of the women in the study was 31.8 years . Total energy intake from beverages in women over 25 years old was found to be 145.3 kcal and significantly lower. All women in the study consumed tea and coffee. The consumption rate of all beverages except energy drinks was found to be higher in the younger adults. A positive correlation was found between the results of an insulin resistance test and the total amount of added sugar from the beverages consumed (r=0.297 p=0.043). 
 Conclusions: Lower levels of consumption of sugar-sweetened beverages may result in a lower burden of chronic diseases. Future studies should explore consumption patterns of added sugar beverages and individual-level associations with such consumption.

Effects of Program to Promote Obesity Prevention Behaviors on Pre-Schoolers: Focused on Kindergartener in Korea

This study aimed to develop a program to promote obesity prevention behaviors for pre-schoolers and to confirm the effectiveness of the program in Korea. The program comprised 8 sessions for 4 weeks including combined classroom lectures and physical activities. A non-equivalent control group pre-post test study design was used, and seventy two children, aged 5 to 6 years (experimental group: 33, control group: 39) and their parents participated in the study. To examine the effectiveness of the program, children's knowledge, intake of sugar-added beverages and fruits & vegetables, time of outdoor play and screen time, and parental self-efficacy were measured. Data were analyzed with SPSS/WIN ver. 22.0 and R 4.0.2, using descriptive analysis, chi-square test, Fisher's exact test, the independent t-test, and Analysis of covariance (ANCOVA). The results showed that the experimental group reported significantly increased knowledge (p < .001) and longer time of outdoor play on weekends (p = .033). However, there were no significant differences in the intake of sugar-added beverages and fruits & vegetables, screen time, and parental self-efficacy in the two groups. This study confirms the applicability of an obesity prevention intervention at kindergartens in Korea. The results can be used as basic data for the study of childhood obesity prevention in Korea.

Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan.

Dietary patterns have been proposed to be related to dyslipidemia and hyperglycemia. This study investigated the correlation of dietary patterns with components of dyslipidemia and fasting plasma glucose (FPG) among young and middle-aged adults (aged between 20 and 50 years) with dyslipidemia and abnormal FPG in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2001 to 2010. A total of 13,609 subjects aged between 20 and 50 years were selected. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Elevated FPG level was defined according to the American Diabetes Association. The factor analysis was conducted to identify three dietary patterns. Higher scores of the meat–convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil, and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables–fruits–seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy–complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. Our results support that the dietary pattern may have a role in the prevention and management of dyslipidemia and abnormal fasting plasma glucose.

Survival analysis of caries incidence in African-American school-aged children.

To conduct an assessment of time-dependent covariates related to dental caries of the permanent dentition among a low socioeconomic status, understudied cohort of children, incorporating time-dependent covariates through the application of extended Cox proportional hazards modeling. This study modeled the time to first cavitated dental caries in permanent teeth among school-aged children and assessed factors associated with this event. A cohort of 98 low socioeconomic status African-American children with mean age of 5.85 years at baseline was recruited in Uniontown, Alabama and followed prospectively for 6 years. None of these children had dental caries on permanent teeth at baseline, and oral examinations were performed annually. Caries-free survival curves were generated to describe time to event (having first decayed, filled, or missing permanent surface). Bivariate and multivariable extended Cox hazards modeling was used to assess the relationships between time-dependent and time-independent covariates and time to event. Twenty-eight children (28.6 percent) had their first permanent tooth caries event during the 6-year follow-up. Multivariable results showed that greater consumption of water was associated with lower dental caries hazard, while previous primary tooth caries experience was associated with greater dental caries hazard after adjustment for frequency of consumptions of milk, added-sugar beverages, and 100 percent juice. There was a global/overall significant caries protective effect of water consumption during the school-age period of child development.

"Just Say It Like It Is!" Use of a Community-Based Participatory Approach to Develop a Technology-Driven Food Literacy Program for Adolescents.

