The relative reinforcing value of sweet versus savory snack foods after consumption of sugar- or non-nutritive sweetened beverages Beverage Intake Among Preschool Children and Its Effect on Weight Status Beverage consumption patterns of children born at different risk of obesity. The effects of water and non‐nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial Globalization of Diabetes Tea-induced calmness: Sugar-sweetened tea calms consumers exposed to acute stressor Two‐year follow‐up of a primary care‐based intervention to prevent and manage childhood obesity: the High Five for Kids study Need for specific sugar-sweetened beverage lessons for fourth- and fifth-graders. Taxing sugar-sweetened beverages: a survey of knowledge, attitudes and behaviours. Reduction in sugar-sweetened beverages is not associated with more water or diet drinks. Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial. Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children. The Use of Low-Calorie Sweeteners by Children: Implications for Weight Management123 Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake Effects on uric acid, body mass index and blood pressure in adolescents of consuming beverages sweetened with high-fructose corn syrup Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study. A randomized trial of sugar-sweetened beverages and adolescent body weight. Tipping the balance: use of advergames to promote consumption of nutritious foods and beverages by low-income African American children. The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children☆ Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial. Improving Self-Regulation for Obesity Prevention in Head Start: A Randomized Controlled Trial
The effects of sugar-sweetened ( SSB ) and non-nutritive sweetened ( NSB ) beverages on the regulation of appetite , energy intake and body weight regulation remain controversial . Using a behavioral choice paradigm , we sought to determine the effects of consuming a SSB or NSB on appetite and the reinforcing value of sweet relative to salty/savory snack foods . In a r and omized crossover study , 21 healthy weight adults consumed 360 ml of SSB ( sucrose ; 31 g ) or NSB ( sucralose ; 4 g ) with a st and ardized meal . Hedonic ratings for the sweet and salty/savory snack foods used for the reinforcement task were assessed prior to the start of the study . Satiety and the desire to eat foods with a specific taste profile were assessed before and every 30 min post-meal for 4 h. The relative reinforcing value of the snack foods was assessed using a computer-based choice task ( operant responding with concurrent schedules of reinforcement ) 4 h post-meal . Hedonic ratings did not differ between the most highly liked sweet and salty/savory snack foods . Beverage type did not influence measures of satiety or the desire to eat foods with a specific taste . However , sweet snacks were more ( p < 0.05 ) reinforcing relative to salty/savory snack foods after consuming a NSB than after a SSB . In conclusion , this is the first study to demonstrate that NSB can increase the motivation to gain access to sweet snacks relative to salty/savory snack foods later in the day OBJECTIVE . The obesity epidemic in the United States continues to increase . Because obesity tends to track over time , the increase in overweight among young children is of significant concern . A number of eating patterns have been associated with overweight among preschool-aged children . Recently , 100 % fruit juice and sweetened fruit drinks have received considerable attention as potential sources of high-energy beverages that could be related to the prevalence of obesity among young children . Our aim was to evaluate the beverage intake among preschool children who participated in the National Health and Nutrition Examination Survey 1999–2002 and investigate associations between types and amounts of beverages consumed and weight status in preschool-aged children . METHODS . We performed a secondary analysis of the data from the National Health and Nutrition Examination Survey 1999–2002 , which is a continuous , cross-sectional survey of a nationally representative sample of the noninstitutionalized population of the United State . It included the collection of parent reported demographic descriptors , a  24-hour dietary recall  , a  measure of physical activity  , and a st and ardized physical examination .  The 24-hour dietary recall was obtained in person by a trained interviewer and reflected the foods and beverages that were consumed by the participant the previous day . The National Health and Nutrition Examination Survey food groups were classified on the basis of the US Department of Agriculture 's Food and Nutrient Data base for Dietary Studies . We review ed the main food descriptors used and classified all beverages listed . One hundred percent fruit juice was classified as only beverages that contained 100 % fruit juice , without sweetener . Fruit drinks included any sweetened fruit juice , fruit-flavored drink ( natural or artificial ) , or drink that contained fruit juice in part . Milk included any type of cow milk and then was subcategorized by percentage of milk fat . Any sweetened soft drink , caffeinated