Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial

Abstract

BackgroundSince sugar-sweetened beverages (SSB) may contribute to the development of overweight in children, effective interventions to reduce their consumption are needed. Here we evaluated the effect of a combined school- and community-based intervention aimed at reducing children’s SSB consumption by promoting the intake of water. Favourable intervention effects on children’s SSB consumption were hypothesized.MethodsIn 2011-2012, a controlled trial was conducted among four primary schools, comprising 1288 children aged 6-12 years who lived in multi-ethnic, socially deprived neighbourhoods in Rotterdam, the Netherlands. Intervention schools adopted the ‘water campaign’, an intervention developed using social marketing. Control schools continued with their regular health promotion programme. Primary outcome was children’s SSB consumption, measured using parent and child questionnaires and through observations at school, both at baseline and after one year of intervention.ResultsSignificant positive intervention effects were found for average SSB consumption (B -0.19 litres, 95% CI -0.28;-0.10; parent report), average SSB servings (B -0.54 servings, 95% CI -0.82;-0.26; parent report) and bringing SSB to school (OR 0.51, 95% CI 0.36;0.72; observation report).ConclusionsThis study supports the effectiveness of the water campaign intervention in reducing children’s SSB consumption. Further studies are needed to replicate our findings.Trial registrationCurrent Controlled Trials: NTR3400

Interventions to reduce consumption of sugar‐sweetened beverages or increase water intake: evidence from a systematic review and meta‐analysis

“…Risk of bias across the 40 studies meta-analysed (in 38 existing articles) was generally medium to high, and unclear judgments were due to insufficient study details for all appraised domains; only four studies were judged to be of higher quality (48,55,63,73). The risk of bias for allocation concealment was high in 6 studies (16%) and unclear for 23 (61%) as a result of including nonrandomized interventions (40,46,50,60,62,66,70). A high risk of bias was found for outcome assessment in 8 studies (20%) as many results were not reported as being adjusted for confounders or attrition rates.…”

“…We extracted data on socio-demographic features to identify the effects of interventions on health equity. All studies indicated the gender of participants at baseline; 8 studies were conducted only in females (37,39,58,59,62,63,70,74), one in a male sample (49), 11 in low-income populations (42,45,49,50,53,56,60,63,68,72,74), 15 studies reported a health condition at baseline (being overweight or obese and having metabolic-syndrome),14 studies reported race/ethnicity of participants (African-American, Native-Canadian, American-Indian, Hispanic, Caucasian). Three studies (41,43,51) analysed results by gender and one study reported economic costs of the intervention (46).…”

“…The theory of social learning (83) suggests this technique is particularly influential in changing behaviour, especially when participants are able to model someone they like or admire and when they see the behaviour modelled by more than one person (84) (in this context, both parental figures). Drawing from the relevant studies in this review, it is possible that participants could reduce their SSB intake particularly through demonstrations on how to choose and prepare less-sweetened alternatives incorporated within the intervention activities (50,55,62,63). Indeed, Baranowski and colleagues (59) piloted a summer camp initiative in African-American girls at higher risk of obesity.…”

Water Consumption in European Children: Associations with Intake of Fruit Juices, Soft Drinks and Related Parenting Practices

“…For that reason, several intervention studies have examined the effects of the replacement of sugary beverages’ consumption by the consumption of water, in which a reduction in total calories [9,20,21], positive behavioural changes and weight loss have been demonstrated [20]. Nevertheless, discouraging children from drinking sugary drinks and switching to water is challenging, considering the many physical and social environmental factors that may influence their choices.…”

Improved Interpretive Accuracy of Sugar Content on Beverage Labels Following an Educational Intervention for Children

“…Attempts to reduce SSB consumption include initiatives by major beverage companies to reduce the caloric content, taxation policies, nutritional counseling, and substituting with water or non-caloric sweeteners instead [9][10][11][12][13][14]. Although several investigators have demonstrated the effectiveness of education, in a meta-analysis of recent studies aimed at reducing SSB consumption, none included an educational intervention aimed specifically at children and devoted to awareness of sugar content in beverages [15].…”