Substituting Water for Sugar-Sweetened Beverages Reduces Circulating Triglycerides and the Prevalence of Metabolic Syndrome in Obese but Not in Overweight Mexican Women in a Randomized Controlled Trial1,2
Mexico’s sugar-sweetened beverage (SSB) intake is among the highest globally. Although evidence shows that increases in SSB intake are linked with increased energy intake, weight gain, and cardiometabolic risks, few randomized clinical trials have been conducted in adults.
Objective:
The aim of this study was to determine if replacing SSBs with water affects plasma triglycerides (TGs) (primary outcome), weight, and other cardiometabolic factors.
Methods:
We selected overweight/obese (BMI ≥25 and <39 kg/m2) women (18–45 y old) reporting an SSB intake of at least 250 kcal/d living in Cuernavaca, Mexico. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or the education provision (EP)–only group (n = 120). The WEP group received biweekly water deliveries, and both groups received equal monthly nutrition counseling. During nutrition counseling, the WEP group sessions included activities to encourage increased water intake, reduced SSB intake, and substitution of water for SSBs. Repeated 24-h dietary recalls, anthropometric measurements, and fasting blood samples were collected at baseline and at 3, 6, and 9 mo. The Markov–Monte Carlo method was used for multiple imputation; separate mixed-effects models tested each outcome.
Results:
An intent-to-treat (ITT) analysis indicated that the WEP group increased water intake and decreased SSB intake significantly over time, but there were no differences in plasma TG concentrations between groups at the end of the intervention (WEP at baseline: 155 ± 2.10 mg/dL; WEP at 9 mo: 149 ± 2.80 mg/dL; EP at baseline: 150 ± 1.90 mg/dL; EP at 9 mo: 161 ± 2.70 mg/dL; P for mean comparisons at 9 mo = 0.10). Secondary analyses showed significant effects on plasma TGs (change from baseline to 9 mo: WEP, −28.9 ± 7.7 mg/dL; EP, 8.5 ± 10.9 mg/dL; P = 0.03) and metabolic syndrome (MetS) prevalence at 9 mo (WEP: 18.1%; EP: 37.7%; P = 0.02) among obese participants.
Conclusions:
Providing water and nutritional counseling was effective in increasing water intake and in partially decreasing SSB intake. We found no effect on plasma TGs, weight, and other cardiometabolic risks in the ITT analysis, although the intervention lowered plasma TGs and MetS prevalence among obese participants. Further studies are warranted. This trial was registered at http://www.clinicaltrials.gov as NCT01245010.
Supported in part by a grant from the Danone Research Center to the National Institute of Public Health, Cuernavaca, Mexico, which provided water for the intervention and partially supported S.H.-C.’s research sabbatical at the University of North Carolina at Chapel Hill. The Danone Research Center had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation or approval of themanuscript. This is a free access article, distributed under terms (http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Author disclosures: None of the authors consulted with the Danone Research Center, but some of the authors received grants to conduct clinical studies (S. Barquera), grants for epidemiologic analyses/talks on beverage patterns at the British Nutrition Society (B. Popkin), or partial support for sabbatical research at the University of North Carolina at Chapel Hill (S. Hernández-Cordero). S. Rodríguez-Ramírez, M. A. Villanueva-Borbolla, T. González de Cossio, and J. Rivera Dommarco, no conflicts of interest.
