A new proposed guidance system for beverage consumption in the United States

The Beverage Guidance Panel was assembled to provide guidance on the relative health and nutritional benefits and risks of various beverage categories. The beverage panel was initiated by the first author. The Panel's purpose is to attempt to systematically review the literature on beverages and health and provide guidance to the consumer. An additional purpose of the Panel is to develop a deeper dialog among the scientific community on overall beverage consumption patterns in the United States and on the great potential to change this pattern as a way to improve health. Over the past several decades, levels of overweight and obesity have increased across all population groups in the United States. Concurrently, an increased daily intake of 150-300 kcal (for different age-sex groups) has occurred, with approximately 50% of the increased calories coming from the consumption of calorically sweetened beverages. The panel ranked beverages from the lowest to the highest value based on caloric and nutrient contents and related health benefits and risks. Drinking water was ranked as the preferred beverage to fulfill daily water needs and was followed in decreasing value by tea and coffee, low-fat (1.5% or 1%) and skim (nonfat) milk and soy beverages, noncalorically sweetened beverages, beverages with some nutritional benefits (fruit and vegetable juices, whole milk, alcohol, and sports drinks), and calorically sweetened, nutrient-poor beverages. The Panel recommends that the consumption of beverages with no or few calories should take precedence over the consumption of beverages with more calories.     

Beverage consumption and adult weight management: A review

Total energy consumption among United States adults has increased in recent decades, and energy-containing beverages are a significant contributor to this increase. Because beverages are less satiating than solid foods, consumption of energy-containing beverages may increase energy intake and lead to weight gain; trends in food and beverage consumption coinciding with increases in overweight and obesity support this possibility. The purpose of this review is to present what is known about the effect of beverage consumption on short-term (i.e., meal) energy intake, as well as longer-term effects on body weight. Specific beverages addressed include water, other energy-free beverages (diet soft drinks, coffee and tea), and energy-containing beverages (soft drinks, juices and juice drinks, milk and soy beverages, alcohol). Existing evidence, albeit limited, suggests that encouraging water consumption, and substituting water and other energy-free beverages (diet soft drinks, coffee and tea) for energy-containing beverages may facilitate weight management. Energy-containing beverages acutely increase energy intake, however long-term effects on body weight are uncertain. While there may be health benefits for some beverage categories, additional energy provided by beverages should be compensated for by reduced consumption of other foods in the diet.     

Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009

Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008-9, beverages accounted for 21, 14 and 18?% of daily energy intake for children aged 1·5-18 and 4-18 years, and adults (19-64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10?% increase in the price of SSB could potentially result in a decrease of 7·5?ml/capita per d. A similar 10?% tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5?ml/capita per d and increased reduced-fat milk purchase by 7?ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.     

Knowledge,perceptions, and behaviors of adults concerning nonalcoholic beverages suggest some lack of comprehension related to sugars

Key recommendations in the 2010 Dietary Guidelines for Americans and US Department of Agriculture's MyPlate are to reduce the intake of added sugars, particularly from sugar-sweetened beverages, and drink water instead of “sugary” beverages. However, little is known about consumer knowledge, perceptions, and behaviors regarding sugars in beverages. We hypothesized that consumers would have limited or inaccurate knowledge of the sugars in beverages and that their beverage consumption behaviors would not reflect their primary concerns related to sugars in beverages. An online survey was completed by 3361 adults 18 years and older residing throughout the United States. Water was consumed in the highest amounts followed by (in descending amounts) other beverages (includes coffee and tea), added sugar beverages, milk, diet drinks, and 100% fruit juice and blends. Participants primarily associated the term “sugary” with beverages containing added sugars; however, almost 40% identified 100% fruit juice as sugary. Some participants misidentified the types of sugars in beverages, particularly with respect to milk and 100% fruit juices. Generally, beverage choices were consistent with stated concerns about total, added, or natural sugars; however, less than 40% of participants identified added sugars as a primary concern when choosing beverages despite public health recommendations to reduce the intake of added sugars and sugar-sweetened beverages. Results suggest that there may be a considerable level of consumer misunderstanding or confusion about the types of sugars in beverages. More consumer research and education are needed with the goal of helping consumers make more informed and healthy beverage choices.     

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.     

