Soft drink consumption among US children and adolescents: nutritional consequences

OBJECTIVE: To determine whether carbonated soft drink consumption is associated with consumption of milk, fruit juice, and the nutrients concentrated in these beverages. DESIGN: Data collected as part of the 1994 Continuing Survey of Food Intakes by Individuals were analyzed. Information on food and nutrient intake was derived from 2 days of dietary recall data collected via an in-person interview. SUBJECTS AND PARTICIPANTS: Nationally representative sample of people of all ages residing in the United States (response rate = 76.2%). Analyses were restricted to children aged 2 to 18 years (N = 1,810). STATISTICAL ANALYSES PERFORMED: Logistic regression analyses were conducted to predict the odds of low milk and juice consumption by soft drink consumption level. To determine whether intake of select nutrients varied by soft drink consumption, multiple linear regression modeling was conducted. Analyses were conducted using sample weights and software appropriate for the survey design. RESULTS: Energy intake was positively associated with consumption of nondiet soft drinks. For example, mean adjusted energy intake was 1,830 kcal/day for school-aged children who were nonconsumers of soft drinks compared with 2,018 kcal/day for children in this age group who consumed an average of 9 oz of soda or more per day. Those in the highest soft drink consumption category consumed less milk and fruit juice compared with those in the lowest consumption category (nonconsumers). CONCLUSIONS: Nutrition education messages targeted to children and/or their parents should encourage limited consumption of soft drinks. Policies that limit children's access to soft drinks at day care centers and schools should be promoted.     

Lunchbox contents of Australian school children: room for improvement

OBJECTIVE: In light of the increasing prevalence of obesity in children and the potential of schools as a setting for intervention, we aimed to identify the main foods and beverages consumed at primary school and to determine differences in consumption patterns between children who used the school canteen and those who did not. DESIGN: Cross-sectional survey of school foods in 1681 5-12 y old children, 2003-2004. SETTING: Barwon South-Western region of Victoria, Australia. RESULTS: The school food provided an average (+/-s.e.m.) of 3087+/-26 kJ. Bread was the most frequently consumed food and contributed 20% of total energy at school, biscuits 13%, fruit 10%, muesli/fruit bars 8%, packaged snacks 7%, and fruit juice/cordial 6%. About 10% of children used the school canteen and these children obtained more total energy and more energy from cakes, fast foods and soft drink than noncanteen users (P<0.001). In all, 68% of children had fruit in their lunchboxes, however, over 90% of children had energy-dense, micronutrient-poor snacks ('junk food'). CONCLUSIONS: Fruit intake in primary schools seems reasonably high but could be targeted for further increase as part of promoting a healthy diet. Of concern, however, are the excessive amounts of energy-dense foods in school lunchboxes. These should be considered a priority for health promotion efforts along with reducing the consumption of sweetened drinks. These measures are urgently needed to improve the school-based diets of Australian children and attempt to curb the increasing prevalence of childhood obesity.     

National survey beverage consumption data for children and adolescents indicate the need to encourage a shift toward more nutritive beverages

The American Academy of Pediatrics (AAP) recently issued recommendations for 100% fruit juice consumption for children and adolescents. National survey data (1994-1996, 1998 Continuing Survey of Food Intakes by Individuals) were used to evaluate intake of 100% fruit juice for comparison with AAP recommendations. Mean daily intakes of 100% fruit juice were 0.9, 4.6, and 3.4 ounces in children aged <6 months, 6 months-6 years, and 7-18 years, respectively, which fall within AAP recommendations for these age groups. At age 5, mean intake of fruit drinks and ades exceeded that of 100% fruit juice (P=.009). Carbonated soft drink intake exceeded that of 100% fruit juice at age 5 and of milk at age 13 (P<.04). By age 13, adolescents drank more carbonated soft drinks than 100% fruit juice, milk, or fruit drinks and ades. Increased consumption of nutrient-dense beverages (100% fruit juice, milk) and water as part of a varied diet should be encouraged.     

