Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents: A Randomized, Controlled Pilot Study

Ebbeling, Cara B.; Feldman, Henry A.; Osganian, Stavroula K.; Chomitz, Virginia R.; Ellenbogen, Sheila J.; Ludwig, David S.

doi:10.1542/peds.2005-0983

Cited by 480 publications

(482 citation statements)

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“…29 Our review addressed these limitations and aimed to evaluate a broader scope of metabolic health outcomes (beyond weight gain and body composition) focusing on long-term effects and including prenatal exposures. With stringent requirements for long-term outcomes after early NNS exposure (before 12 years of age) and NNS-specific longitudinal analyses demonstrating clearly prospective relationships (baseline NNS exposures associated with subsequent metabolic outcomes), some studies included in previous reviews were excluded from ours because of insufficient duration and evaluation of adolescent populations, 38,39 multifaceted interventions, 40 or unclear temporality of exposure. 41,42 Even with our search strategy improvements, evaluation of new studies, and strict inclusion criteria to reduce heterogeneity and address our modified research question, we have found insufficient evidence to clearly determine whether an association exists between earlylife NNS exposure and long-term metabolic health.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

Reid¹,

Chauhan

Rabbani

et al. 2016

Pediatrics

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CONTEXT: Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health impact is unclear, particularly when exposure occurs during early life.OBJECTIVE: To synthesize evidence from prospective studies evaluating the association of early-life NNS exposure and long-term metabolic health.DATA SOURCES: Medline, Embase, and Cochrane Library (inception to July 2015). STUDY SELECTION:We aimed to include randomized controlled trials (RCTs) evaluating NNSbased interventions and prospective cohort studies reporting NNS exposure among pregnant women, infants, or children (<12 years of age), with a minimum study duration of 6 months. DATA EXTRACTION:The primary outcome was BMI; secondary outcomes included growth velocity, overweight/obesity, adiposity, and adverse metabolic effects. Study quality and risk of bias were evaluated using validated assessment tools. RESULTS:We identified 6 eligible cohort studies and 2 RCTs (n = 15 641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure.LIMITATIONS: Meta-analysis was limited because of the small number of eligible studies and heterogeneity of populations and outcomes. CONCLUSIONS:There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population.

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

Reid¹,

Chauhan

Rabbani

et al. 2016

Pediatrics

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“…Many cross-sectional studies have shown a positive association between consumption of sweetened beverages, mainly in teenagers, and body weight [58][59][60][61][62][63][64][65] (reviewed in [66]). Interventional studies further showed that adding sweetened beverages to the usual diet led to an increase in body weight [67,68], while reducing sweetened beverages intake in overweight subjects decreased body weight [69][70][71][72][73]. Several large studies also reported that sweetened beverage consumption increased the risk of developing type 2 diabetes, but this effect was essentially linked to body weight changes [74][75][76].…”

Section: Do Changes In Fructose Consumption Explain the Current Epidementioning

confidence: 99%

Fructose and metabolic diseases: New findings, new questions

et al. 2010

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There has been much concern regarding the role of dietary fructose in the development of metabolic diseases. This concern arises from the continuous increase in fructose (and total added caloric sweeteners consumption) in recent decades, and from the increased use of high-fructose corn syrup (HFCS) as a sweetener. A large body of evidence shows that a high-fructose diet leads to the development of obesity, diabetes, and dyslipidemia in rodents. In humans, fructose has long been known to increase plasma triglyceride concentrations. In addition, when ingested in large amounts as part of a hypercaloric diet, it can cause hepatic insulin resistance, increased total and visceral fat mass, and accumulation of ectopic fat in the liver and skeletal muscle. These early effects may be instrumental in causing, in the long run, the development of the metabolic syndrome. There is however only limited evidence that fructose per se, when consumed in moderate amounts, has deleterious effects. Several effects of a high-fructose diet in humans can be observed with high-fat or high-glucose diets as well, suggesting that an excess caloric intake may be the main factor involved in the development of the metabolic syndrome. The major source of fructose in our diet is with sweetened beverages (and with other products in which caloric sweeteners have been added). The progressive replacement of sucrose by HFCS is however unlikely to be directly involved in the epidemy of metabolic disease, because HFCS appears to have basically the same metabolic effects as sucrose. Consumption of sweetened beverages is however clearly associated with excess calorie intake, and an increased risk of diabetes and cardiovascular diseases through an increase in body weight. This has led to the recommendation to limit the daily intake of sugar calories.Pure, white, and deadly: the dark side of sugar was suspected many years ago, when an association between sugar consumption and coronary heart diseases was recognized and emphasized by John Yudkin [1]. Sugar, a natural sweetener obtained from either sugar cane or beets, is a disaccharide composed of one glucose molecule linked through an α1-4 glycoside bond to a fructose molecule. Fructose, besides contributing to half the total content of sugar, can also be found as a hexose in fruits and honey. More recently, sweeteners started to be produced from corn through starch isolation and hydrolysis to glucose, followed by enzymatic isomerization of part of the glucose into fructose [2,3]. The resulting mixture, known as high-fructose corn syrup (HFCS), has several industrial advantages over sugar, the most important being its low price, and has progressively replaced sugar consumption in North America over the past 30 years.Fructose metabolism has been reviewed extensively elsewhere [4][5][6] and will be only briefly outlined here. In the gut, fructose is transported by specific transporters, GLUT5 [7,8]. In some subjects, fructose absorption is quantitatively limited, and some malabsorption occurs when lar...

