Obesity: Sugar-Sweetened Beverages Increase Toddlers' Risk

Ricki Lewis, PhD

August 06, 2013

Preteenagers, teenagers, and adults are not the only ones to pack on pounds if they drink sugar-sweetened beverages (SSB) regularly. A study published online August 5 in Pediatrics indicates that children aged 2 to 5 years who consume SSB often gain excess weight.

Because high sugar intake has paralleled the increase in childhood obesity, and these drinks have been implicated in weight gain in other age groups, the American Academy of Pediatrics recommends that young children avoid these products, which include soda, sports drinks, and juices with added sugar.

Mixed results from past studies on the effects of SSB on weight gain in 2- to 5-year-olds reflect flawed design, according to Mark D. DeBoer, MD, from the University of Virginia in Charlottesville, and coauthors. The problems include small sample sizes and reliance on cross-sectional data from small populations.

Therefore, Dr. DeBoer and colleagues analyzed data from 9600 children included in the Early Childhood Longitudinal Survey, adjusting for television viewing habits, socioeconomic status, race/ethnicity, and mother's body mass index. Children were examined and body mass index recorded at ages 9 months and 2, 4, and 5 years; researchers interviewed parents at similar times.

At 2 years of age, 9.3% of children consumed 1 or more SSB per day, by 4 years that percentage rose to 13.0%, and it was 11.6% at 5 years.

The results suggest that weight gain associated with SSB can be seen by age 4 years, but not earlier. Five-year-olds who consumed the products regularly, when compared with age-mates who drank soda and sweetened juices rarely or not at all, had a higher odds ratio for obesity (1.43; confidence interval, 1.10 - 1.85; P < .01).

The effect may be delayed. Children drinking SSB at age 2 years experienced a greater rate of increase in weight during the next 2 years than did their non-SSB-drinking peers.

Associated information suggested risk factors: black and Hispanic children were more likely to frequently consume SSB, as were those on the lower end of the socioeconomic scale and those whose mothers were overweight or obese. Children who drank the most SSB were also more likely to spend more than 2 hours a day watching television and to drink less than a single serving a day of milk.

Limitations of the study include parental report of SSB consumption rather than actual monitoring, incomplete dietary and exercise information, and no information on the fathers. The researchers conclude that policy changes should aim to reduce SSB consumption in young children.

In an accompanying editorial, Anisha I. Patel, MD, MSHS, from the Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and Lorrene Ritchie, PhD, RD, from the Atkins Center for Weight and Health, University of California, Berkeley, discuss how to implement the recommendations in the real world, especially considering the recent failure of New York City to control of purchases of large sugary drinks. They suggest:

  • instituting best practices for beverages in child care settings and training providers and children to recognize and consume alternative drinks;

  • targeting SSB-reducing interventions beyond the child-care setting to include parks, mobile vendors, and restaurants, which could provide water or milk instead of SSB;

  • adding water to the government's "My Plate" guidelines;

  • developing educational materials for health educators and clinicians; and

  • prohibiting marketing of SSBs to children.

The authors and commentators have disclosed no relevant financial relationships.

Pediatrics. Published online August 5, 2013. Abstract


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