Dose-Response and Substitution Analyzes of Sweet Beverage Consumption and Body Weight in Dutch Adults: The Lifelines Cohort Study

Abstract

Background/MethodsProspective studies investigating sweet beverages and body weight associations show inconsistent results. Within the SWEET project, we examined prospective dose-response associations of sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB), and fruit juice with body weight-related outcomes among 78,286 Dutch adults followed for ~4 years. Baseline intakes were assessed using a validated food-frequency questionnaire (FFQ) with 150 ml representing a standard serving. Outcome variables were body weight change, waist circumference change, overweight/obesity, and abdominal obesity. Associations were investigated by using linear and non-linear dose-response analysis, as well as substitution models while adjusting for multiple socio-demographic, lifestyle, health, and dietary variables.ResultsParticipants were 46 ± 13 (mean ± SD) years old and 60% were women. Adjusted dose-response analyzes indicated an association between SSB and LNCB, and both body weight (+0.02 kg/year; SE 0.01 and +0.06 kg/year; SE 0.01) and waist circumference changes (+0.04 cm/year; SE: 0.01 and +0.11 cm/year; SE: 0.01). Associations for overweight/obesity and abdominal obesity incidence were +3% (95%CI: 1.00–1.06) and +2% (95%CI: 0.99–1.06) for SSB and +8% (95%CI: 1.06–1.11) and +5% (95%CI: 1.03–1.07) for LNCB, respectively. Substitution of SSB with LNCB was associated with higher weight change (+0.04 kg/year), waist circumference change (+0.09 cm/year), overweight/obesity incidence (+6%), but not abdominal obesity incidence. For fruit juice, we observed beneficial associations for intake levels below ~1 serving/day with weight, waist circumference change, and overweight/obesity incidence, and no association with abdominal obesity. Subsequent substitution analyzes indicated a small beneficial association for the replacement of SSB with fruit juice on weight (−0.04 kg/year) and waist circumference (−0.04 cm/year), but not with other outcomes.ConclusionsOverall, our results suggest that habitual consumption of both SSB and LNCB may adversely affect weight-related outcomes. In contrast, fruit juice consumption <150 ml may be beneficial with respect to weight and waist circumference.

Consumption of 100% Fruit Juice and Body Weight in Children and Adults

“…Cohort studies that did not adjust for total energy intake showed a positive association for juice with body weight (0.21 kg; 95% CI, 0.15-0.27 kg), whereas studies that adjusted for energy intake found an inverse association (−0.08 kg; 95% CI, −0.11 to −0.05; P for meta-regression <.001). Significant differences were also found for study location with studies conducted in North America (0.14 kg; 95% CI, 0.02-0.26) showing significant body weight gain, whereas no significant association was observed among studies conducted in Europe (−0.15 kg; 95% CI, −0.37 to 0.08; P for meta-regression = .04). There were no significant subgroup differences found for RCTs in adults (eFigures 16 and 17 in Supplement 1).…”

“…No RCTs were identified among children. A total of 25 studies were identified for adults (268 095 adults), with 6 prospective cohort studies with 8 comparisons, and 19 RCTs . The screening and exclusion flowchart is presented in eFigure 1 in Supplement 1.…”

Sugar and low/no-calorie-sweetened beverage consumption and associations with body weight and waist circumference changes in five European cohort studies: the SWEET project

“…Differences across categories of SSB and LNCB consumption were assessed using ANOVA or Kruskal–Wallis for continuous variables and Chi-square tests for categorical variables. Previous restricted cubic spline analyses with data of the Lifelines cohort did not show strong evidence for non-linear associations between SSB or LNCB consumption and body weight and waist circumference changes [ 12 ], and further exploration in other cohorts did not produce further evidence (data not shown). Thus, multiple linear regression analyses were conducted to assess associations between baseline daily SSB and LNCB consumption, and yearly body weight and waist circumference changes in each cohorts.…”

“…Only a few prospective studies have examined the theoretical replacement of SSBs with LNCBs, and its association with weight measures [ 9 – 11 ], showing either beneficial [ 9 ] or no associations [ 10 , 11 ]. In contrast, we recently observed that the theoretical replacement of SSB consumption with LNCB consumption was associated with higher weight and waist circumference change amongst 78,826 Dutch adults [ 12 ]. Thus, despite the low caloric content of LNCBs and its suggested beneficial effects on weight gain based on RCTs, data from prospective studies do not unambiguously support the hypothesis that LNCBs may prevent weight gain.…”

The use and health effects of sugar substitute

“…The incidence of overweight/obesity was increased by 8% (95%CI: 6%-11%) and the incidence of abdominal obesity was increased by 5% (95%CI: 2%-7%). Substitution analysis found that beverage intake was negatively associated with body weight (−0.05kg year −1) and waist circumference (−0.08cm year −1), and the incidence of overweight/obesity was reduced by 9% (95%CI: 3 to 14%), while replacing sugar-sweetened beverages with an equivalent amount of sugar-replaceable beverages associated with a 6 percent increase in the incidence of overweight/obesity (95%CI: 2 to 10%) [9]. Hence, it is imperative to avoid excessive consumption of both sugar, which plays a crucial role in human metabolism, and non-nutritional sweeteners.…”