or uncaffeinated , was categorized as soda . Diet drinks included any fruit drink , tea , or soda that was sweetened by low-calorie sweetener . Several beverages were removed from the analysis because of low frequency of consumption among the sample . Water was not included in the analysis because it is not part of the US Department of Agriculture 's Food and Nutrient Data base categories . For the purpose s of this analysis , the beverages were converted and reported as ounces , rather than grams , as reported by the National Health and Nutrition Examination Survey , to make it more clinical ly relevant . The child 's BMI percentile for age and gender were calculated on the basis of Centers for Disease Control and Prevention criteria and used to identify children 's weight status as underweight ( < 5 % ) , normal weight ( 5 % to < 85 % ) , at risk for overweight ( 85 % to < 95 % ) , or overweight ( ≥95 % ) . Because of the small number of children in the underweight category , they were included in the normal-weight category for this analysis . Data were analyzed using SUDAAN 9.0.1 statistical software programs . SUDAAN allows for improved accuracy and validity of results by calculating test statistics for the stratified , multistage probability design of the National Health and Nutrition Examination Survey . Sample weights were applied to all analyses to account for unequal probability of selection from oversampling low-income children and black and Mexican American children . Descriptive and χ2 analyses and analysis of covariance , adjusting for age , gender , ethnicity , household income , energy intake , and physical activity , were conducted . RESULTS . All children who were aged 2 to 5 years were identified ( N = 1572 ) . Those with missing data were removed from additional analysis , result ing in a final sample of 1160 preschool children . Of the 1160 children analyzed , 579 ( 49.9 % ) were male . White children represented 35 % , black children represented 28.3 % , and Hispanic children represented 36.7 % of the sample . Twenty-four percent of the children were overweight or at risk for overweight ( BMI ≥85 % ) , and 10.7 % were overweight ( BMI ≥95 % ) . There were no statistically significant differences in BMI between boys and girls or among the ethnicities . Overweight children tended to be older ( mean age : 3.83 years ) compared with the normal-weight children ( mean age : 3.48 years ) . Eighty-three percent of children drank milk , 48 % drank 100 % fruit juice , 44 % drank fruit drink , and 39 % drank soda .  Whole milk was consumed by 46.5 % of the children , and 3.1 % and 5.5 % of the children consumed skim milk and 1 % milk , respectively . Preschool children consumed a mean total beverage volume of 26.93 oz/day , which included 12.32 oz of milk , 4.70 oz of 100 % fruit juice , 4.98 oz of fruit drinks , and 3.25 oz of soda . Weight status of the child had no association with the amount of total beverages , milk , 100 % fruit juice , fruit drink , or soda consumed . There was no clinical ly significant association between the types of milk ( percentage of fat ) consumed and weight status . In analysis of covariance , daily total energy intake increased with increased consumption of milk , 100 % fruit juice , fruit drinks , and soda . However , there was not a statistically significant increase in BMI on the basis of quantity of milk , 100 % fruit juice , fruit drink , or soda consumed . CONCLUSIONS . On average , preschool children drank less milk than the 2005 Dietary Guidelines for Americans recommendation of 16 oz/day . Only 8.6 % drank low-fat or skim milk , as recommended for children who are older than 2 years . On average , preschool children drank < 6 oz/day 100 % fruit juice . Increased beverage consumption was associated with an increase in the total energy intake of the children but not with their BMI . Prospect ively study ing preschool children beyond 2 to 5 years of age , through their adiposity rebound ( ∼5.5–6 years ) to determine whether there is a trajectory increase in their BMI , may help to clarify the role of beverage consumption in total energy intake and weight status BACKGROUND Increased intake of sugar-sweetened beverages and fruit juice has been associated with overweight in children . OBJECTIVE This study prospect ively assessed beverage consumption patterns and their relationship with weight status in a cohort of children born at different risk for obesity . METHODS AND PROCEDURES Participants were children born at low risk ( n = 27 ) or high risk ( n = 22 ) for obesity based on maternal prepregnancy BMI ( kg/m(2 ) ) . Daily beverage consumption was generated from 3-day food records from children aged 3 - 6 years and coded into seven beverage categories ( milk , fruit juice , fruit drinks , caloric and non-caloric soda , soft drinks including and excluding fruit juice ) . Child anthropometric measures were assessed yearly . RESULTS High-risk children consumed a greater percentage of daily calories from beverages at age 3 , more fruit juice at ages 3 and 4 , more soft drinks ( including fruit juice ) at ages 3 - 5 , and more soda at age 6 compared to low-risk children . Longitudinal analyses showed that a greater 3-year increase in soda