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“…11,12 In contrast, drinking plain water instead of SSBs is one approach for individuals trying to reduce dietary energy intake and thereby possibly benefit obesity prevention and control. [13][14][15] Hence, consuming water as part of a healthy diet (eg, one that contains fruits, vegetables, whole grains, low-fat/reduced fat dairy, and lean meats) can aid weight management [13][14][15][16] and, if substituted for SSB consumption, also possibly avert the adverse consequences associated with SSB intake such as dental caries, 6 and avoid risks from high levels of SSBs such as developing obesity [2][3][4][5] and type 2 diabetes. 7 One approach for promoting water intake is to make free potable drinking water widely accessible in public facilities, including schools.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Low Water Intake among US High School Students—National Youth Physical Activity and Nutrition Study, 2010

Park¹,

Blanck²,

Sherry³

et al. 2012

Journal of the Academy of Nutrition and Dietetics

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Drinking plain water instead of sugar-sweetened beverages is one approach for reducing energy intake. Only a few studies have examined characteristics associated with plain water intake among US youth. The purpose of our cross-sectional study was to examine associations of demographic characteristics, weight status, dietary habits, and other behavior-related factors with plain water intake among a nationally representative sample of US high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,049 students in grades 9 through 12 were used. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95% CIs for variables associated with low water intake (<3 times/day). Nationwide, 54% of high school students reported drinking water <3 times/day. Variables significantly associated with Address correspondence to: Sohyun Park, PhD, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mailstop K26, Atlanta, GA 30341. spark3@cdc.gov. STATEMENT OF POTENTIAL CONFLICT OF INTERESTNo potential conflict of interest was reported by the authors. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript a greater odds for low water intake were age ≤15 years (OR 1.1), consuming <2 glasses/day of milk (OR 1.5), nondiet soda ≥1 time/day (OR 1.6), other sugar-sweetened beverages ≥1 time/day (OR 1.4), fruits and 100% fruit juice <2 times/day (OR 1.7), vegetables <3 times/day (OR 2.3), eating at fast-food restaurants 1 to 2 days/week and ≥3 days/week (OR 1.3 and OR 1.4, respectively), and being physically active ≥60 minutes/ day on <5 days/week (OR 1.6). Being obese was significantly associated with reduced odds for low water intake (OR 0.7). The findings of these significant associations of low water intake with poor diet quality, frequent fast-food restaurant use, and physical inactivity may be used to tailor intervention efforts to increase plain water intake as a substitute for sugar-sweetened beverages and to promote healthy lifestyles. KeywordsDrinking water; Dietary intake; Adolescents; Sugar-sweetened beverages; Television Sugar-Sweetened Beverages (Ssbs) are the largest source of added sugar and an important contributor of energy in the diet of US youth. 1 Consumption of SSBs has been associated with obesity, 2-5 dental caries, 6 type 2 diabetes, 7 poor mental health, 8,9 poor academic grades, 10 and displacement of nutrient-rich foods. 11,12 In contrast, drinking plain water instead of SSBs is one approach for individuals trying to reduce dietary energy intake and thereby possibly benefit obesity prevention and control. [13][14][15] Hence, consuming water as part of a healthy diet (eg, one that contains fruits, vegetables, whole grains, low-fat/reduced fat dairy, and lean meats) can aid weight management [13][14][15][16] and, if substituted for SSB consumption, also possibly aver...

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Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents: A Randomized, Controlled Pilot Study

Cited by 480 publications

References 33 publications

Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

Fructose and metabolic diseases: New findings, new questions

Factors Associated with Low Water Intake among US High School Students—National Youth Physical Activity and Nutrition Study, 2010

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