A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

Abstract

BACKGROUND Consumption of sugar-sweetened beverages may cause excessive weight gain. We aimed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents. METHODS We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention. We hypothesized that the experimental group would gain weight at a slower rate than the control group. RESULTS Retention rates were 97% at 1 year and 93% at 2 years. Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups (1.7 servings per day), declined to nearly 0 in the experimental group at 1 year, and remained lower in the experimental group than in the control group at 2 years. The primary outcome, the change in mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) at 2 years, did not differ significantly between the two groups (change in experimental group minus change in control group, −0.3; P = 0.46). At 1 year, however, there were significant between-group differences for changes in BMI (−0.57, P = 0.045) and weight (−1.9 kg, P = 0.04). We found evidence of effect modification according to ethnic group at 1 year (P = 0.04) and 2 years (P = 0.01). In a prespecified analysis according to ethnic group, among Hispanic participants (27 in the experimental group and 19 in the control group), there was a significant between-group difference in the change in BMI at 1 year (−1.79, P = 0.007) and 2 years (−2.35, P = 0.01), but not among non-Hispanic participants (P>0.35 at years 1 and 2). The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years (−0.5%, P = 0.40). There were no adverse events related to study participation. CONCLUSIONS Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up (the prespecified primary outcome). (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00381160.)

Sugar-sweetened beverage consumption and central and total adiposity in older children: a prospective study accounting for dietary reporting errors

“…The smaller sample size of these studies (<300) compared with our study of more than 2000 older children may explain the conflicting observations as it increases the chance of type 2 errors. As well, our study, which shows that SSB intake is associated with greater fat mass accumulation in children transitioning into adolescence, is consistent with a recent well-designed randomized controlled trial conducted in overweight and obese adolescents who regularly consume SSB (44) . In that study, Ebbeling et al (44) found that those assigned to receive non-caloric beverage provisions for 1 year had smaller gains in BMI compared with those assigned to the control group.…”

“…As well, our study, which shows that SSB intake is associated with greater fat mass accumulation in children transitioning into adolescence, is consistent with a recent well-designed randomized controlled trial conducted in overweight and obese adolescents who regularly consume SSB (44) . In that study, Ebbeling et al (44) found that those assigned to receive non-caloric beverage provisions for 1 year had smaller gains in BMI compared with those assigned to the control group. Interestingly, body fat did not relate to the experimental condition, but it was obtained by bioelectrical impedance (as opposed to DXA as in our study), which has been shown to inaccurately measure body fat in overweight individuals (45) .…”

Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct

“…Explanation (2) could be supported by previous observational studies suggesting an association between non-caloric sweeteners and consumption of artificially sweetened beverages and weight gain [25,26], although recent randomised trials conducted in children and adolescents do not support this hypothesis [27,28].…”

Current patterns of water and beverage consumption among Mexican children and adolescents aged 1–18 years: analysis of the Mexican National Health and Nutrition Survey 2012

“…Beverage displacement changes towards more sweetened beverages have been previously documented in children in relation to weight management (26,27) . Overall, consumption of caloric sweetened beverages has been extensively linked with obesity and poor heath outcomes independently of energy intake, given their effect on satiety and insulin metabolism (28)(29)(30) . Given the nutritional and health implications associated with these beverages, the Beverage Consumption Recommendations for the Mexican Population encouraged the consumption of plain water as a first choice (750-2000 ml/d), followed by no/low calorie beverages with no sugar added and skimmed milk.…”