08.05.2013

• Action Points
  Preschoolers who consumed sugary drinks were more likely to gain excess weight and run the risk of being obese compared with non-drinkers.
• The take-home message from this study for practitioners and parents is to be vigilant about children’s sugary drink consumption habits.

Preschoolers who consumed sugary drinks were more likely to gain excess weight and run the risk of being obese compared with non-drinkers, researchers found.

Among 4- and 5-year-olds, a higher rate of sugar-sweetened beverage consumption was associated with higher body mass index (BMI, P<0.05 and P<0.001, respectively) while a higher odds ratio for obesity was seen at age 5 (1.43, 95% CI 1.10-1.85, P<0.01) , according to Mark DeBoer, MD, of the University of Virginia’s Department of Pediatrics in Charlottesville, and colleagues.

Although the association for obesity was not seen in 2-year-olds, those that drank sugary drinks had a greater increase in BMI over the next 2 years versus infrequent and non-drinkers (P<0.05), they wrote online in the journal Pediatrics.

The take-home message from this study for practitioners and parents is to be vigilant about children’s sugary drink consumption habits, notedKeith Ayoob, Ed.D, RD, of the Albert Einstein College of Medicine in New York City.

“It was disturbing to me as a pediatric nutritionist that kids are getting these beverages at such a young age,” he told MedPage Today, adding that young children should not consume so many empty calories.

“That’s not acceptable, and we have to acknowledge that parents are not making some very wise choices about the beverages they’re giving their kids. We need to educate and motivate parents to make better choices,” Ayoob added.

Last week, the New York State Supreme Court Appellate Division upheld a lower court’s decision to block the New York City Board of Health’s ban on oversized sugary drinks in fast food restaurants.

Sugary beverages have been associated with a host of health problems, such asincreased risks of genetic obesity andkeeping on excess pounds in adults who choose to imbibe, but little research has been done to evaluate health risks of sodas and sports drinks in younger children.

DeBoer and colleagues evaluated the effect of sugary drinks on BMI in 9,600 children evaluated at ages 9 months, 2 years, 4 years, and 5 years, who were enrolled in the Early Childhood Longitudinal Survey — Birth Cohort, a representative survey of the U.S. population of children born in 2001.

Parents answered survey questions about beverage intake at ages 2, 4, and 5. Sugar-sweetened beverages were defined as soda, sports drinks, and fruit drinks that were not 100% fruit juice. They also looked at when the drinks were consumed — such as at meals or with snacks — and if the child was a regular or infrequent/nondrinker.

The researchers evaluated height and weight and were converted into age- and gender-specific percentiles and z-scores.

Overall, “there was a high prevalence of overweight and obesity in the study population,” the authors reported, with 15.1% of 2-year-olds categorized as overweight and obese. A little over 16% of 4- and 5-year-olds were considered overweight.

They found that a “relatively low” proportion of 2-year-olds drank sugary drinks, but that percentage of children who had one or less servings (8 ounces) daily increased as they got older — 9.3% at age 2, 13% at age 4, and 11.6% at age 5.

At ages 4 and 5, black and Hispanic children reported higher rates of regular consumption, as did those of lower socioeconomic status.

Sugary drink consumption was not associated with obesity at age 2, but was associated with being overweight in two of three multivariable logistic regression models at age 4, obesity in one model at age 4, being overweight in the unadjusted model at age 5, and obesity in all models at age 5 versus infrequent and non-drinkers.

Those drinking one or more servings a day had a greater increase in BMI z-scores from ages 2 to 4 than non-drinkers, while those who imbibed frequently from ages 4 to 5 “had a similar change in BMI z-score … compared with infrequent/non-drinkers.”

The researchers also found that at all ages, a greater proportion of children drinking at least one daily serving of a sugary drink had a mother who was overweight or obese (P<0.001).

And in a fully adjusted model, kids ages 4 and 5 who drank at least one serving a day of were more likely to watch more than 2 hours of television daily (OR 1.43, CI 1.17-1.74 and OR 1.76, CI 1.31-2.37, P<0.001 for both).

Finally, milk consumption was more likely to be lower among 4-year-olds who had at least one sugary drink per day (OR 1.36, CI 1.01-1.45, P<0.05), but not among 5-year-olds (OR 1.11, CI 0.91-1.37, P=0.30)

Limitations of this study included data based on parental report and not direct observation, incomplete dietary information, and lack of data on physical activity to assess for potential compensation in energy expenditure.

In an accompanying editorial, Anisha Patel, MD, and Lorrene Ritchie, PhD, of the University of California (UC) San Francisco and UC Berkeley, pointed out that the current study “emphasizes the hazards of the vacuum in [sugar-sweetened beverage] policy solutions targeting young children.”

They suggested a number of policy interventions that could be helpful for this age group, including:

• Wider scopes for restrictions in childcare and community settings for sugary drinks
• Dissemination of best practices and education
• Training on beverages for parents and children
• Accountable limits on sugary drinks in dietary guidelines
• Industry-aided strategies for health promotion and drinking water instead of sugary drinks

“Isn’t it time to effect meaningful policies and implementation strategies to curb [sugar-sweetened beverage] consumption in our youngest children?,” they concluded.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

LAST UPDATED 08.06.2013