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“Sugar sweetened beverage “means any nonalcoholic beverage Carbonated or noncarbonated, which is intended for human consumption and contains any added caloric sweetener. [1] In addition, it contains more than 10 calories per 8 ounce.
These beverages include: sweetened water, non diet soda, fruit or vegetable drinks containing less than 70 % natural fruit or vegetable juice, sports drinks, energy drinks and sweetened bottled coffee or tea.
Sugar sweetened beverages provide little or no nutritional value, but contain huge amount of sugar. [2]
تعديل…..
“One 12-ounce can of sugar-sweetened soda contains 150 calories and 40 to 50 grams of sugar. If these calories are added to a typical US diet with no offsetting reduction in other caloric sources, one can of soda per day can lead to a 15-pound weight gain in a year. A better mechanism for weight gain could not have been developed than introducing a liquid carbohydrate with calories that are not fully compensated for by increasing satiety. Liquid calories are a relatively new addition to the human diet-perhaps the human satiety circuit has not yet adapted to register these calories for what they are.”
Dr. Caroline Apovian, Sugar-Sweetened Soft Drinks, Obesity, and Type 2
Diabetes, American Medical Association,2004;
Emerging_ evidence_ also_ suggests_ that_ higher_ consumption_of_ sugar_sweetened_ soft_ drinks_ may_ raise_
the_risk_of_developing_type_2_diabetes_and_the_metabolic_syndrome._Soft_drinks_contain_large_amounts_
of_ simple_ sugars,_ which_ can_ induce_ higher_ glycemic_ and_ insulinemic_ responses._ Soft_ drinks_ are_ an_
important_source_of_glycemic_load_in_the_diet,_which_has_been_associated_with_the_risk_of_developing_
type_2_diabetes_and_cardiovascular_disease.
Frank B. Hu MD, PhD, SUGAR_SWEETENED_SOFTDRINK__
CONSUMPTION_AND_RISK_OF_TYPE_2__
DIABETES_AND_CARDIOVASCULAR_RISK,CMR,2009;2,2,13-18
Health consequences of (SSB):
In fact, sugar sweetened beverages cause health risks both because of what they include (mainly sugars, extra calories, and various additives) and what they replace in the diet (foods and beverages that provide minerals, vitamins, and other nutrients).
SSB and Obesity:
Obesity becomes the most prevalence public health problem that increases dramatically. The prevalence of overweight is tripled in children and adult. There are many environmental factors that associated with development of obesity due to change in food and beverage consumption. These factors that may influence children to consume soft drinks are different such as taste, preference, soft drink availability and television viewing. From the survey which was done for 560 American children, the researchers found that over 80% of respondent consume soda at least weekly, and 30% consume soda daily [3]. Also they found that these children who consume soft drinks, their parents and peers share them and they watched TV 3.5hday and have easily access to soft drinks in both home and school.
Researchers also found that there is association between increased sweetened beverage and increase in BMI. Some studies show a clear relationship between consumption of sugar sweetened beverage, particularly soft drinks, and increase in the prevalence of overweight and obesity.
Knowing the factors that contribute to the consumption of soft drinks will aid in prevention and treatment of overweight in children and adolescent. Dietitian must increase parent’s awareness of unhealthy life style, behavior, help them to control family’s eating habits, limit watching TV. For children who are at risk of overweight, limit access to soft drinks and decrease TV viewing [4].
In some point, families and their children may resist making life style changes, so addressing these factors may encourage them to make decision in their eating habits.
Family can also develop a strategy to modify their life style and improve their health, so the results will be healthier children, families who can battle the epidemic of obesity [5].
Indeed a number of large scale epidemiological studies have found consistent positive associations between SSB consumption and long-term weight gain and risk of chronic diseases including metabolic syndrome (MetSyn), T2DM and CHD. SSB consumption is thought to lead to weight gain because of the high added sugars content and low satiety of these beverages and incomplete compensation for total energy at subsequent meals following intake of liquid calories. In addition, because of their high amounts of rapidly absorbable carbohydrates such as sucrose or high-fructose corn syrup (HFCS), coupled with the large quantities often consumed, SSB’s may increase risk of T2DM independent of obesity as a potential contributor to a high dietary glycemic load (GL) which lead to inflammation , insulin resistance, and impaired beta-cell function. Hu FB, Malik VS, Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence, Physiol Behav (2010), doi:10.1016/j.physbeh.2010.01.036
Several recent studies suggest that increased abdominal adiposity and waist circumference (W_ C) is a strong predictor of all – cause mortality [7].