Five-Year Longitudinal and Secular Shifts in Adolescent Beverage Intake: Findings from Project EAT (Eating Among Teens)-II

Detailed research examining concurrent longitudinal and secular changes in adolescent beverage intake is not currently available, particularly since the year 2000. This study's objective was to evaluate these trends in beverage intake in a large, diverse adolescent cohort. Project EAT (Eating Among Teens)-II is a 5-year longitudinal study (n=2,516) including two cohorts, which allows for the observation of longitudinal changes from early to mid-adolescence (junior high to high school) and from mid- to late adolescence (high school to post high school). Project EAT-II also examined secular trends in adolescent health behavior from 1999-2004 in mid-adolescence. Daily beverage servings were assessed using the Youth and Adolescent Food Frequency Questionnaire. Longitudinal findings indicate that intake of soda and sugar-sweetened beverages (including soda, sweetened iced teas, and fruit drinks) increased significantly among younger males, and alcohol increased across all groups (P<0.01). Consumption of certain beverages decreased with age: fruit juice (among all males and older females, P≤0.02), milk (older adolescents, P<0.01), other milk beverages (all females and older males, P<0.01), diet soda (younger adolescents, P<0.01), and coffee/tea (all males and younger females, P<0.01). Significant secular decreases were observed in fruit juice and coffee/tea for males and females (P≤0.05). Overall, these findings reflect recent secular and longitudinal shifts in adolescent beverage consumption during the critical transition period from early to mid-adolescence and mid- to late adolescence. Although additional research is needed to better understand nuances in adolescent consumption patterns, registered dietitians and other health care practitioners working with adolescents should address the importance of limiting sugar-sweetened beverages with low nutrient density.     

Beverage consumption in the US population

OBJECTIVE: The purpose of this study was to examine beverage consumption across age, sex, and race/ethnicity categories using the most current data available, the National Health and Nutrition Examination Survey 1999-2002. DESIGN: Beverage consumption that included fluid milk, fruit juices, regular and diet carbonated soft drinks, regular and diet fruit drinks/ades, coffee, and tea was examined among white, African-American, and Mexican-American persons in age groups 6 to 11 years, 12 to 19 years, 20 to 39 years, 40 to 59 years, and >60 years. Data from the National Health and Nutrition Examination Survey 1999-2002 were used in this study. STATISTICAL ANALYSIS: Group means were estimated for the age group, sex, and race/ethnicity subgroups. The probability that any of these group means were equal to one another was tested using statistical software. RESULTS: The data showed marked differences in beverage consumption depending on age, sex, and race/ethnicity. In general, males consumed more beverages than did females. Specifically, white and Mexican-American persons of all ages consumed more milk than did African-American persons. On average, African-American males and females of all ages consumed significantly more fruit drinks/ades than did other race/ethnicity groups. In contrast, white persons consumed more carbonated soft drinks than did other race/ethnicity groups. CONCLUSION: Average beverage consumption varied depending on age, sex, and race/ethnicity. Knowledge of differences in beverage consumption patterns is important for food and nutrition professionals and nutrition policymakers. Better understanding of the many factors that influence beverage consumption levels is needed.     

The ORAC/kcal ratio qualifies nutritional and functional properties of fruit juices,nectars, and fruit drinks

Fruit beverages are source of antioxidants, but their sugar content plays an important role in the epidemic of obesity. In this study, we considered 32 fruit beverages consumed in Italy (13 fruit juices, 11 nectars, and 8 fruit drinks), which were analyzed for caloric intake, total phenols (TP), ascorbic acid, and antioxidant capacity (oxygen radical absorbance capacity (ORAC) method). Results showed that the caloric intake was almost completely provided by the sugar content, ranging from 5.5 to 19%. The ORAC/kcal ratio was taken as an indicator of the antioxidant performance of fruit beverages. Fruit juices containing berries, red orange, and goji showed the best performances, together with berries or pears nectars and fruit drinks made with rose hips or tea extracts. The 95% of antioxidant capacity was provided by TP, which showed a significant linear correlation with the net ORAC values. Overall, the results indicate that the ORAC/kcal ratio is a suitable parameter to rank the quality of fruit beverages.     

Are Nutrition Standards for Beverages in Schools Associated with Healthier Beverage Intakes among Adolescents in the US?

