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Arch Pediatr Adolesc Med. 2004;158:290.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Giammattei et al¹ found that both diet and sugar-sweetened soft drinks were positively associated with obesity and concluded that "it is not the calories in drinks per se that are responsible for this association." We are surprised by this assertion, in view of the methodological limitations of their study. The design was cross-sectional in nature, and very few relevant covariates were examined in statistical models. Therefore, the potential for confounding and reverse causality must be carefully weighed. As the authors acknowledge, obese children are probably more likely to drink diet soda, a fact that might explain entirely the observed association. We conducted a prospective observational study of soft drinks and obesity during 2 academic years and sought to control for multiple demographic, dietary, and behavioral confounders (including whether the child was exercising to lose weight).² We found that sugar-sweetened drinks were positively associated, while diet drinks were negatively associated with . . . [Full Text of this Article]

David S. Ludwig, MD, PhD
Division of Endocrinology
Children's Hospital
300 Longwood Ave
Boston, MA 02115

Cara B. Ebbeling, PhD; Karen E. Peterson, ScD, RD; Steven L. Gortmaker, PhD
Boston

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Arch Pediatr Adolesc Med. 2004;158(3):290.
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