The consumption of nonalcoholic carbonated beverages or soft drinks and sweetened juices by children has rapidly increased during short period displacing water and nutrient – dense beverage such as dairy products. [8]
As it stated before that obesity among children becomes a big health concern around the world.
The prevalence of overweight and obesity amongst children in Qatar state has previously been reported between 37.5% and 41.6 % [9] males and females children respectively.
In general, obesity presents an entirely new set of public health problem reported in Qatar, considering a major risk factor for non- communicable diseases.
Obesity is a risk factor for cardiovascular disease [10], Diabetes [11] and certain types of cancer [12]. It can also be associated with non- fatal but debilitating illnesses such as respiratory difficulties, infertility and musculoskeletal disorders [13]. According to data available in previous studies, overweight and obesity among Qatari adolescents from both sexes are 23.6% and 36.5% [14] females and males respectively.
Childhood corpulence is a predictor for adult disease [15]. In particular recent studies have shown that increased BMI in childhood may predict the occurrence of obesity in adulthood [16, 17].
In children as apposed to adults, the BMI values vary with both age and gender, thus the proffered assessment is BMI- for- age, in which children with body mass index (BMI) for age between 85th and 95th percentile are classified as being overweight and those in the ≥ 95th percentile are considered obese [18].
Excessive calorie intake in the form of a number of macronutrients has been associated with weight gain. energy intake from sugar- sweetened beverage (SSB) now accounts for a significant fraction of the total caloric intake of young people[19], and consumption has been implicated in promoting obesity in several ,but not all studies[20].
The World Health Organization has implicated the consumption of sugar sweetened beverages (SSBs) as “probable contributor” to the obesity epidemic. The National Food Survey in the United Kingdom documented a five – fold increase in household consumption of SSBs between 1974 and 1999, from 180 to 976 g/wk. A similar trend was observed in the United States, where the average daily consumption of SSBs by children (6 to 17 y of age) more than doubled between 1977 and 1998, from 150 to 350 g/d (5 to 12 oz/d) [21].
Sucrose, fructose and glucose -sweetened beverage intake has been associated with poor diet quality and fast food consumption [22].
In a study published in United State, they include “desire to drink DD” scale which measure difference in the quality and frequency with which children want to drink.
Behavioral correlate of DD:
High scoreƒ more frequent desire to have drink but indication of type of drink.
DD relates to thirstƒ scores should be associated to or with all consumption of all drinks.
DD relates to liking for sweet things in mouthƒ high score would be expected to consume higher quantities of sweetened beverage [23].
Consumption of SSB and obesity in childhood
Studies reviewed
Several studies have been published examining the potential contribution of sugar-sweetened beverages (SSB) to weight gain in children. There are many cross-sectional studies identified, some of these reported a positive association between the frequencies of intake sugar sweetened drinks and obesity while some found no association. Overall, there is extensive evidence that sugary drinks contribute to weight gain in children. Both baseline intake and changes in the intakes of these drinks are associated with an increase risk of weight gain in both children and adolescents
Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective observational analysis. Lancet 2001; 357:505-508.
A study conducted in United State on sample of 10,371 boys and girls aged 2-19 years from representative US sample. The results were positive linked that overweight children BMI > 95th consume a grater % of energy from soft drinks and total beverages than non-overweight children.
Troiano RP, Briefel RR, Carroll MD, Bialostosky K. Energy and fat intakes of children and adolescents in the United States: data from the National Health and Examination Surveys. Am J Clin Nutr 2000; 72:1343S-1353S.
Another study conducted on 185 Canadian children aged 4-16 years also indicated appositive association between high consumption of SSB and increase BMI and overweight.
Gillis LJ, Bar-Or O. Food away from home, sugar-sweetened drink consumption and juvenile obesity. J Am Coll Nutr 2003; 22:539-545.
