[Jog] Re: [PHNUTR-L] Consumption of soft drinks
Jennifer L YOUNG
Jennifer.L.Young at state.or.us
Wed Jun 9 19:48:46 PDT 2004
FYI - Forwarding new studies on soft drink consumption.
ARBOR CLINICAL NUTRITION UPDATES ©
This week we consider recent evidence on the health impact of excessive
consumption of soft drinks in the diet.
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NUTRITION RESEARCH REVIEW
Study 1: Soft drink and bones
Carbonated soft drink intake is linked with lower bone mineral density
in adolescent girls, according to new UK research from Northern Ireland.
Subjects: 591 boys and 744 girls aged 12 or 15 years.
Method: Cross-sectional observational study. Usual beverage consumption
was assessed by dietary history, and bone mineral density (BMD) measured.
Results: Adjusted regression found a significant inverse relationship
between total carbonated soft drink intake and bone density in the
dominant heel for girls only (ß=-0.01, p<0.05). This association was
confined to non-cola and diet drinks.
Reference: J Bone Miner Res. 2003 Sep;18(9):1563-9.
Study 2: Reducing soft drinks lowers weight
A school program discouraging consumption of carbonated soft drinks
slowed rising obesity rates in an English clinical trial that has just
Subjects: 644 school children (aged 7-11 years).
Method: Randomised clinical trial in 6 schools (in which whole classes
were the unit of randomisation). The intervention group had a 1 hour
session each school term for 12 months focusing on adverse effects of
sugar and carbonated drinks, and the benefits of healthy diet and
lifestyle. A 3-day dietary history was recorded before and afterwards.
Results: Only the intervention children had a decrease in carbonated
soft drink consumption (from 1.9 to 1.3 glasses/3 days, compared to 1.6
to 1.8 glasses/3 days in the control group). Only the control group had
an increase in the proportion of children who were overweight or obese
over the 12 month period - see Table.
Table: Changes in % of children overweight (>91st %ile)
over 12 month trial
Intervention 19.4% 16.9%
Control 20.3% 20.1%
Reference: BMJ. 2004 May 22;328(7450):1237. Epub 2004 Apr 23.
Study 3: Soft drink and fatness
American research has shown that fatness is linked to both consumption
of soft drinks and time spent watching television.
Subjects: 319 children in classes 6 and 7.
Method: Cross-sectional observational study. Children completed a
questionnaire on their usual soft drink intake and TV habits.
Anthropometry included body fat measurement using bioelectrical impedance.
Results: A higher BMI was seen in those children who drank more soft
drink (>=3 vs < 3 glasses/day, z score=1.02 vs 0.51, p<0.003) and those
watching more TV (>=2 vs < 2 hrs/night , z score=0.82 vs 0.34, p<0.001).
Reference: Arch Pediatr Adolesc Med. 2003 Sep;157(9):882-6.
The link between consumption of soft drinks - particularly sweetened
soft drinks - and dental caries is well established 1.
Nutritionists have also raised concerns that excess soft drink intake
could displace milk and contribute to calcium deficiency, and that the
`empty calorie sugar in soft drinks is a factor in the rapidly
worsening problem of overweight and obesity in our children 2.
Other potential problems related to specific constituents of soft drinks
include the calcium leaching effect of phosphoric acid 3 and the impact
of excess caffeine in cola drinks (e.g. in possibly contributing to
raised blood pressure) 4 . A recent paper has proposed that high
fructose corn syrup (used to sweeten most soft drinks) has specific
metabolic consequences that favoured obesity 5, whilst other evidence
shows soft drinks can cause sharp insulin responses 6.
One thing of which there is no doubt is that soft drink intake amongst
children is increasing. Recent US estimates, for example, are that
consumption doubled over the last two decades and now adds 188 kcal/day
to the energy intake of children who drink them 7, 8.
The new Study 1 found a direct link between bone mineral density and
soft drink intake, but only in girls. A previous study (restricted to
teenage girls) reported a strong association between carbonated drink
consumption and bone fractures 9. On the other hand there is limited and
inconsistent evidence on whether soft drink intake is, in fact, linked
to lower calcium intake 10-12 and any such relationship is likely to be
influenced by many other factors (e.g. family habits 13).
This is likely to also be true of the connection between soft drinks and
obesity. Whilst a few studies have shown an association with overweight
11, 14, 15 or energy expenditure 16, the number of such reports is small
for such an important issue. And of course exercise levels are always a
crucial factor in any obesity discussion 17.
Being a randomised clinical trial Study 2 is thus a worthwhile and
ambitious contribution, even though a number of weaknesses in the
methodology (acknowledged by the authors in their discussion) mean that
this is an interesting rather than a definitive result regarding soft
drinks. At the same time, it does suggest that a coordinated approach to
health and nutrition education in schools can yield positive results in
an environment where the prevalence of overweight children was high and
rose rapidly over just one year.
Whatever the current status of research on the precise health effects of
soft drink consumption, we are in the midst of an obesity epidemic
amongst children. It is hard to reasonably deny the need to take steps
in schools to make healthy, nutrient-dense foods more available and
`empty calories , including both high fat snacks and sugary soft drinks,
less easily available 17.
1. Gen Dent. 2003 Jan-Feb;51(1):30-6.
2. Pediatrics. 2004 Jan;113(1 Pt 1):152-4.
3. Rev Invest Clin. 1998 May-Jun;50(3):185-9.
4. Arch Pediatr Adolesc Med. 2004 May;158(5):473-7.
5. Am J Clin Nutr. 2004 Apr;79(4):537-43.
6. Eur J Cancer Prev. 1999 Aug;8(4):289-95.
7. J Am Diet Assoc. 2003 Oct;103(10):1326-31.
8. Am J Clin Nutr. 2003 Dec;78(6):1068-73.
9. Arch Pediatr Adolesc Med. 2000 Jun;154(6):610-3.
10. J Am Coll Nutr. 2004 Feb;23(1):18-33.
11. J Pediatr. 2003 Jun;142(6):604-10.
12. Br J Nutr. 2003 Mar;89(3):419-29.
13. J Nutr. 2001 Feb;131(2):246-50.
14. J Am Coll Nutr. 2003 Dec;22(6):539-45.
15. Lancet. 2001 Feb 17;357(9255):505-8.
16. J Am Diet Assoc. 1999 Apr;99(4):436-41.
17. JAMA. 2002 Nov 6;288(17):2181.
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