Overweight and Sweet Drink Consumption in Preschoolers

Reducing consumption of sweetened beverages is rapidly becoming a focal point for
public health interventions to prevent obesity. Since 1977, consumption of carbonated
soft drinks and fruit drinks has increased by 68% and 42%, respectively. A number of
studies, including a least one randomized trial, have found a positive association between
various sweetened beverages and overweight in school children. One question that is
often raised is: do all sweetened beverages have the same effect? Cross-sectional and
observational studies have found some conflicting results on the association of juice and

overweight in preschoolers, but none of these studies have simultaneously examined the
role of other noncarbonated sweetened beverages. The purpose of this study was to
determine the effect of juice and other sweetened beverages on overweight status in a
large group of preschool children.

The sample consisted of 10,904 two- and three- year old children who were monitored
through the Missouri Pediatric Surveillance System and participated in a demonstration
project funded by the Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) from 2000-2002. Weight and height data are available on these children
at baseline (ages 2-3 yrs) and one year later. Based on dietary data from the Harvard
Food Frequency Questionnaire, the authors calculated the number of drinks per day of
vitamin C-containing fruit juice, other fruit juice, fruit drinks (like Kool-aid, lemonade),
and carbonated beverages. They also considered in their analysis intake of high-fat
foods, other high-sugar foods, and total energy. Overweight, the main outcome variable,
was defined as body mass index (BMI) > 95th percentile. The authors analyzed the
effects of sweetened beverages on overweight status, after controlling for child’s age,
ethnicity, and birth weight.

At baseline, 75% of the children were normal/underweight; 14% were at-risk of
overweight, and 10% were overweight. By the one year follow-up, 25% of those
originally at-risk of overweight became overweight and 67% of those overweight at
baseline remained so at follow-up. Children who were at-risk of overweight or
overweight at baseline were twice as likely to become or stay overweight if they drank
more than one sweetened beverage a day. This effect of sweetened beverages appears to
be independent of other sweet or high-fat foods that have also been linked to overweight.
Sweetened drinks, not including carbonated soft drinks, had a similar, significant
association with overweight. High intake of juice alone was only marginally related to
risk of remaining overweight from baseline to follow-up.

Conclusions and Implications: This study and others continue to suggest a relationship
between greater consumption of sweetened beverages and overweight status in children.
To understand the underlying causes and guide prevention efforts, well-designed
randomized trials are needed.

Source: Welsh JA, Cogswell ME, Rogers S, Rockett H, Mei Z, Grummer-Strawn LM. Overweight among low-
income preschool children associated with the consumption of sweet drinks: Missouri. 1999-2002 Pediatrics
2005: 115: 223-229.