Correlates of soft drink and fruit juice consumption among Swedish adolescents

The aim of the study was to investigate how soft drink and fruit juice consumption in teenagers is associated with life-style, other food choices, eating behaviour and maternal characteristics. A cross-sectional study of 16-year-old girls (n 275) and boys (n 199) and their mothers was undertaken. Questionnaires were used to assess habitual dietary intake, eating behaviour, physical activity, smoking and educational level. Weight and height were measured. It was found that eating breakfast less than five times per week was independently associated with a high soft drink consumption in both girls and boys. A low intake of cooked meals and milk and a high intake of salty snacks were associated with soft drinks in boys only, and a low intake of fruits in girls only. A high maternal juice intake, low milk and high fruit consumption were independent correlates of fruit juice intake in both girls and boys. In girls, being a smoker, having a smoking mother, a high soft drink intake, scoring low on emotional eating and high on cognitive restraint were also associated with fruit juice intake. A low intake of soft drinks and cooked meals was associated with fruit juice intake in boys only. Neither soft drinks nor fruit juice was associated with BMI. In conclusion, a high intake of both fruit juice and soft drinks were associated with a lower intake of foods such as milk and cooked meals. It might be possible to influence fruit juice intake among teenagers by aiming at their mothers, whereas the adolescents themselves should be targeted when the aim is to reduce soft drink consumption.     

What are the key food groups to target for preventing obesity and improving nutrition in schools?

OBJECTIVE: To determine differences in the contribution of foods and beverages to energy consumed in and out of school, and to compare consumption patterns between school canteen users and noncanteen users. DESIGN: Cross-sectional National Nutrition Survey, 1995. SETTING: Australia. SUBJECTS ON SCHOOL DAYS: A total of 1656 children aged 5-15 y who had weekday 24-h dietary recall data. RESULTS: An average of 37% of total energy intake was consumed at school. Energy-dense foods and beverages such as fat spreads, packaged snacks, biscuits and fruit/cordial drinks made a greater contribution to energy intake at school compared to out of school (P< or =0.01). Fast foods and soft drinks contributed 11 and 3% of total energy intake; however, these food groups were mostly consumed out of school. Fruit intake was low and consumption was greater in school. In all, 14% of children purchased food from the canteen and they obtained more energy from fast food, packaged snacks, desserts, milk and confectionary (P< or =0.05) than noncanteen users. CONCLUSIONS:: Energy-dense foods and beverages are over-represented in the Australian school environment. To help prevent obesity and improve nutrition in schools, biscuits, snack bars and fruit/cordial drinks brought from home and fast food, packaged snacks, and confectionary sold at canteens should be replaced with fruit and water.     

Sugar consumption among Canadians of all ages

According to the 2004 Canadian Community Health Survey-Nutrition, Canadians consumed an average of 110 grams (26 teaspoons) of sugar a day, approximately 20% of their total energy intake. While over 30% of this sugar came from vegetables and fruit, 35% came from the "other" foods category, which consists of items such as soft drinks, salad dressings and candy. The top ten sources of sugar accounted for approximately 85% of daily sugar intake. Beverages (milk, fruit juice, fruit drinks and regular soft drinks) represented 44% of the sugar consumed by children and adolescents, and 35% of that consumed by adults. Diabetics' average sugar intake was less than that of non-diabetics, but at 17%, exceeded the recommended 10% cut-off of total daily calories.     

Association between adolescents’ consumption of total and different types of sugar‐sweetened beverages with oral health impacts and weight status

Objective: To examine the associations between adolescents’ intake of sugar‐sweetened beverages (SSBs) with oral health impacts (OHI) and weight status. Methods: Cross‐sectional health survey with anthropometry and self‐report OHI (toothache and avoiding some foods because of oral problems) and SSB intake (fruit juice, flavoured water, soft, diet, sports and energy drinks) collected in 2015. Results: A total of 3,671 adolescents participated (50% girls; mean age 13.2 years ±1.7). Drinking ≥1cup/day of SSBs was consistently associated with higher odds of OHI compared with drinking <1cup/day: diet soft drinks (AOR, 5.21 95%CI 2.67, 10.18); sports drinks (AOR 3.60 95%CI 1.93, 6.73); flavoured water (AOR 3.07 95%CI 1.55, 6.06); and energy drinks (AOR 2.14 95%CI 1.44, 3.19). Daily SSB intake was not consistently associated with weight status. The odds of overweight/obesity (AOR 1.27 95%CI 1.01, 1.59) and obesity (AOR 1.61 95%CI 1.01, 2.57) were higher for energy drink consumption, compared with not drinking energy drinks; and the odds of abdominal obesity were twice as high among adolescents who drank ≥1cup/day of sports drinks, compared with <1cup/day intake. Conclusions: Daily consumption of SSBs is prevalent among adolescents and is consistently associated with higher odds of OHI. The most popular SSBs among adolescents were energy drinks. Different types of SSB were differentially associated with OHI and weight status. Implications for public health: Different types of SSBs were differentially associated with OHI and weight status in adolescents. Diet soft drinks and new generation SSBs such as energy and sport drinks and flavoured water had a greater impact on adolescents’ OHI compared with soft drinks and fruit juice.     