FuelUp&Go! is a technology-driven food literacy program consisting of six in-person skill building sessions as well as fitness trackers, text messages, and a companion website. A community-based participatory research approach was used with adolescents who were recruited to participate in a Kid Council. Qualitative data were collected about the use of surveys, program activities, recipes, technology and text messages, and music and incentives. Changes suggested by Kid Councilmembers informed the design and development of a pilot program. Participants were recruited for the pilot program and completed pre- and postintervention surveys. The results indicated food-related knowledge remained low but increased from baseline to follow-up. Attitudes toward vegetables and physical activity increased slightly. Self-reported participation in physical activity and consumption of sugar-added beverages moved in positive directions. These findings suggest that community-based participatory research approach is an effective approach to engage adolescents in the development of a technology-driven food literacy program.

Food Consumption According to the Days of the Week - National Food Survey, 2008-2009.

ABSTRACTOBJECTIVE Evaluate the variations in energy, nutrients, and food groups intake between days of the week and weekend days in the Brazilian population.METHODS We used data from the first National Food Survey (2008-2009) of a one-day food log of a representative sample of the Brazilian population aged 10 years or older (n = 34,003). For the analyses, we considered the sample weights and the effect of the study design. The mean (and standard deviations) and frequencies (%) of energy, nutrients, and food groups consumption were estimated for weekdays (Monday to Friday) and weekend (Saturday and Sunday), we then estimated the differences according to the days of the week for the population strata analyzed.RESULTS The average daily energy intake for the weekend was 8% higher than the one observed for weekdays. The average percentage contribution of carbohydrate to the daily energy intake was higher during the week compared to Saturday and Sunday (56.3% versus 54.1%, p < 0.01). The inverse was observed for averages of the contribution to the daily intake of energy from total fat (26.8% versus 28.4%), saturated fat (9.1% versus 9.9%) and trans fat (1.4% versus 1.6%). The most significant changes between weekdays and weekend days were observed for eggs, sugar-added beverages, puff snacks and chips, beans, and pasta. During weekends, the frequency of beverage with added sugar consumption increased by 34%, the amount consumed increased by 42%, and the contribution to energy intake increased by 62% when compared to weekdays.CONCLUSIONS The Brazilian population increases energy intake and unhealthy food markers on weekends compared to weekdays.

Breakfast eating among Brazilian adolescents: Analysis of the National Dietary Survey 2008-2009

ABSTRACT Objective: To characterize breakfast eating among Brazilian adolescents. Methods: Food intake was estimated based on a 1-day food record of adolescents aged 10-19 years, according to the first National Diet Survey (2008-2009). Breakfast was considered as the first meal of the day eaten between 4 and 11 am. Results: Ninety-three percent of adolescents reported eating breakfast. This meal contributed to 17.7% of the daily energy intake. The most commonly consumed food groups were: coffee and tea, breads, butter/margarine, milk, cakes and cookies, packaged snacks, corn-based dishes, cheese, processed meats, and fruit juice. In the Northern region there was a higher frequency of coffee and tea and roots and tubers intake and lower frequency of milk intake than that in the other regions in the country. In the Northeastern region, the intake of corn and eggs was high; in the Southern region, there was high intake of processed meats and fruits. Adolescents from families in the first income quartile reported higher intake of coffee and tea, packaged snacks, corn, and roots and tubers intake, and lower intake of milk and dairy products. Adolescents from families in the highest income quartile reported higher intake of milk, fruit juice, cheese, and sugar-added beverages. Conclusion: In Brazil, the contribution of breakfast to daily energy intake among adolescents is low. The nutritional quality of breakfast improved with increased income. The three most frequently consumed items were coffee and tea, breads, and butter/margarine.