Under the U.S. Department of Agriculture’s Smart Snacks in School standards, beverages sold in schools are restricted to water, flavored or unflavored non-fat milk or unflavored low-fat milk (and milk alternatives), and 100% fruit and vegetable juices; and, at the high school level, diet (≤10 kcal), low-calorie (≤60 kcal), and caffeinated beverages may also be sold. Using data from the School Nutrition and Meal Cost Study, this study examined whether secondary school student beverage consumption was associated with school-level à la carte and vending machine beverage availability, controlling for district, school, and student characteristics. On average, most beverages sold in middle schools (84.54%) and high schools (74.11%) were Smart Snacks compliant; while 24.06 percent of middle school students and 14.64 percent of high school students reported consuming non-compliant beverages, including non-compliant milk, fruit drinks, and sports or energy drinks. School beverage availability was not related to consumption among middle school students; however, high school students were less likely to consume non-compliant beverages when enrolled in schools that sold a higher proportion of compliant beverages (Range: OR = 0.97–0.98, 95% CI = 0.95, 1.00). Findings from this study build upon prior research illustrating the role that schools can play in influencing student dietary intake.     

Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012–2013

Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.     

Lifestyle, dietary habits and consumption pattern of male university students according to the frequency of commercial beverage consumptions

Because excessive consumption of sugar-sweetened beverages may reduce the quality of nutritional intake, this study examined the consumption patterns of commercial beverages, lifestyle, dietary habits, and perception of sweet taste. Participants were 407 male university students in Kyeonggido, Korea, and information was collected by self-administered questionnaire. Among them, 58 nonsmokers volunteered to participate in the taste test. Participants were divided into three groups according to the frequency of commercial beverage consumptions: 120 rare (< 1 serving/week), 227 moderate (1-3 servings/week) and 133 frequent (> 3 servings/week) consumption groups. More subjects from the rare consumption group chose water, tea, and soy milk, and more from the frequent consumption group chose carbonated soft drinks and coffee (P = 0.031) as their favorite drinks. Frequent consumption group consumed fruit juice, coffee, and sports and carbonated soft drinks significantly more often (P = 0.002, P = 0.000, P = 0.000, respectively), but not milk and tea. Frequent consumption group consumed beverages casually without a specific occasion (P = 0.000) than rare consumption group. Frequent drinking of commercial beverages was associated with frequent snacking (P = 0.002), meal skipping (P = 0.006), eating out (P = 0.003), eating delivered foods (P = 0.000), processed foods (P = 0.001), and sweets (P = 0.002), and drinking alcoholic beverages (P = 0.029). Frequent consumption group tended to have a higher threshold of sweet taste without reaching statistical significance. The results provide information for developing strategies for evidence-based nutrition education program focusing on reducing consumption of unnecessary sugar-sweetened commercial beverages.     

The Potential Effects of Caffeinated Beverages on Insulin Sensitivity

Caffeinated beverages, most commonly tea and coffee, may have important effects on insulin regulation that may give their consumption an important role among nutritional factors in the development of diseases of glucose and insulin metabolism, such as diabetes and atherosclerotic vascular diseases. These beverages include compounds that may have contradictory effects on insulin and glucose: Caffeine impairs insulin sensitivity, but polyphenolic molecules within tea, coffee, and cocoa augment the effects of insulin. In addition, epidemiologic associations exist between greater consumption of such beverages and lower risk of diabetes. The beneficial effects of such beverages might be enhanced by changing the process of their preparation and substitution of other substances commonly added to caffeinated beverages that impair the effect of insulin, such as sugar or milk.     

The frequency and magnitude of price‐promoted beverages available for sale in Australian supermarkets

Objective : Price promotions are used to influence purchases and represent an important target for obesity prevention policy. However, no long‐term contemporary data on the extent and frequency of supermarket price promotions exists. We aimed to evaluate the frequency, magnitude and weekly variation of beverage price promotions available online at two major Australian supermarket chains over 50 weeks. Methods : Beverages were categorised into four policy‐relevant categories (sugar‐sweetened beverages, artificially‐sweetened beverages, flavoured milk and 100% juice, milk and water). The proportional contribution of each category to the total number of price proportions, the proportion of price promotions within the available product category, the mean discount, and weekly variation in price promotions were calculated. Results : For Coles and Woolworths respectively, 26% and 30% of all beverages were price promoted in any given week. Sugar‐sweetened beverages made up the greatest proportion of all price promotions (Coles: 46%, Woolworths: 49%). Within each product category, the proportion of sugar‐sweetened and artificially‐sweetened beverages that were price promoted was similar, higher than the other categories and reasonably constant over time. Diet drinks and sugar‐sweetened soft drinks were most heavily discounted (by 29–40%). Conclusions : Beverage price promotions are used extensively in Australian supermarkets, undermining efforts to promote healthy population diets. Implications for public health : Policies restricting price promotions on sugar‐sweetened beverages are likely to be an important part of strategies to reduce obesity and improve population nutrition.     