Sugary drink consumption behaviours among young adults at university

Aim: Sugary drink consumption is associated with weight gain, and young adults are the highest consumers. To inform a university healthy beverage intervention, we studied the settings and the types and amounts of sugary drinks consumed by a sample drawn from the student population. Methods: Fifty university students (24 male) were recruited to keep records of all beverages consumed over four consecutive days. The records were analysed by gender, drink category and consumption setting. Results: Males drank marginally more sugary drinks than females (median daily intake of 526 mL compared with 300 mL, P = 0.06). Median energy intake from sugary drinks was 928 kJ for males and 481 kJ for females. Carbonated soft drinks and fruit‐based drinks accounted for 64% of energy from sugary drinks for males; and fruit and sweetened milk‐based drinks accounted for 68% of energy for females. Half of all sugary drink consumption occurred at home followed by social settings. Conclusion: Health promotion programmes aiming to reduce sugary drink consumption in this group would benefit from gender‐differentiated strategies with respect to types of drinks consumed with a focus on the home and social settings.     

Drink consumption in British preschool children: relation to vitamin C, iron and calcium intakes

Objective To examine the impact of soft drinks, fruit juices, milk and tea consumption on vitamin C, iron and calcium intakes in a large, representative sample of preschool children in the UK.
Design Secondary analysis of 4-day weighed dietary diaries.
Sample 1675 children aged 1.5–4.5 years living in the UK in 1992/993.
Results Fruit juice consumers, but not soft drink consumers, had higher vitamin C intakes and higher plasma ascorbate levels than nonconsumers ( P  < 0.001). However, overall intakes tended to exceed the RNI and 45% of children still had adequate intakes without the contribution of soft drinks and 56% without the contribution of fruit juice. Children who did not consume fruit juice or soft drinks were no more likely to have depleted levels of vitamin C than consumers. Tea drinkers had diets which were lower in iron and vitamin C than nonconsumers ( P  < 0.005). They had lower levels of haemoglobin ( P  < 0.05) but not ferritin. Children under 4 years old were less likely to meet the RNI for iron if they were tea drinkers ( P  < 0.005) but no more likely to be anaemic. Calcium intakes were significantly higher for whole milk consumers than for nonconsumers ( P  < 0.005) and 73% of overall calcium intake was predicted by quantity of all milks consumed. Whole milk consumers both under and over 4 years of age were significantly more likely to reach the RNI for calcium ( P  < 0.00005 and P  < 0.05).
Conclusions Preschool children's drinking has an impact on their intakes of vitamin C, iron and calcium. In particular, intakes of calcium are closely linked to the amount of milk consumed in this age group.     

Risk of inadequate intakes of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18

A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins, A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit and fruit juice/beverage intake was also solicited. Data drawn from the selected studies yielded a total of 6540 children and adolescents in eight geographical areas. The sample was stratified by age (children: 4 to 14 years old and adolescents: 13-18 years old) and sex. Inadequate intakes (below two-thirds of the recommended values) were notable in children for vitamin E, vitamin C, and vitamin A and in girls, iron. In adolescents, low intakes were especially marked for vitamin E and vitamin A, and in girls, calcium, folate, and iron. Adolescents consumed more vegetables, fruit juice, and fruit drinks whereas children had higher fruit intakes. Regional differences in consumption were also detected. Strategies for improving nutrient intake in these vulnerable populations are discussed.     

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.     