The Sweetness Technology of Sugar Substituted Low-Calorie Beverages

A perturbing increase in the number of diabetics and obese people in all age groups of the population has raised concern in the scientific and industrial community to develop low calorie or no added sugar beverages. Nowadays such sugar-free beverages are gaining popularity because of their inherent thirst quenching properties and fewer calories. Production of such beverages has been possible with the replacement of sugar and incorporation of artificial sweeteners which are low/free in calorie content. The sweetness technology for low-calorie beverages has attained strong commercial success with the safe use of non-nutritive sweeteners that deliver good taste quality. However, some considerations for their efficient use include their solubility and stability in beverage systems along with cost effectiveness. The assessment of non-nutritive sweeteners shows that high-potency artificial non-caloric, include synthetic sweeteners, i.e. aspartame, acesulfame-K, Cyclamate, Neotame, Saccharin and Sucralose whereas natural ones embrace Stevia and Monk Fruit extract. Each one has limitations for taste quality if used singly, i.e., short maximal sweetness response, “off” tastes or/and fast/slow-onset of sweet tastes. However, if used in combination their sweetness intensity increases and taste profile matches the sucrose. The beverage taste profile varies depending upon the type and combination of sweeteners. Optimum blend ratios harmonize the taste profile of specific flavor of beverage and are best determined by sensory testing various blends.

Food access and consumption in a rural settlement in Castanhal, PA, Brazil

The study aimed to assess the food accessibility and consumption among families in the Cupiuba rural settlement, in the city of Castanhal, Para, Brazil. It was found that the access to food is worrying and indicated that most families are in food insecurity conditions. Moreover, income and food safety level were associated. The consumption of the settler families comprises mainly high-energy, low-nutrient content foods, characterized by the low intake of fruits and vegetables and the introduction of processed foods with high energy density and sugar-added beverages, although the traditional dietary habits (rice and beans) are still present. This configures a diet at risk for important nutritional deficits, obesity, and many non-communicable chronic diseases.

Knowledge, perceptions, and behaviors of adults concerning nonalcoholic beverages suggest some lack of comprehension related to sugars

Key recommendations in the 2010 Dietary Guidelines for Americans and US Department of Agriculture's MyPlate are to reduce the intake of added sugars, particularly from sugar-sweetened beverages, and drink water instead of “sugary” beverages. However, little is known about consumer knowledge, perceptions, and behaviors regarding sugars in beverages. We hypothesized that consumers would have limited or inaccurate knowledge of the sugars in beverages and that their beverage consumption behaviors would not reflect their primary concerns related to sugars in beverages. An online survey was completed by 3361 adults 18 years and older residing throughout the United States. Water was consumed in the highest amounts followed by (in descending amounts) other beverages (includes coffee and tea), added sugar beverages, milk, diet drinks, and 100% fruit juice and blends. Participants primarily associated the term “sugary” with beverages containing added sugars; however, almost 40% identified 100% fruit juice as sugary. Some participants misidentified the types of sugars in beverages, particularly with respect to milk and 100% fruit juices. Generally, beverage choices were consistent with stated concerns about total, added, or natural sugars; however, less than 40% of participants identified added sugars as a primary concern when choosing beverages despite public health recommendations to reduce the intake of added sugars and sugar-sweetened beverages. Results suggest that there may be a considerable level of consumer misunderstanding or confusion about the types of sugars in beverages. More consumer research and education are needed with the goal of helping consumers make more informed and healthy beverage choices.

Effect of Nutrition Changes on Foods Selected by Students in a Middle School‐Based Diabetes Prevention Intervention Program: The HEALTHY Experience

The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high-fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added-sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.

Rationale, design and methods of the HEALTHY study nutrition intervention component.

The HEALTHY study was a randomized, controlled, multicenter and middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Here we describe the design of the HEALTHY nutrition intervention component that was developed to modify the total school food environment, defined to include the following: federal breakfast, lunch, after school snack and supper programs; a la carte venues, including snack bars and school stores; vending machines; fundraisers; and classroom parties and celebrations. Study staff implemented the intervention using core and toolbox strategies to achieve and maintain the following five intervention goals: (1) lower the average fat content of foods, (2) increase the availability and variety of fruits and vegetables, (3) limit the portion sizes and energy content of dessert and snack foods, (4) eliminate whole and 2% milk and all added sugar beverages, with the exception of low fat or nonfat flavored milk, and limit 100% fruit juice to breakfast in small portions and (5) increase the availability of higher fiber grain-based foods and legumes. Other nutrition intervention component elements were taste tests, cafeteria enhancements, cafeteria line messages and other messages about healthy eating, cafeteria learning laboratory (CLL) activities, twice-yearly training of food service staff, weekly meetings with food service managers, incentives for food service departments, and twice yearly local meetings and three national summits with district food service directors. Strengths of the intervention design were the integration of nutrition with the other HEALTHY intervention components (physical education, behavior change and communications), and the collaboration and rapport between the nutrition intervention study staff members and food service personnel at both school and district levels.

