Association of Sugar-Sweetened Beverage Frequency with Adiposity: Evidence from the “Children of 1997” Birth Cohort

Abstract

Background: Observationally, sugar-sweetened beverage (SSB) consumption is associated with adiposity in Western children but could be confounded. We examined the association of SSB frequency with adiposity in the non-Western setting of Hong Kong. Methods: We examined the associations of SSB consumption frequency at 11 and 13 years assessed by using a food frequency questionnaire with subsequent body mass index (BMI) z-score and overweight/obesity up to 18 years using generalized estimating equations, and with waist circumference, waist-to-hip ratio, and body fat percentage at 16-19 years using linear regression in a population-representative Chinese birth cohort "Children of 1997" (n = 3628). Results: At 11 and 13 years, 6.8% and 8.2% of children respectively consumed SSB daily. Neither SSB frequency at 11 nor at 13 years was associated with subsequent BMI z-score or overweight/obesity up to 18 years, or with waist circumference, waist-to-hip ratio, or body fat percentage at 16-19 years adjusted for age, sex, socioeconomic position, health status, physical activity and other food consumption, although bias to the null from under-reporting cannot be eliminated. Conclusion: Although we cannot definitively exclude a small association of SSB frequency with adiposity, lack of association of SSB frequency with adiposity in a non-Western setting with low SSB consumption suggests that the role of SSB in adiposity appears to be minor.Nutrients 2020, 12, 1015 2 of 13 unreliable [8]. A few randomized controlled trials (RCT) have been conducted in children [9,10], which suggested reducing SSB intake reduces weight. However, meta-analyses of RCTs have revealed mixed findings. One meta-analysis showed no overall effect of SSB intake on weight in children, possibly due to low compliance in some included trials [6]. This meta-analysis also found weight decrease for reduced sugars intake and weight increase for increased sugars intake in trials of adults with ad libitum diets [6]. However, some others showed small effects of SSB intake on weight or BMI, which may be more marked for increasing consumption of SSB on weight gain and among the overweight [5,11,12]. As a beverage containing naturally occurring sugars, 100% fruit juice was not associated with weight gain in children aged 7 to 18 years in a meta-analysis of observational studies [13], but no RCT to date has tested the effect of 100% fruit juice on adiposity in children.Given the inconclusive evidence concerning the effect of SSB on adiposity, assessing the association in settings with different confounding patterns can be helpful [14]. Unlike in Western developed settings, obesity is less clearly socially patterned in Hong Kong Chinese children [15,16]. Chinese children also consume fewer SSBs than those in Western developed countries [17]. SSB consumption in Chinese children may have different socioeconomic patterns than in Western settings, where children of lower SEP tend to consume more SSB [18]. Here, we examined the association of SSB frequency at 11 and 13 years ...

Association of genetically predicted blood sucrose with coronary heart disease and its risk factors in Mendelian randomization

“…However, observational studies, largely from Western settings, may be biased by confounding by socioeconomic position and lifestyle 14 . In contrast, our previous findings from a birth cohort of Hong Kong Chinese children, where adiposity is not strongly confounded by socio-economic position 15 , suggested no association of SSB consumption with adiposity 16 . Randomized controlled trials (RCT) of the effect of sugar intake on CVD or T2D are lacking.…”

“…However, the studies of SSB also found positive associations of artificially sweetened beverages with T2D 9,32 , implying that the associations might be due to confounding rather than to sugar itself. The null association with adiposity is concordant with our previous finding of SSB with adiposity in Hong Kong Chinese children 16 , but inconsistent with positive associations of sugar or SSB intake with weight gain in observational studies in Western populations 10,11 . The finding is more consistent with meta-analyses of RCTs showing no effect of substituting sugar for other carbohydrates on weight 10,17,20 .…”

Environment-wide and epigenome-wide association study of adiposity in “Children of 1997” birth cohort

“…In this environment-wide and epigenome-wide association study, we systematically examined associations of over four hundred exposures with adiposity in a unique Chinese birth cohort, as well as the association of DNA methylation with adiposity. Building on the previous studies in this birth cohort (19)(20)(21)23), we not only confirmed established risk factors, such as maternal second-hand smoking (48), but also added by identifying novel exposures not reported in previous EWAS in western settings (8,9), such as consumption of ASB and soymilk. The comparison with RCTs or MR studies support a role of higher birth weight, dairy intake, binge eating and possibly earlier puberty in adiposity.…”

Consumption of sugar‐sweetened beverages and metabolic markers in children – a narrative review of the evidence

“…Because of social desirability bias, SSB consumption may have been underreported regardless of what instrument for assessing dietary intake is used, where non‐differential misclassification of SSB consumption frequency usually biases towards the null (Hebert et al, 1995; Zhang et al, 2020).…”