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Findings From the 1999-2004 National Health and Nutrition Examination Survey

Andrew A. Bremer, MD, PhD; Peggy Auinger, MS; Robert S. Byrd, MD, MPH

Arch Pediatr Adolesc Med. 2009;163(4):328-335.

Objective  To evaluate the relationship between insulin resistance–associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels.

Design  A cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National Center for Health Statistics.

Setting  Nationally representative samples of US adolescents participating in the National Health and Nutrition Examination Survey during the years 1999-2004.

Participants  A total of 6967 adolescents aged 12 to 19 years.

Main Exposure  Sugar-sweetened beverage consumption and physical activity levels.

Outcome Measures  Glucose and insulin concentrations, a homeostasis model assessment of insulin resistance (HOMA-IR), total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations, triglyceride concentrations, systolic and diastolic blood pressure, waist circumference, and body mass index (calculated as weight in kilograms divided by height in meters squared) percentile for age and sex.

Results  Multivariate linear regression analyses showed that increased sugar-sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased HDL cholesterol concentrations; alternatively, increased physical activity levels were independently associated with decreased HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations.

Conclusions  Sugar-sweetened beverage intake and physical activity levels are each independently associated with insulin resistance–associated metabolic parameters and anthropometric measurements in adolescents. Moreover, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects on several health-related outcome variables.

Author Affiliations: Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California (Drs Bremer and Byrd); and the Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York (Ms Auinger).

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