Soft drinks consumption, diet quality and BMI in a Mediterranean population

Abstract

Objectives: Evidence of the effects of soft drinks consumption on BMI and lifestyle in adult populations is mixed and quite limited. The aim of the present study was to determine the association of soft drinks consumption with BMI and lifestyle in a representative Mediterranean population. Design: Two independent, population-based, cross-sectional (2000 and 2005) studies. Dietary intake was assessed using a validated FFQ. Weight and height were measured. Setting: Girona, Spain. Subjects: Random sample of the 35-to 74-year-old population (3910 men and 4285 women). Results: Less than half (41?7 %) of the population consumed soft drinks; the mean consumption was 36?2 ml/d. The prevalence of sedentary lifestyle increased with the frequency of soft drinks consumption (P 5 0?025). Daily soft drinks consumption significantly increased the risk of low adherence to the Mediterranean diet (OR 5 0?57, 95 % CI 0?44, 0?74 v. top tertile of Mediterranean diet score). Multiple linear regression analyses, controlled for potential confounders, revealed that an increment in soft drinks consumption of 100 ml was associated with a 0?21 kg/m 2 increase in BMI (P 5 0?001). Only implausibly low reports of energy consumption showed a null association between soft drinks consumption and BMI. Conclusions: Soft drinks consumption was not embedded in a healthy diet context and was positively associated with BMI and sedentary lifestyle in this Mediterranean population.

Systematic review of the evidence for an association between sugar-sweetened beverage consumption and risk of obesity

“…Although the evidence is very limited, both of the observational studies that adjusted for energy from non-sugar-sweetened beverage sources showed a significant association between soft drink/soda consumption and increased BMI ( Table 2). 42,78 In a meta-analysis of sugar-sweetened beverage consumption and weight gain, meta-regressions for adjustment for total energy (P = 0.37) suggested that total energy intake may not be a substantial source of heterogeneity. 16 However, when the analysis was stratified on the basis of whether the study was adjusted for total energy intake, the estimate for change in body weight was significant and was greater in studies that did not adjust for total energy intake (0.08; 95%CI, 0.02-0.14; I 2 = 91.1%; n = 17) than in studies that did adjust for total 42 energy intake, in which the estimate for change was not significant (0.04; 95%CI, 0.00-0.07; I 2 = 0%; n = 3).…”

“…A separate review, however, was conducted on the limited studies that adjusted for energy intake from non-sugarsweetened beverage sources. 42,78 In addition to the consideration of energy intake, measurement of physical activity, an important component of energy balance, was also a confounder that needed to be considered in the observational studies. Conclusions could not be drawn from 45 of the studies identified for one or more of the following reasons: 1) associations were not adjusted for total energy intake and/or physical activity; 2) there was no indication that the food frequency questionnaire used to estimate sugar-sweetened beverage intake had been validated; 3) incidence of obesity was combined with incidence of overweight; and 4) statistical analysis for the relationship between sugar-sweetened beverage intake and BMI or incidence of obesity was not provided.…”

“…Two observational studies were identified (Table 2). 42,78 Schulze et al 78 conducted a prospective cohort analysis of moderate quality that included 51,603 young and middle-aged women from the Nurses' Health Study II. After adjustment for a number of confounders that included age, BMI, physical activity, and energy from non-sugar-sweetened beverage sources, women who consistently consumed ≥1 sugar-sweetened soft drink per day had a significantly greater increase in BMI than women who consumed ≤1 sugar-sweetened soft drink per week (P < 0.001).…”

“…Balcells et al 42 carried out a cross-sectional study that included 7,101 Spanish men and women. This moderate-quality study found a significant positive association between soft drink consumption and BMI after adjustment for age, gender, physical activity, and energy intake excluding soft drinks (95%CI, 0.112-0.313; P < 0.001).…”

Sugar consumption, metabolic disease and obesity: The state of the controversy

“…There are a several epidemiological studies that report a significant positive relationship between sugar-sweetened beverage consumption and BMI, even with adjustment for total energy intake (126–130). This does suggest that it is possible that consumption of fructose could have effects on body weight that are independent of total energy intake.…”