Although sugar-sweetened beverage (SSB) consumption has been tightly linked to weight status among older children, the data regarding these relationships in children aged 2 to 5 years have been mixed. Our objective was to evaluate longitudinal and cross-sectional relationships between SSB consumption and weight status among children aged 2 to 5 years.
We assessed SSB consumption and BMI z scores among 9600 children followed in the Early Childhood Longitudinal Survey—Birth Cohort, using linear and logistic regression and adjusting for race/ethnicity, socioeconomic status, mother’s BMI, and television viewing.
Higher rates of SSB consumption were associated with higher BMI z scores among children age 4 (P < .05) and 5 (P < .001) but not yet at 2 years. Children aged 5 years who drank SSB regularly (compared with infrequent/nondrinkers) had a higher odds ratio for being obese (1.43, confidence interval 1.10–1.85, P < .01). In prospective analysis, children drinking SSB at 2 years (compared with infrequent/nondrinkers) had a greater subsequent increase in BMI z score over the ensuing 2 years (P < .05).
Similar to what is seen among older children, children aged 2 to 5 years drinking SSB demonstrate both prospective and cross-sectional correlations with higher BMI z score. Pediatricians and parents should discourage SSB consumption to help avoid potential unhealthy weight gain in young children. From a public health standpoint, strong consideration should be made toward policy changes leading to decreases in SSB consumption among children.
Comments
Naturally Flavored Seltzer Water in the Home
In their article "Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children," DeBoer and colleagues conclude that "As a means of protecting against excess weight gain, parents and caregivers should be discouraged from providing their children with SSB [sugar-sweetened beverages] and consuming instead calorie-free beverages and milk."1 In their policy paper published at the same time, Patel and Ritchie recommend making milk or water the default for children's restaurant meals.2 The New York City Department of Health and Mental Hygiene recommends water, seltzer water, or (for children over 2 years of age) fat-free or 1% milk, instead of SSBs.3
However, instituting beverage changes in the home may be difficult. Young children do not find plain water appealing. Although those of us who live in New York City have excellent tap water, other parts of the country (and world) are not as fortunate. In addition, although children find the "bubbles" or "fizz" in plain seltzer to be appealing, the lack of flavor is not. Anecdotal evidence suggests that naturally flavored seltzer water, which has both flavor and bubbles, could be a successful substitute for SSBs. Inexpensive, store brands of naturally flavored, bottled seltzer are commercially available in chain supermarkets and drugstores in New York City.
Education does not necessarily change behavior.4 The Nuffield Council on Bioethics (in the United Kingdom) has developed an eight-step intervention ladder for public health policy.5 Their intermediate steps for shaping choice at a societal level are enabling choice, changing the default policy, and guiding choice with incentives. Any or all of these steps could be used to evaluate the promotion of home use of naturally flavored seltzer water as an alternative to SSBs for families with young children.
References:
1. DeBoer MD, Scharf RJ, Demmer RT. Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children. Pediatrics. 2013;132(3):413-420.
2. Patel AI, Ritchie L. Striving for Meaningful Policies to Reduce Sugar- Sweetened Beverage Intake Among Young Children. Pediatrics. September 1, 2013 2013;132(3):566-568.
3. Are You Pouring on the Pounds? Health Bulletin: New York City Department of Health and Mental Hygiene. 2009;8(6).
4. Snetselaar LG. Chapter 19: Intervention: Counseling for Change. In: Mahan L, Escott-Stump S, eds. Krause's Food & Nutrition Therapy, 12th Edition 12th ed. St. Louis: Saunders Elsevier; 2008:489-505.
5. Nuffield Council on Bioethics. Public health: ethical issues. London; 2007.
Conflict of Interest:
None declared
Increased Sugar Intake in Children: More than Just Environment
In the article "Sugar-Sweetened Beverages and Weight Gain in 2- to 5- Year-Old Children" DeBoer and colleagues extended the existing research linking intake of sugar sweetened beverages (SSBs) and obesity1. While previous studies have suggested that consumption of SSB in adults, school- aged children and adolescents is associated with increased body weight, the current article extended this association to young children (ages 2- 5), finding that children who regularly drink SSBs (including sodas, sports drinks and sugar-added fruit juices) had higher body mass index (BMI) z scores compared to age-matched children who were infrequent or non -drinkers.
DeBoer et al. mentioned that more children consuming SSBs daily had a mother than was obese or overweight, alluding to a complex interaction of environment and potential genetic and epigenetic factors. While traditional genetic models might play a role in the observed effects, such a propensity for weight gain, or a liking for palatable foods such as SSBs, there are other genetic environmental interactions to consider.
Like many of the mothers in the DeBoer study, a majority of women at child-bearing age are overweight, and this is most likely due to overeating the tasty, high-fat, high-sugar foods that are ubiquitous in our society. This intake during pregnancy can have lasting effects on the offspring. For example, it has been suggested that prenatal diets can affect the offspring's preference for palatable foods2 while producing concomitant aberrations in reward pathway-related neurochemicals and expression of the associated genes3. Specifically, in a recent article from our laboratory, "Effects of perinatal exposure to palatable diets on body weight and sensitivity to drugs of abuse in rats" (2012), offspring born to dams consuming a high-fat diet showing a preference for fat in adulthood4. Similarly, offspring born to dams consuming a soda-like beverage while pregnant showed a preference for sugar solution in adulthood, compared to offspring born to rats that were fed a nutritive diet5. Further, in the animal literature, there is evidence that a mother's diet during pregnancy can lead to differences in body weight in the offspring into adulthood4, even when they are consuming a nutritive diet.
Taken together these data begin to paint a picture of the complex interactions leading to increased intake of SSBs and weight gain in children. With the current epidemic of early childhood obesity it's important to further explore these factors and their interactions to further obesity treatment and prevention.
1. Deboer, M. D., Scharf, R. J. & Demmer, R. T. Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children. Pediatrics, doi:10.1542/peds.2013-0570 (2013).
2. Bayol, S. A., Farrington, S. J. & Stickland, N. C. A maternal 'junk food' diet in pregnancy and lactation promotes an exacerbated taste for 'junk food' and a greater propensity for obesity in rat offspring. The British journal of nutrition 98, 843-851, doi:10.1017/S0007114507812037 (2007).
3. Ong, Z. Y. & Muhlhausler, B. S. Maternal "junk-food" feeding of rat dams alters food choices and development of the mesolimbic reward pathway in the offspring. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 25, 2167-2179, doi:10.1096/fj.10-178392 (2011).
4. Bocarsly, M. E. et al. Effects of perinatal exposure to palatable diets on body weight and sensitivity to drugs of abuse in rats. Physiology & behavior 107, 568-575, doi:10.1016/j.physbeh.2012.04.024 (2012).
5. Bocarsly, M. E. et al. Effects of Prenatal Diet in Rats on Food Preference and Ethanol Intake in Offspring. Appetite 57S, S1-S49 (2011).
Conflict of Interest:
None declared