February 2013

The Relationships between Sugar-Sweetened Beverage Intake and Cardiometabolic Markers in Young Children

                In the US pediatric population, approximately one third of children and adolescents are overweight and at risk for cardiometabolic disease. Increased consumption of sugar-sweetened beverages (SSB) appears to be a major contributor to the obesity epidemic.  The rise in SSB in the US has paralleled the obesity trend and from the late 1970s to 2001, Americans increased their average daily SSB intake by 135%.  This concurrent rise has also be evident in the pediatric populations as well with total energy intake coming from SSB increased from 4.8% in 1970’s to 10.3% in 2001.  SSB include that comprise the largest percentage of these calories are: sodas, fruit drinks, sport drinks, energy drinks, chocolate milk, and vitamin water. Also, a higher intake of SSB in children is also associated with poor overall dietary choices. This study is looking at the relationship between SSB intake and cardio metabolic markers in children aged 3 to 11 years old by using National Health and Nutrition Examination Survey Data from 1999 to 2004.  Data from these years are the most recent data available, unfortunately, because it was the latest years that took blood samples from pediatric populations.

                Subjects included children younger than age 12, specifically those 3-11 years old.  This study looked at cardiometabolic factors that included: high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, C-reactive protein (CRP), waist circumference and BMI.  The races that were included in this study were: non-Hispanic white, non-Hispanic black, and Mexican Americans.  The dietary information was obtained through a 24 hour dietary recall interview with a trained interviewer.  In this study SSB is defined as energy containing soft drinks, colas, sugar-sweetened fruit drinks, and other sugar-sweetened beverages. The groups were then divided into lowest (none), medium, and highest consumers.  Twenty-five percent of the population included in this study reported no SSB intake and were included in the lowest intake group. 

                A total of 4,880 Children were finally used to analyze the relationship between SSB and cardiometabolic factors.  The lowest intake group consumed no SSB, the medium group consumed ~11.84oz to 23.12oz per day, and the highest group consumed ~35.12-135.33oz per day.  Higher SSB intake in children was significantly associated with increased CRP and waist circumferences while having a negative relationship with HDL cholesterol levels. The association between BMI and SSB approached statistical significance but fell just short (p=.07). No associations were found between SSB intake and total cholesterol, LDL cholesterol and triglyceride concentrations.  Adjustments were made to take into account age, sex, race, physical activity, energy intake, and poverty status. The study also found that the largest consumers of SSB are those aged 9 to 11 and shows trends of increased beverage intake as participant’s age.  This study found a positive correlation between several cardiometabolic disease risk factors and intake of SSB including increased CRP, waist circumferences and lower HDL while finding borderline data for BMI.  There were no relations in total cholesterol, LDL cholesterol, and triglycerides with SSB in this study.

The Relationships between Sugar-Sweetened Beverage Intake and Cardiometabolic Markers in Young Children

Ethan C. Kosova, Peggy Auinger, Andrew A. Bremer

Journal of the Academy of Nutrition and Dietetics 1 February 2013 (volume 113 issue 2 Pages 219-227 DOI: 10.1016/j.jand.2012.10.020)

Artificial Sweeteners: A Systematic review of metabolic effects in youth

                This article is looking at the effects of artificial sweeteners and how they affect weight on other factors in children.  I chose this article because the easiest answer for most people to get kids off of SSB is to offer them a diet beverage instead.  However, this is a lot of controversial research out there on how effective that really is on making any of the health situations better than regular SSB. This review article was published in the Journal of Pediatric Obesity and its key purpose was to examine if replacement of sugar-sweetened products with those containing artificial sweeteners is truly beneficial.

                An association between artificial sweetener intake and weight gain was first observed in epidemiological studies with adults.  Several large-scale studies, including the NHANES and San Antonio Heart Study have shown a positive association between artificial sweetener (AS) and increases in weight/BMI. Other large scale studies have shown association between AS intake and incidence of metabolic syndrome and its components, including waist circumference, blood pressure, and fasting blood glucose. Other studies show links in consumption with insulin resistance, incidence of type 2 diabetes, and poor glucose control in patients with pre-existing diabetes.   Some benefits associated with AS consumption as seen in research include decreased weight regain after dieting, and weight-stability or minimal short-term weight loss compared with caloric-sweetener supplementation. 

                It has been suggested that dissociation of the sensation of sweet taste from caloric intake may promote appetite, leading to greater food consumption and weight gain.  It has also been hypothesized that people learn to associate sweet items with low calorie foods and therefore over eat other highly sweetened products.  Sweet-taste receptors including T1R and alpha-gustducin respond to both sugar and AS.  They are located not only in the mouth but also in gut lining. In the cut they act as critical mediators of glucagon-like-peptide-1 secretions.  Stimulation of intestinal taste receptors with sucralose led to more rapid absorption of sugar into the bloodstream.  This effect of causing increased sugar and hormone responses may be a factor in increased insulin secretions and affecting people’s weight, appetite, and glycemia.

                This study looked at studies published in peer reviewed journals, that included children aged 0-18, and specifically address AS consumption with metabolic health.  Study ended up review 18 human studies.  The study showed that if given a sugar sweetened pudding or a AS pudding to children and then allowed to eat a meal.  The children generally make up the calories that they did not get in the AS pudding in the meal whereas with the real sugar pudding kids at less of the meal so they calories still equaled the same in both groups.  Comparing studies with over 10,000 children and consumption of AS beverages found a positive correlation with AS intake and higher BMI scores over 2 year period.  One observational study did show an inverse association between artificial sweetener use and weight gain in 548 ethnically diverse school children over 19 month period however.  In the interventional studies conducted on children they failed to show a metabolic effect.  There was no difference in weight loss for subjects receiving aspartame vs placebo. Another study also reported in teenage girls either sugar or AS beverages as a snack during weight loss there were no differences between groups in blood pressure, waist circumference, or lipid profile. 

                Overall they do state that people who tend to go for AS beverages are people who are already worried about weight/calorie intake and therefore that could be the association with BMI.  They did find some support from studies that AS could be training children to associate sweet taste with low caloric density and result in overeating.  However, the few randomized controlled studies conduct in children did not find an association between AS and weight change.

Brown, R. J., de Banate, M., & Rother, K. L. (2010). Artifcial Sweeteners: A systematic review of metabolic effects in youth. International Jounral Of Pediatric Obesity, 5(4), 305-312. Doi:10.3109/17477160903497027