山东6～14岁儿童软饮料消费及其游离糖摄入分析

目的评估山东省6~14岁儿童软饮料饮用情况及由此摄入游离糖的风险,为指导儿童软饮料摄入及控制肥胖发生提供科学参考。方法采用多阶段分层整群随机抽样的方法,选择山东省内东营、济南、济宁、莱芜、聊城、临沂、青岛、泰安、威海、潍坊、烟台11个地区为调查点,其中各市调查点分城市和农村人口分别调查。结果共调查山东6~14岁儿童2 044人,男性1 039人,女性1 005人,城市556人,农村1 488人。碳酸饮料饮用率和饮用量男性均大于女性(χ2=5.582,t=2.625,P均0.05),果汁和蔬菜汁、咖啡或咖啡味饮料和含乳饮料饮用率女性大于男性(χ2=7.588,7.386,8.252,P均0.05)。城市儿童的饮用率总体高于农村(χ2=4.983,P0.05)。女性酸奶和咖啡类饮料的饮用量明显高于男性(t=-1.980,-2.555,P均0.05)。城市和农村均有特定种类饮料饮用量高于对方(P0.05)。城市儿童单双糖及游离糖(26.0 g/d,17.1 g/d)摄入量明显高于农村儿童(16.9 g/d,11.8 g/d)(t=8.14,5.30,P均0.05)。结论儿童经饮料摄入游离糖的供能未超过世界卫生组织、中国居民膳食指南和美国心脏协会的建议值,但所占比例较高。     

Australian print news media coverage of sweet, non-alcoholic drinks sends mixed health messages

Objective: This study aimed to analyse the contribution of Australian print news coverage to the public profile of sweet, non‐alcoholic beverages. News media portrayal of health contributes to individuals’ decision‐making. The focus on sugar‐sweetened beverages reflects their contribution to excessive energy intake. Methods: One year's coverage of sweet, non‐alcoholic beverages by major Australian newspapers was analysed using content and frame analysis. Research questions addressed which sweet drinks are most prominently covered, what makes sweet drinks newsworthy and how are the health aspects of sweet drinks framed? Results: Fruit juice was the most widely covered sweet drink, closely followed by carbonated, sugar‐sweetened soft drinks. Overall coverage was positively oriented towards sweet drinks, with fruit juice primarily portrayed as having health benefits. Some coverage mentioned risks of sweet drinks, such as obesity, tooth decay, metabolic syndrome and heart attack. Conclusions: Sweet drinks often enjoy positive coverage, with their health benefits and harms central to their ability to attract journalists’ attention. However, the mix of coverage may be contributing to consumer confusion about whether it is safe and/or healthy to consume sweet non‐alcoholic drinks. Implications: Framing of sweet drinks as healthy may undermine efforts to encourage individuals to avoid excess consumption of energy‐dense drinks which offer few or minimal health benefits.     

Soft drink consumption and urinary stone recurrence: a randomized prevention trial.

The object of this study was to determine if a strong association between soft drink (soda) consumption and recurrence of urinary stone disease, found in an earlier case-control study of adult males, had a causal component. The study sample consisted of 1009 male subjects, who completed an episode of urinary stone disease, who were aged 18-75 at that time, and who reported consuming at least 160 ml per day of soft drinks. Half of the subjects were randomized to refrain from consuming soft drinks, while the remaining subjects served as controls. The intervention group had an observed 6.4% advantage in actuarial 3 yr freedom from recurrence (p = 0.023 one-sided) over the control group. One important secondary finding was that for those who reported at the time of the index stone that their most consumed drink was acidified by phosphoric acid but not citric acid, the experimental group had a 15% higher 3 yr recurrence-free rate than the controls, p = 0.002, while for those who reported at the time of the index stone that their most consumed drink was acidified by citric acid with or without phosphoric acid, the experimental group had a similar 3 yr recurrence-free rate to the controls, p = 0.55. This interaction was significant, p = 0.019.     

