Trends in children's sweetened-beverage consumption

Nutrition Research Newsletter, Feb, 2005

Obesity among children has increased dramatically over the past three decades. Currently, 10.4% of preschool children, 15.3% of school-age children, and 15.5% of adolescents are overweight (body mass index [BMI]>95th percentile). Obese children tend to become obese adults. Overweight children tend to remain overweight during follow-up periods of up to 20 years and in general have a 1.5- to 2-fold increased risk of being overweight as adults. Obesity in early life is associated with coronary heart disease, hypertension, and type 2 diabetes in adulthood.

Trends in beverage consumption among children and adolescents suggest that soft drinks may be replacing more nutritious beverages such as fruit juices and milk. Data from national dietary surveys indicate that consumption of soft drinks has increased dramatically among US children and adolescents. During the same time frame, children's consumption of milk has significantly decreased. Whether milk has simply become less popular or whether soft drinks have been substituted for milk remains to be determined in longitudinal studies. High consumption of soft drink might lead to excessive energy intake, which may be contributing to childhood obesity.

The Bogalusa Heart Study, a long-term epidemiologic study of cardiovascular risk factors from childhood to adulthood, provides the opportunity to document eating patterns of children from 1973 to 1994 in a well-defined biracial (white-black) population in Bogalusa, LA. The goal of this study was to examine changes in children's sweetened-beverage consumption over two decades, and whether trends in energy intake, milk consumption, and BMI varied among the sweetened-beverage consumption groups. Information on food and nutrient intake was derived from a single 24-hour dietary recall collected from children who participated in one of seven cross-sectional surveys. A total of 1,548 10-year-old children (65% white, 35% African American; 51% female, 49% male) were randomly selected to participate in the study. For each survey period, the 24-hour recalls were analyzed on the Moore Extended Nutrients database, and the nutrient information was stored in a file.

The percentage of children consuming sweetened beverages significantly decreased from 83% (1973) to 81% (1994), particularly consumption of soft drinks and coffee with sugar. However, the mean gram amount of tea with sugar consumed significantly increased, with no changes in the mean gram amount of fruit drinks, soft drinks, and coffee with sugar consumed. When comparing tertiles of sweetened-beverage consumption over time, the mean gram consumption significantly increased from 1973 to 1994 for those children who were in the medium to high tertiles. The mean BMI significantly increased from 1973 to 1994 in children within all of the sweetened-beverage consumption groups; however, there were no significant differences in total BMI across the sweetened-beverage consumption groups. The total gram amount of milk consumption was significantly lower in the medium to high sweetened-beverage consumption groups compared with the lower to no sweetened-beverage consumption groups. Total energy intake remained unchanged from 1973 to 1994 within all four sweetened-beverage consumption groups. Total energy intake was significantly higher in the high sweetened-beverage consumption group compared with the other three sweetened-beverage consumption groups.

Children's sweetened-beverage consumption has changed over a 21-year period. Data suggest that there was no linear relationship between sweetened-beverage consumption and BMI and total energy intake. However, total milk consumption was lower in the medium to high sweetened-beverage consumption groups compared to the low to no consumption groups. More studies are needed to confirm these regional findings, which may not be reflective of national trends. Despite the decrease in the percentage of Bogalusa children consuming sweetened beverages, the mean gram amount of sweetened beverages consumed increased, reflecting the increased consumption of tea with sugar. Moreover, the increased gram amount consumed was found in children who consumed moderate to high amounts of sweetened beverages.

To summarize, there was a decrease in the percentage of children consuming sweetened beverages; however, those children who were consuming sweetened beverages were consuming larger quantities. Apparently there are regional variations in the percentage of children consuming sweetened beverages and in the type of sweetened beverages being consumed. Nevertheless, careful monitoring of children's sweetened-beverage intake is warranted because energy contribution must be balanced with energy expenditure. In addition, consumption of milk should be encouraged, particularly if increased soft drink consumption begins to replace milk consumption.

R Rajeshwari, S Yang, T Nicklas, G Berenson. Secular trends in children's sweetened-beverage consumption (1973 to 1994): The Bogalusa Heart Study. JADA 105(2):208-214 (February 2005) [Correspondence: Theresa A. Nicklas, DrPH, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX 77030. Email: tnicklas@bcm.tmc.edu]