Children who consumed sugar-sweetened beverages between meals ⩾4–6 times/week at 2.5–4.5 years of age were more likely to be overweight at 4.5 years of age
Correspondence to: Dr L Dubois, University of Ottawa, Ottawa, Ontario, Canada;
What is the relation between consumption of sugar-sweetened beverages (carbonated or fruit-flavoured drinks) between meals and overweight in preschool children?
population-based cohort study (Longitudinal Study of Child Development in Quebec [LSCDQ]).
1549 of a random sample of 2103 preschool children from the LSCDQ were included in the nutrition study.
child’s regular consumption (⩾4–6 times/wk) of sugar-sweetened beverages (carbonated or fruit-flavoured drinks but not pure fruit juices) at 2.5−4.5 years of age, birth weight, and sex; maternal age, immigrant status, and education; family income sufficiency, annual gross income, and family type (1 or 2 parents); and parental obesity or overweight (body mass index [BMI] ⩾25 kg/m2).
overweight at 4.5 years (BMI ⩾95th percentile on US Centers for Disease Control and Prevention growth charts).
At 4.5 years of age, the incidences of overweight in non-consumers and regular consumers of sugar-sweetened beverages between meals at 2.5–4.5 years of age were 6.9% and 15%, respectively. Multivariate analysis showed that children who regularly consumed sugar-sweetened beverages between meals had greater risk of overweight than non-consumers, even when other risk factors such as birth weight >4000 g, family income insufficiency, and parental obesity or overweight were considered in the analysis (table). Results were similar when energy intake, macronutrient intake, and serving of food groups were considered in the analysis. Children who regularly consumed sugar-sweetened beverages between meals and had family income sufficiency (adjusted odds ratio [OR] 2.7, 95% CI 1.2 to 6.3) or insufficiency (OR 3.4, CI 1.0 to 12) were more likely to be overweight than non-consumers who had family income sufficiency.
Children who consumed sugar-sweetened beverages between meals ⩾4–6 times/week at 2.5–4.5 years of age were more likely to be overweight at 4.5 years of age.
Dubois L, Farmer A, Girard M, et al. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc 2007;107:924–34.
Clinical impact ratings: Family/General practice 5/7; Health promotion 6/7; Obesity 6/7; Paediatrics 5/7
Source of funding: in part, Canadian Institute of Health Information; Population Health Initiative; Canadian Institute of Health Research.
The growing rate of childhood overweight and obesity is a topical issue.1 The study by Dubois et al examined the relation between consumption of sugar-sweetened beverages between meals and overweight in preschool children. The results provide evidence to support what many practitioners have believed for some time—that drinking sugar-sweetened beverages is associated with overweight in children. Strengths of the study include its longitudinal design and the actual measurement of BMI, which is often misreported when based on self-report data.2
However, a dietary-recall interview and a food-frequency questionnaire were used, and these measures are subject to bias. In addition, approximately 1 in 5 children were from immigrant families, and the prevalence of overweight differs among ethnic groups.2 Furthermore, measurement of overweight using the American standard of ⩾95th percentile has limitations. The best measure of childhood overweight and obesity is still debated.3
Dubois et al found that children were 3 times more likely to be overweight when their families had insufficient incomes. Children from families with insufficient incomes consumed more sugar-sweetened beverages between meals than children from families with sufficient incomes. Relevant health promotion messages should include consumption of diet drinks as well as the usual water and milk to reduce preschoolers’ caloric intake.4 Structural variables are also responsible for disparities in obesity rates, and public initiatives should not be limited to targeting individuals. For instance, the correlation between low-income neighbourhoods and the number of fast food outlets suggests that the foci of action should also include working with, or even regulating, such providers to reduce overall energy intake.