Sugar-added beverages consumption among kindergarten children of Crete: effects on nutritional status and risk of obesity

ObjectiveTo assess the intake of sugar-added beverages such as soft drinks and commercially available fruit juices in kindergarten children, and to examine its association with obesity indices, physical activity levels and dietary habits.MethodsA total of 856 children aged 4–7 years living in Crete, Greece in 2004–5 were included in this cross-sectional study. Nutrient and food intake was assessed with the use of 3-day weighed food records. Body measurements were used in order to assess BMI and waist circumference, and moderate-to-vigorous physical activity was calculated with the use of a questionnaire.ResultsApproximately 59.8% of all children consumed sugar-added beverages on a daily basis. High intake of sugar-added beverages (> 250 g/day) was associated with low intakes of calcium (p < 0.001), vitamin A and E (p < 0.010), fruits and vegetables (p = 0.007), and milk and yogurt (p = 0.048). Compared to non or low consumers, high consumers of sugar-added beverages (> 250 g/day) had higher BMI levels and two times greater risk of being overweight and/or obese (OR:2.35, p = 0.023).ConclusionHigh intake of sugar-added beverages in kindergarten children is associated with poor eating habits and inadequate nutrient intake, as well as increased risk for developing childhood obesity.

Diet Quality in Young Children Is Influenced by Beverage Consumption

Background: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality.Objective: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children.Methods: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1–5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods.Results: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1–5 years), soda pop (2, 3, 4, 5 and 1–5 years) and added sugar beverages (2, 3, 4, 5 and 1–5 years). Dairy dependent fractions of 1–5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1–5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes.Conclusions: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.

Sugar-added beverages and adolescent weight change.

The increase in consumption of sugar-added beverages over recent decades may be partly responsible for the obesity epidemic among U.S. adolescents. Our aim was to evaluate the relationship between BMI changes and intakes of sugar-added beverages, milk, fruit juices, and diet soda. Our prospective cohort study included >10,000 boys and girls participating in the U.S. Growing Up Today Study. The participants were 9 to 14 years old in 1996 and completed questionnaires in 1996, 1997, and 1998. We analyzed change in BMI (kilograms per meter squared) over two 1-year periods among children who completed annual food frequency questionnaires assessing typical past year intakes. We studied beverage intakes during the year corresponding to each BMI change, and in separate models, we studied 1-year changes in beverage intakes, adjusting for prior year intakes. Models included all beverages simultaneously; further models adjusted for total energy intake. Consumption of sugar-added beverages was associated with small BMI gains during the corresponding year (boys: +0.03 kg/m2 per daily serving, p = 0.04; girls: +0.02 kg/m2, p = 0.096). In models not assuming a linear dose-response trend, girls who drank 1 serving/d of sugar-added beverages gained more weight (+0.068, p = 0.02) than girls drinking none, as did girls drinking 2 servings/d (+0.09, p = 0.06) or 3+ servings/d (+0.08, p = 0.06). Analyses of year-to-year change in beverage intakes provided generally similar findings; boys who increased consumption of sugar-added beverages from the prior year experienced weight gain (+0.04 kg/m2 per additional daily serving, p = 0.01). Children who increased intakes by 2 or more servings/d from the prior year gained weight (boys: +0.14, p = 0.01; girls +0.10, p = 0.046). Further adjusting our models for total energy intake substantially reduced the estimated effects, which were no longer significant. Consumption of sugar-added beverages may contribute to weight gain among adolescents, probably due to their contribution to total energy intake, because adjustment for calories greatly attenuated the estimated associations.