Impact of Masked Replacement of Sugar-Sweetened with Sugar-Free Beverages on Body Weight Increases with Initial BMI: Secondary Analysis of Data from an 18 Month Double–Blind Trial in Children

Abstract

BackgroundSubstituting sugar-free for sugar-sweetened beverages reduces weight gain. This effect may be more pronounced in children with a high body mass index (BMI) because their sensing of kilocalories might be compromised. We investigated the impact of sugar-free versus sugary drinks separately in children with a higher and a lower initial BMI z score, and predicted caloric intakes and degree of compensation in the two groups.Methods and FindingsThis is a secondary, explorative analysis of our double-blind randomized controlled trial (RCT) which showed that replacement of one 250-mL sugary drink per day by a sugar—free drink for 18 months significantly reduced weight gain. In the 477 children who completed the trial, mean initial weights were close to the Dutch average. Only 16% were overweight and 3% obese. Weight changes were expressed as BMI z-score, i.e. as standard deviations of the BMI distribution per age and sex group. We designated the 239 children with an initial BMI z-score below the median as ‘lower BMI’ and the 238 children above the median as ‘higher BMI’. The difference in caloric intake from experimental beverages between treatments was 86 kcal/day both in the lower and in the higher BMI group. We used a multiple linear regression and the coefficient of the interaction term (initial BMI group times treatment), indicated whether children with a lower BMI responded differently from children with a higher BMI. Statistical significance was defined as p ≤ 0.05. Relative to the sugar sweetened beverage, consumption of the sugar—free beverage for 18 months reduced the BMI z-score by 0.05 SD units within the lower BMI group and by 0.21 SD within the higher BMI group. Body weight gain was reduced by 0.62 kg in the lower BMI group and by 1.53 kg in the higher BMI group. Thus the treatment reduced the BMI z-score by 0.16 SD units more in the higher BMI group than in the lower BMI group (p = 0.04; 95% CI -0.31 to -0.01). The impact of the intervention on body weight gain differed by 0.90 kg between BMI groups (p = 0.09; 95% CI -1.95 to 0.14). In addition, we used a physiologically-based model of growth and energy balance to estimate the degree to which children had compensated for the covertly removed sugar kilocalories by increasing their intake of other foods. The model predicts that children with a lower BMI had compensated 65% (95% CI 28 to 102) of the covertly removed sugar kilocalories, whereas children with a higher BMI compensated only 13% (95% CI -37 to 63).ConclusionsThe children with a BMI above the median might have a reduced tendency to compensate for changes in caloric intake. Differences in these subconscious compensatory mechanisms may be an important cause of differences in the tendency to gain weight. If further research bears this out, cutting down on the intake of sugar-sweetened drinks may benefit a large proportion of children, especially those who show a tendency to become overweight.Trial RegistrationClinicalTrials.gov NCT00893529

Metabolic Effects of Replacing Sugar-Sweetened Beverages with Artificially-Sweetened Beverages in Overweight Subjects with or without Hepatic Steatosis: A Randomized Control Clinical Trial

“…However, while many intervention studies in which fructose or sugar were added to the usual daily intakes of participants documented significant increases in plasma triglycerides [29,30], few interventions involving the reduction of dietary sugar over several months or years have reported on plasma lipids. One such study, which had previously reported a lower BMI increase in children receiving ASBs than in controls receiving SSBs [31], has recently reported published data related to the study’s secondary outcomes: in spite of a two-year intervention, there was also absolutely no effect of replacing SSBs with ASBs on fasting blood triglyceride concentrations [32]. …”

Low- and No- Calorie Sweeteners (LNCS): critical evaluation of their safety and health risks

“…of growth and energetic balance to estimate the degree of caloric compensation that each child had to compensate for the loss of the sugar calories from their drinks by increasing their intake of kilocalories from other foods and beverages. Children with overweight (16%) and obesity (3%) also participate in the trial (Katan et al, 2016). Ot was possible to verify that the children with BMO above the media had a reduction of the tendency to compensate the changes in the intake of calories.…”

Asupan gula sederhana sebagai faktor risiko obesitas pada siswa-siswi sekolah menengah pertama di Kecamatan Pamulang, Kota Tangerang Selatan

“…Data Riskesdas tahun 2010 menunjukkan bahwa prevalensi nasional kegemukan pada remaja usia 13-15 tahun sebesar 2,5% (5). Provinsi Banten merupakan salah satu dari 14 provinsi yang memiliki prevalensi kegemukan pada remaja usia 13 Hasil analisis regresi logistik permodelan digunakan untuk mengetahui adanya hubungan variabel pendidikan ibu, pekerjaan ibu, pendidikan ayah, pekerjaan ayah dan asupan gula sederhana dengan kejadian obesitas. Hasil analisis model 1 menunjukkan bahwa pendidikan ibu, pekerjaan ibu, pendidikan ayah, dan asupan gula sederhana memiliki hubungan yang signifikan secara statistik terhadap kejadian obesitas (p<0,05), sedangkan pekerjaan ayah tidak memiliki hubungan yang signifikan terhadap kejadian obesitas.…”

“…Sebuah penelitian pada tahun 2016 menjelaskan bahwa terdapat hubungan yang signifikan antara konsumsi minuman manis dengan Indeks Massa Tubuh (IMT) pada anak-anak (13). Konsumsi minuman bebas gula selama 18 bulan mengurangi skor IMT sebesar 0,05 SD pada kelompok dengan IMT yang lebih rendah dan sebesar 0,21 SD pada kelompok dengan IMT yang lebih tinggi.…”