Beverage patterns among Canadian children and relationship to overweight and obesity

Sweetened beverage intake has risen in past decades, along with a rise in prevalence of overweight and obesity among children. Our objective was to examine the relationship between beverage intake patterns and overweight and obesity among Canadian children. Beverage intake patterns were identified by cluster analysis of data from the cross-sectional Canadian Community Health Survey 2.2. Intake data were obtained from a single 24-hour recall, height and weight were measured, and sociodemographic data were obtained via interview. Data on children and adolescents aged 2-18 years who met inclusion criteria (n = 10?038) were grouped into the following categories: 2-5 years (male and female), 6-11 years (female), 6-11 years (male), 12-18 years (female), and 12-18 years (male). χ2 test was used to compare rates of overweight and obesity across clusters. Logistic regression was used to determine the association between overweight and obesity and beverage intake patterns, adjusting for potential confounders. Clustering resulted in distinct groups of who drank mostly fruit drinks, soft drinks, 100% juice, milk, high-fat milk, or low-volume and varied beverages (termed "moderate"). Boys aged 6-11 years whose beverage pattern was characterized by soft drink intake (553 ± 29 g) had increased odds of overweight-obesity (odds ratio 2.3, 95% confidence interval 1.2-4.1) compared with a "moderate" beverage pattern (23 ± 4 g soft drink). No significant relationship emerged between beverage pattern and overweight and obesity among other age-sex groups. Using national cross-sectional dietary intake data, Canadian children do not show a beverage-weight association except among young boys who drink mostly soft drinks, and thus may be at increased risk for overweight or obesity.     

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PurposePrevious studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.MethodsInterviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.ResultsMore frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = ?.04, p = .007), but depressive symptoms did not predict soft drink consumption.ConclusionsMore frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.     

Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights

Childhood obesity is currently at its highest: recent statistics show that 16% of children between the ages of 6 and 11 y are overweight [> or =95th percentile of body mass index (BMI; in kg/m(2)) for age] and that an additional 14.3% are at risk of becoming overweight (> or =85th percentile but < 95th percentile of BMI for age). As children's body weights have increased, so has their consumption of fast foods and soft drinks. The proportion of foods that children consumed from restaurants and fast food outlets increased by nearly 300% between 1977 and 1996. Children's soft drink consumption has also increased during those years, and now soft drinks provide soft drink consumers 188 kcal/d beyond the energy intake of nonconsumers. These changes in food intakes among children may partly explain the rise in childhood obesity observed in the past few years. Although the mechanism of appetite regulation will not be explored in this report, it is hypothesized that the greater energy intakes in children who consume large amounts of soft drinks and fast foods are not compensated for by increased physical activity or decreased energy intakes. Furthermore, overweight and obesity in childhood may predispose persons to morbidity in adulthood. Blood pressure and fasting insulin and cholesterol concentrations are higher in overweight children than in normal-weight children. This review focuses on current food patterns and eating habits of children, in an attempt to explain their increasing BMI. In addition, a critical review of food service and political practices regarding food choices for children at school is included.     

Associations of adequate intake of calcium with diet, beverage consumption, and demographic characteristics among children and adolescents

OBJECTIVE: The objective of this study is to examine various factors associated with total calcium intake and percent adequate intake (% AI) of calcium by children and adolescents, with respect to age, gender, race/ethnicity, and diet and beverage choices. DESIGN: Data from the U.S. Department of Agriculture's Continuing Survey of Food Intake by Individuals 1994-96, 98 were used in the analyses. Age groupings (2-3, 4-8, 9-13, and 14-18 year olds) were based on the National Academy of Sciences recommendations for AI of calcium-500, 800, 1,300, and 1,300 mg calcium per day, respectively. RESULTS: Consumption of milk products was strongly and positively associated with calcium intake. Consumption of carbonated soft drinks and other non-dairy beverages was also positively associated with calcium intake, but this association was very weak. Beverage choices of African-American children and adolescents are significantly different than white and Hispanic children and adolescents. For example, African-American adolescent girls consume fewer milk products and more fruit drinks/ades. Average daily carbonated soft drink consumption is approximately 1.6 and 1.0 twelve ounce cans among 14-18 year old boys and girls, respectively. CONCLUSION: Carbonated soft drink consumption among adolescent girls is modest and does not appear to be linked to decreased calcium intake. The analyses in this paper show that creative effective, efficient, and targeted policies should be considered to help adolescent girls increase calcium intake. Making low-fat milk products, flavored milks, calcium-fortified beverages and foods more attractive and available will help encourage girls to consume more of this important mineral. When adequate calcium intake is not achieved through foods, health professionals should consider recommending calcium supplements.