Trends in Sugar-Sweetened Beverages: Are Public Health and the Market Aligned or in Conflict?

Adverse health consequences of consuming sugar-sweetened beverages are frequently cited as an example of market failure, justifying government intervention in the marketplace, usually in the form of taxation. However, declining sales of sugar-sweetened beverages in Australia and a corresponding increase in sales of drinks containing non-nutritive sweeteners, in the absence of significant government regulation, appear to reflect market forces at work. If so, the public health challenge in relation to sugar-sweetened beverages may have less to do with regulating the market and more to do with harnessing it. Contrary to assertions that consumers fail to appreciate the links between their choice of beverage and its health consequences, the health conscious consumer appears to be driving the changes taking place in the beverage market. With the capacity to meet consumer expectations for convenience and indulgence without unwanted kilojoules, drinks containing non-nutritive sweeteners enable the “small change” in health behaviour that individuals are willing to consider. Despite the low barriers involved in perpetuating the current trend of replacing sugar-sweetened beverages with drinks containing non-nutritive sweeteners, some public health advocates remain cautious about advocating this dietary change. In contrast, the barriers to taxation of sugar-sweetened beverages appear high.     

Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity

Obesity is a major epidemic, but its causes are still unclear. In this article, we investigate the relation between the intake of high-fructose corn syrup (HFCS) and the development of obesity. We analyzed food consumption patterns by using US Department of Agriculture food consumption tables from 1967 to 2000. The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States. Our most conservative estimate of the consumption of HFCS indicates a daily average of 132 kcal for all Americans aged > or = 2 y, and the top 20% of consumers of caloric sweeteners ingest 316 kcal from HFCS/d. The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis. In addition, unlike glucose, fructose does not stimulate insulin secretion or enhance leptin production. Because insulin and leptin act as key afferent signals in the regulation of food intake and body weight, this suggests that dietary fructose may contribute to increased energy intake and weight gain. Furthermore, calorically sweetened beverages may enhance caloric overconsumption. Thus, the increase in consumption of HFCS has a temporal relation to the epidemic of obesity, and the overconsumption of HFCS in calorically sweetened beverages may play a role in the epidemic of obesity.     

Beverage choices of young females: changes and impact on nutrient intakes

OBJECTIVE: To examine trends in beverage consumption and evaluate the impact of beverage choices on the nutrient intakes of females ages 12 to 19 years. DESIGN: Dietary intake data from the USDA's Nationwide Food Consumption Surveys, including the Continuing Survey of Food Intakes by Individuals (CSFII), were assessed for trends in beverage consumption. The CSFII 1994-1996 data was used to examine the diets of young females grouped based on their milk and soda consumption status. Mean energy, nutrient, and beverage intakes were compared. SUBJECTS: Females with complete dietary intake information on Day 1 of the survey were included in the study. There were 732 females ages 12 to 19 years in the CSFII 1994-1996.Statistical Analysis Percentages of females consuming specific beverages were estimated. Pairwise mean comparisons were made between groups based on milk and soda consumption status. RESULTS: Milk intakes decreased by 36% whereas that of sodas and fruit drinks almost doubled from the late 1970s to the mid 1990s. The CSFII 1994-1996 data showed that between ages 12 and 19 years, intakes of fruit juices, soda, tea, fruit drinks, and alcoholic beverages either increased or remained relatively steady, while milk intakes decreased with an increase in age. At age 12 years, 78% drank milk and had the lowest soda intake (276g), while at age 19-years, only 36% drank milk and drank a high amount of soda (423g). Those who did not drink milk had inadequate intakes of vitamin A, folate, calcium, phosphorus, and magnesium. APPLICATION: A rapid decrease in milk intake during the early adolescent years indicates a need for interventions at this age. Dietitians should identify barriers to drinking milk and recommend strategies for including appropriate food sources to increase calcium intakes during growing years. Nutrition educators should provide parents of adolescent children with ideas for ensuring the adequacy of their children's calcium intakes. J Am Diet Assoc. 2002; 102: 1234-1239.     