The results of a study on 3048 multi- ethnic New Zealand children from both gender aged 5-14 years stated that children dinking soft drinks > 1 per day had higher mean BMI than those with intake < 1 per week ( 19.7cf. 18.8 KgM2)
Scragg R, Wilson N, Schaaf D, Fitzgerald E, Utter J. Risk factor for obesity in New Zealand children aged 5-14 years: results from the 2002 national Children.s Nutrition Survey. Australasian Epidemiologist 2004;11:23-24.
Findings from small food consumption studies from various countries including South Africa, the Philippines and New Zealand are also indicative of high consumption levels of sugar sweetened beverages.
A recent study was conducted in Saudi Arabia, a total study sample consisted of 9433 males and females aged 10- 19 years old participated in a designed Food Frequency Questionnaire. BMI and W_C measurements were obtained and correlated with dietary Intake. The results show that the overall prevalence of overweight and obesity was 12.2% and 27.0% respectively, with boys having higher obesity rates than girls. W_C and BMI was positively correlated with sugar sweetened carbonated beverages (SSCB) intake in boys only.
Kate S Collison, Marya Z Zaidi, Shazia N Subhani.al, Sugar- sweetened carbonated beverage consumption correlated with BMI, waist circumference, and poor dietary choices in school children, BMC Public Health, 2010;10: 234,2-12.
Bones and osteoporosis
People who prefer to drink soft drinks and or any type of sweetened beverages instead of milk or other daily products probable their intake of calcium will be low and this will lead to osteoporosis, which is a disease that cause bone fragile and broken .
The risk factor of osteoporosis depends on how much bones mass is built up early in life. Girls build 92 percent of their bone mass by age 18, but if they don’t consume sufficient calcium in their teenage years, they can not catch up later.
That’s why experts recommend higher calcium intakes for youths aged 9 to 18 than for adults aged 19 to 50 [24].
Although osteoporosis takes decades to develop, preliminary research suggests that the lower calcium intake that may result for example from drinking soda pop instead of milk can contribute to broken bones in children [25].
Heart Disease
Heart disease is the nation’s number- one killer. Some of the most important causes are diets high in saturated and trans fats and cholesterol.
In many adults, a diet or beverage that is high in sugar may also be a modest contributor to heart disease [ 26].
A study of young adults (19 to 38 years old) in Louisiana found a strong association between consumption of sweetened beverages and risk factors for syndrome X [27].
Diabetes
In fact, soft drinks are harmful for people with diabetes since one pack of them contain 33 grams of table sugars (sucrose) and this type of sugar is absorbed rapidly which will raise blood sugars quickly. This action impacts negatively on controlling diabetes [28].
Kidney stones
Kidney stones consider as one of the most painful disorders to distress humans and one of the most common disorders of the urinary tract.
Researchers had subjects consume large volume of cola drinks for one or several days. The next day, the subjects’ urine contained higher levels of oxalate
and lower levels of magnesium and citrate, changes that could contribute to kidney stone formation [29 ].
SSB and Tooth Decay
Scientists have noticed a connection between soft drink consumption and dental health.
Like obesity (or any issue involving human health), tooth decay is a complex subject. It is the result of many factors, including the types of foods that are consumed and frequency of eating occasions. Foods that are “sticky” and cling to the teeth are more likely to cause tooth decay. The amount of time that sugar remains in contact with teeth is another important variable. Soft drinks and other sugar-containing liquids pass over the teeth very quickly. A recent study examined dental caries and beverage consumption among 1- to 5-year-old children and found an association between soft drinks and increased caries.
Marr Barr,Longmont, Colorado, Soft Drinks, Childhood Overweight, and the Role of Nutrition Educators, Nutrition Education and Behavior, 2004; 36:258-265.
In addition, drinking soft drinks between meals was found to increase the number of dental decay and caries in a twenty-year longitudinal study. As a result of an increasing consumption of soft drinks and commercial fruit juices, over the past years, the prevalence of dental erosion and decay has increased dramatically. Acids from the soft drinks have been known to induce the dissolution or erosion of dental enamel as well as caries lesion due to the combined effect of bacteria and degradation of carbohydrates present in the drinks [30].
Nationally, there is great concern about the effects of carbonated- beverages consumption on obesity, osteoporosis, heart diseases, tooth decay, and other health problems.
