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Y. Claire Wang, MD, ScD; David S. Ludwig, MD, PhD; Kendrin Sonneville, MS, RD, LDN; Steven L. Gortmaker, PhD

Arch Pediatr Adolesc Med. 2009;163(4):336-343.

Objective  To estimate the net caloric impact from replacing sugar-sweetened beverages (SSBs) with alternatives in children and adolescents in naturalistic settings.

Design  Secondary analysis based on nationally representative cross-sectional study.

Setting  Fixed-effect regression analysis of 2 nonconsecutive 24-hour dietary recalls from the 2003-2004 National Health and Nutrition Examination Survey data.

Participants  Children and adolescents 2 to 19 years of age (N = 3098).

Main Exposures  Within-person beverage consumption between 2 surveyed days.

Main Outcome Measures  The association between changes in the consumption of SSBs and other beverages and changes in total energy intake (TEI) of the same individual.

Results  Each additional serving (8 oz) of SSB corresponded to a net increase of 106 kcal/d (P < .001; 95% confidence interval [CI], 91 to 121 kcal/d), holding other beverages constant. Increases were also seen (all P < .001) for each additional serving of whole milk (169 kcal/d; 95% CI, 143 to 195 kcal/d), reduced-fat milk (145 kcal/d; 95% CI, 118 to 171 kcal/d), and 100% juice (123 kcal/d; 95% CI, 90 to 157 kcal/d). No net increases in TEI were seen for water (8 kcal/d; P = .27; 95% CI, –6 to 22 kcal/d) or diet drinks (47 kcal/d; P = .20; 95% CI, –23 to 117 kcal/d). Substituting SSBs with water was associated with a significant decrease in TEI, controlling for intake of other beverages, total beverage and nonbeverages, and fast-food and weekend effects. Each 1% of beverage replacement was associated with 6.6-kcal lower TEI, a reduction not negated by compensatory increases in other food or beverages. We estimate that replacing all SSBs with water could result in an average reduction of 235 kcal/d.

Conclusion  Replacing SSB intake with water is associated with reductions in total calories for all groups studied.

Author Affiliations: Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York (Dr Wang); and Department of Society, Human Development, and Health (Ms Sonneville and Dr Gortmaker), Harvard School of Public Health, and Department of Medicine, Children's Hospital Boston (Dr Ludwig), Boston, Massachusetts.

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