Low- and No-Calorie Sweetener (LNCS) Consumption Patterns Amongst the Spanish Adult Population

Low- and no-calorie sweeteners (LNCS) are a group of food additives characterized by their high sweetness intensity and virtually zero caloric content, attributes that make them potential substitutes for added sugars in processed foods and beverages. However, there is currently scarce information available about both the different LNCS used in food products available in Spain and their consumption patterns. Prompted by these reasons, the aim of this research work was to identify the presence and consumption of LNCS in food and beverages consumed by a representative sample of the Spanish adult population (n = 507). For this purpose, a Food Frequency Questionnaire was carried out. Overall, it was found that 4.5% of the foods and 22.3% of the beverages consumed by the surveyed population contained LNCS. The food groups that presented the highest percentage of daily servings containing LNCS were non-alcoholic beverages such as soft drinks and juices (36.1%); sugars and sweets such as chocolates, candies, or chewing gum (14.2%); milk and dairy products (7.0%); meat and derivative products (5.1%); cereals and derivatives (4.3%); appetizers (1.7%); and, finally, sauces and condiments such as ketchup or mustard (1.0%). The main LNCS consumed were acesulfame-K, sucralose, sorbitol, aspartame, and cyclamate, although their prevalence of use differs greatly among foods, beverages, or tabletop sweeteners. Our results show the great diversity of food groups that are currently including these compounds as ingredients. Consequently, there is a need for these food additives to be included in food composition databases, which should be regularly updated to include LNCS in order to facilitate their assessment and monitoring in dietary nutritional surveys.     

Secular trends in children's sweetened-beverage consumption (1973 to 1994): the Bogalusa Heart Study

OBJECTIVE: To determine whether children's sweetened-beverage consumption has changed over a 21-year period (1973 to 1994) in Bogalusa, LA, and whether trends in energy intake, milk consumption, and body mass index (BMI) varied among the sweetened-beverage consumption groups. DESIGN: Information on food and nutrient intake was derived from a single 24-hour dietary recall collected from children who participated in one of seven cross-sectional surveys. SUBJECTS/SETTING: A total of 1,548 10-year-old children (65% white, 35% African American; 51% female, 49% male) were randomly selected to participate in the study. STATISTICAL ANALYSES: The Cochran-Armitage Trend test was applied to examine the trends in sweetened-beverage consumption by 10-year-old children over a 21-year period. A general linear model was used to examine the trend in milk consumption, energy intake, and BMI among the sweetened-beverage consumption groups. RESULTS: The percentage of children consuming sweetened beverages significantly decreased from 83% (1973) to 81% (1994) (P <.05), particularly consumption of soft drinks (P <.01) and coffee with sugar ( P <.0001). However, the mean gram amount of tea with sugar consumed significantly increased (P <.0001), with no changes in the mean gram amount of fruit drinks, soft drinks, and coffee with sugar consumed. When comparing tertiles of sweetened-beverage consumption over time, the mean gram consumption significantly increased from 1973 to 1994 for those children who were in the medium (P <.001) to high (P <.0001) tertiles. The mean BMI significantly increased (P <.001) from 1973 to 1994 in children within all of the sweetened-beverage consumption groups; however, there were no significant differences in total BMI across the sweetened-beverage consumption groups. The total gram amount of milk consumption was significantly lower in the medium to high sweetened-beverage consumption groups compared with the lower to no sweetened-beverage consumption groups. Total energy intake remained unchanged from 1973 to 1994 within all four sweetened-beverage consumption groups. Total energy intake was significantly higher in the high sweetened-beverage consumption group compared with the other three sweetened-beverage consumption groups. CONCLUSIONS: Children's sweetened-beverage consumption has changed over a 21-year period. The percentage of children consuming sweetened beverages decreased from 1973 to 1994, particularly consumption of soft drinks and coffee with sugar. Data suggest that there was no linear relationship between sweetened-beverage consumption and BMI and total energy intake. However, total milk consumption was lower in the medium to high sweetened-beverage consumption groups compared with the low to no consumption groups. More studies are needed to confirm these regional findings, which may not be reflective of national trends.