Elsevier

The Lancet

Volume 357, Issue 9255, 17 February 2001, Pages 505-508
The Lancet

Articles
Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis

https://doi.org/10.1016/S0140-6736(00)04041-1Get rights and content

Summary

Background

The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks. Our aim was to examine this relation.

Methods

We enrolled 548 ethnically diverse schoolchildren (age 11·7 years, SD 0·8) from public schools in four Massachusetts communities, and studied them prospectively for 19 months from October, 1995, to May, 1997. We examined the association between baseline and change in consumption of sugar-sweetened drinks (the independent variables), and difference in measures of obesity, with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools.

Findings

For each additional serving of sugar-sweetened drink consumed, both body mass index (BMI) (mean 0·24 kg/m2; 95% CI 0·10–0·39; p=0·03) and frequency of obesity (odds ratio 1·60; 95% CI 1·14–2·24; p=0·02) increased after adjustment for anthropometric, demographic, dietary, and lifestyle variables. Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI (mean 0·18 kg/m2 for each daily serving; 95% CI 0·09–0·27; p=0·02).

Interpretation

Consumption of sugar-sweetened drinks is associated with obesity in children.

Introduction

The prevalence of obesity among children in USA increased by 100% between 1980 and 1994.1 Recent national estimates indicate that 24% and 11% of children are above the 85th and 95th reference percentiles of body mass index (BMI), for age and sex, respectively. Various environmental and social factors relating to diet and physical activity have been identified that could contribute to obesity.2 One such factor, which has received little attention, is the consumption of sugar-sweetened drinks.

According to data from the US Department of Agriculture (USDA), per capita soft-drink consumption has increased by almost 500% over the past 50 years.3 From 1989–91 to 1994–95, soft-drink intake rose from 195 to 275 mL in the general population, and from 345 to 570 mL among adolescent boys.4 Half of all Americans and most adolescents (65% girls and 74% boys) consume soft drinks daily,5 most of which are sugar-sweetened, rather than artificially sweetened.6 Currently, soft drinks constitute the leading source of added sugars in the diet,7, 8 amounting to 36·2 g daily for adolescent girls and 57·7 g for boys.7 These figures approach or exceed the daily limits for total added sugar consumption recommended by the USDA. Among children of school age, total energy intake is positively associated with soft-drink consumption, ranging from an adjusted mean of 7650 kJ daily for non-consumers to 8435 kJ for those drinking an average of 265 mL or more every day.6

Although this increase in soft-drink consumption coincides with secular increases in obesity prevalence in children, the long-term effects of sugar-sweetened drink consumption on measures of body weight need to be prospectively examined. We aimed to determine the association between change in sugar-sweetened drink consumption and change in BMI, and incidence of obesity among school-age children, over 2 academic years.

Section snippets

Patients

Data for our study were obtained as part of the Planet Health intervention and evaluation project, which took place in schools in four communities in the Boston, Massachusetts, metropolitan area between October, 1995, and May, 1997. We enrolled children from five randomly assigned control schools that did not take part in the lifestyle intervention programme designed to reduce obesity prevalence.9 The median household income of zip-code areas where the control schools were located, averaged

Results

Table 1 shows baseline and follow-up anthropometric and dietary data. Intake of sugar-sweetened drinks increased from baseline to follow-up: only 38 (7%) children showed no change in sugar-sweetened drink intake whereas 57% (312) showed increased intake, with a quarter drinking more than one extra serving daily. BMI also increased. The baseline prevalence of obesity was just over a quarter, and the cumulative incidence of new cases over the 19 months was 9·3%. Children reported moderate to

Discussion

Excessive bodyweight probably now constitutes the most common paediatric medical problem in USA. Although the cause of this apparent obesity epidemic is likely to be multifactorial, our findings suggest that sugar-sweetened drink consumption could be an important contributory factor. The odds ratio of becoming obese among children increased 1·6 times for each additional can or glass of sugar-sweetened drink that they consumed every day. By contrast, increased diet-soda consumption was

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