intake was associated with an increased change in waist circumference , whereas a greater increase in milk intake was associated with a reduced change in waist circumference . There was no significant association between change in intake from any of the beverage categories and change in BMI z-score across analyses . DISCUSSION Children 's familial predisposition to obesity may differentially affect their beverage consumption patterns . Future research should examine the extent to which dietary factors may play a role in pediatric body fat deposition over time Objective To evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners ( NNS ) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program . Methods The study used a r and omized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity . All participants participated in a weight loss program plus assignment to consume 24 ounces ( 710 ml ) of water or NNS beverages daily for 1 year . Results NNS and water treatments were non‐equivalent , with NNS treatment  showing greater weight loss at the end of 1 year . At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg ( P < 0.001 for difference ) . Conclusions Water and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program . NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users  of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program . These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program Type 2 diabetes is a global public health crisis that threatens the economies of all nations , particularly developing countries . Fueled by rapid urbanization , nutrition transition , and increasingly sedentary lifestyles , the epidemic has grown in parallel with the worldwide rise in obesity . Asia 's large population and rapid economic development have made it an epicenter of the epidemic . Asian population s tend to develop diabetes at younger ages and lower BMI levels than Caucasians . Several factors contribute to accelerated diabetes epidemic in Asians , including the “ normal-weight metabolically obese ” phenotype ; high prevalence of smoking and heavy alcohol use ; high intake of refined carbohydrates ( e.g. , white rice ) ; and dramatically decreased physical activity levels . Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia 's diabetes epidemic . Recent advances in genome-wide association studies have contributed substantially to our underst and ing of diabetes pathophysiology , but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk . Nonetheless , interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition . Epidemiologic studies and r and omized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications . Translating these findings into practice , however , requires fundamental changes in public policies , the food and built environments , and health systems . To curb the escalating diabetes epidemic , primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority The food and beverage industry has been increasingly replacing sugar with non-nutritive sweeteners in their sweetened products to control or reduce total calories . Research comparing the effect of nutritive and non-nutritive sweeteners on emotional state of participants exposed to acute stressors is still limited . This study aim ed to determine the effect of drinking tea sweetened with either a nutritive sweetener ( sugar ) or a non-nutritive sweetener ( sucralose or stevia ) on emotional state , in terms of calmness and pleasantness , of participants exposed to an acute stressor . Effects of acute stress on sweetness intensity and overall liking of tea beverages were also determined . Results showed that the possibility of tea-induced calmness , calculated as the difference between calmness ratings after and before drinking a tea sample , was established on stress session in the sugar-sweetened tea .  Overall liking , but not the sweetness intensity , of the sugar-sweetened tea was affected by acute stress . In conclusion , this study provides empirical evidence that the consumption of tea sweetened with nutritive sweetener , but not with non-nutritive sweetener , has calming effect on consumers with acute stress , suggesting that this effect may not be due to the sweet taste of sugar , but due to the caloric nature of the sweetener BACKGROUND The obesity epidemic has spared no age group , even young infants . Most childhood obesity is incident by the age of 5 years , making prevention in preschool years a priority . OBJECTIVE To examine 2-year changes in age- and sex-specific BMI z-scores and obesity-related behaviours among 441 of the 475 originally recruited participants in High Five for Kids , a cluster r and omized controlled trial in 10 paediatric practice s. METHODS The intervention included a more intensive 1-year intervention period ( four in-person visits and two phone calls ) followed by a less intensive 1-year maintenance period ( two in-person visits ) among children who were overweight or obese and age 2 - 6 years at enrolment . The five intervention practice s restructured care to manage these children including motivational interviewing and educational modules targeting television viewing and intakes of fast food and sugar-sweetened beverages . RESULTS After 2 years , compared with usual care , intervention participants had similar changes in BMI z-scores ( -0.04 units ; 95 % CI -0.14 , 0.06 ) , television viewing ( -0.20 h/d ; -0.49 to 0.09 ) and intakes of fast food ( -0.09 servings/week ; -0.34 to 0.17 ) and sugar-sweetened beverages ( -0.26 servings/day ; -0.67 to 0.14 ) . CONCLUSION High Five for Kids , a primarily clinical -based intervention , did not affect BMI z-scores or obesity-related behaviours after 2 years OBJECTIVE Consumption of sugar-sweetened beverages ( SSB ) is linked to obesity . The authors hypothesized that school-based nutrition education would decrease SSB consumption . DESIGN Self-selected interventional cohort with r and om selection for pre and post measurements . SETTING Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools . PARTICIPANTS R and omly selected ( 9 % ) fourth- and fifth- grade classroom students . INTERVENTION The  University of Arizona Nutrition Network provided general nutrition education training and material s to teachers , to be delivered to their students . The University of Arizona Nutrition Network administered behavioral question naires to students in both fall and spring . MAIN OUTCOME MEASURE(S ) Change in SSB consumption . ANALYSES Descriptive statistics were computed for student demographics and beverage consumption on the day before testing . Paired t tests evaluated change in classroom averages . Linear regression assessed potential correlates of SSB consumption . RESULTS Fall mean SSB consumption was 1.1 ( ± 0.2 ) times ; mean milk and water intake were 1.6 ( ± 0.2 ) and 5.2 ( ± 0.7 ) times , respectively . Beverage consumption increased ( 3.2 % ) in springtime , with increased SSBs ( 14.4 % ) accounting for the majority ( P = .006 ) . Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat ( P ≤ .05 ) . CONCLUSIONS AND IMPLICATION S The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather OBJECTIVE To assess current beverage consumption patterns and anticipated reaction to an added 20 % tax on these products . DESIGN A r and om-digit dialled telephone interview lasting 20 min was administered to assess demographics , beverage consumption behaviours and intentions regarding consumption of sugar-sweetened beverages in the event of an additional tax on these beverages . SETTING Respondents were recruited throughout the USA . SUBJECTS The study included 592 adults . RESULTS Sixty-nine per cent of respondents reported consuming at least one pre-packaged sugar-sweetened beverage in the past week ; those who consumed sugar-sweetened beverages averaged seven pre-packaged beverages per week . Ninety-one per cent knew that frequent consumption of soft drinks increases risk of obesity . Thirty-six per cent supported a tax on sugar-sweetened beverages with greatest support among those aged 18 - 24 years , those with BMI < 30 kg/m2 and those with higher levels of education ( P < 0·05 ) . Over one-third of respondents said that they would cut back on their sweetened beverage consumption in the event of an added 20 % tax on these beverages . CONCLUSIONS Our findings suggest that an added tax on these beverages could influence some to cut down on their consumption , reducing their risk of obesity and related illnesses OBJECTIVE The Dutch Obesity Intervention in Teenagers ( DOiT ) is a school-based r and omised controlled trial that was effective in decreasing the consumption of sugar-sweetened beverages among adolescents . The present study examined , using mediation analysis , whether this decrease in consumption of sugar-sweetened beverages could be explained by an increase in the consumption of water or diet drinks . DESIGN Participants completed a question naire about their beverage consumption at baseline and at 8 months ( immediately post-intervention ) , 12- and 20-month follow-ups . A series of multi-level linear regression analyses were performed to examine water and diet drink consumption as potential mediators of the intervention effect on the consumption of sugar-sweetened beverages . SETTING Eighteen Dutch secondary schools . SUBJECTS A total of 747 adolescents ( mean age : 12·7 years ) . RESULTS In addition to the DoiT intervention effect of a reduction in the consumption of sugar-sweetened beverages at 8 months ( -284 ml/d ; 95 % CI -420 , -148 ) and 12 months ( -260 ml/d ; 95 % CI -360 , -160 ) , there was also a significant reduction in diet drinks at 8 months ( -52 ml/d ; 95 % CI -89 , -16 ) . There was no significant difference in water consumption at any follow-up . The decrease in sugar-sweetened beverage consumption could not be explained by an increase in water or diet drink consumption at any time point . CONCLUSIONS Interventions aim ed at reducing sugar-sweetened beverage consumption may be effective without changing consumption of other beverages . Reducing sugar-sweetened beverages was , however , a main message of the DOiT intervention . It is possible that a concomitant promotion of water may have result ed in a greater increase in water intake and replacement of sugar-sweetened beverages with water INTRODUCTION Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages , but warnings ' effects on actual purchase behavior remain uncertain . This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases . STUDY DESIGN Participants completed one study visit to a life-sized replica of a convenience store in North Carolina . Participants chose six items ( two beverages , two foods , and two household products ) . One item was r and omly selected for them to purchase and take home . Participants also completed a question naire . Research ers collected data in 2018 and conducted analyses in 2019 . SETTING / PARTICIPANTS Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers ( usual consumption ≥12 ounces/week ) . INTERVENTION Research staff r and omly assigned participants to a health warning arm ( sugar-sweetened beverages in the store displayed a front-of-package health warning ) or a control arm ( sugar-sweetened beverages displayed a control label ) . MAIN OUTCOME MEASURES The primary trial outcome was sugar-sweetened beverage calories purchased . Secondary outcomes included reactions to trial labels ( e.g. , negative emotions ) and sugar-sweetened beverage perceptions and attitudes ( e.g. , healthfulness ) . RESULTS All 400 participants completed the trial and were included in analyses . Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants . In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity , health warnings led to lower sugar-sweetened beverage purchases ( adjusted difference , -31.4 calories ; 95 % CI= -57.9 , -5.0 ) . Unadjusted analyses yielded similar results ( difference , -32.9 calories ; 95 % CI= -58.9 , -7.0 ) . Compared with the control label , sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention , negative emotions , thinking about the harms of sugar-sweetened beverage consumption , and anticipated social interactions . Trial arms did not differ on perceptions of sugar-sweetened beverages ' added sugar content , healthfulness , appeal/coolness , or disease risk . CONCLUSIONS Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT . Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT03511937 OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines , and examine demographic and household correlates of guideline adherence . DESIGN Cross-sectional ( pre-r and omization ) data from a behavioral intervention trial design ed to prevent unhealthy weight gain in children . PARTICIPANTS A total of 421 children ( aged 5 - 10 years ) at risk for obesity ( body mass index percentile , 70 - 95 ) . MAIN OUTCOMES MEASURED Physical activity ( accelerometry ) , screen time ( parent survey ) , and fruit and vegetable and sugar-sweetened beverage intake ( 24-hour dietary recall ) . ANALYSIS Proportions meeting guidelines were calculated . Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for ( 1 ) physical activity ( ≥ 60 min/d ) , ( 2  ) screen time  ( ≤ 2 h/d ) , ( 3 ) fruit and vegetable intake ( ≥ 5 servings/d ) , and ( 4 ) sugar-sweetened beverage avoidance . RESULTS Few children met more than 1 guideline . Only 2 % met all 4 recommended guidelines and 19 % met none . Each guideline had unique sociodemographic and domain-specific household predictors ( ie , availability of certain foods and beverages , media , and active play and exercise equipment ) . CONCLUSIONS AND IMPLICATION S Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others . Results have implication s for the development of interventions to affect children 's weight-related behaviors and growth trajectories BACKGROUND Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic in the US population , but their causal relation remains unclear . OBJECTIVE The objective of this study was to examine how changes in beverage consumption affect  weight change among adults . DESIGN This was a prospect i ve study of 810 adults participating in the PREMIER trial , an 18-mo r and omized , controlled , behavioral intervention trial .  Measurements ( weight , height , and 24-h dietary recall ) were made at baseline , 6 mo , and 18 mo . RESULTS Baseline mean intake of liquid calories was 356 kcal/d ( 19 % of total energy intake ) . After potential confounders and intervention assignment were controlled for , a reduction in liquid calorie intake of 100 kcal/d was associated with a weight loss of 0.25 kg ( 95 % CI : 0.11 , 0.39 ; P < 0.001 ) at 6 mo and of 0.24 kg ( 95 % CI : 0.06 , 0.41 ; P = 0.008 ) at 18 mo . A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss . Of the individual beverages , only intake of sugar-sweetened beverages ( SSBs ) was significantly associated with weight change . A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg ( 95 % CI : 0.11 , 0.82 ; P = 0.006 ) at 6 mo and of 0.65 kg ( 95 % CI : 0.22 , 1.09 ; P = 0.003 ) at 18 mo . CONCLUSIONS These data support recommendations to limit liquid calorie intake among adults and to reduce SSB consumption as a means to accomplish weight loss or avoid excess weight gain . This trial was registered at clinical trials.gov as NCT00000616 BACKGROUND During the nutrition transition in Chile , dietary changes were marked by increased consumption of high-energy , nutrient-poor products , including sugar-sweetened beverages ( SSBs ) . Obesity is now the primary nutritional problem in posttransitional Chile . OBJECTIVE We conducted a r and omized controlled trial to examine the effects on body composition of delivering milk beverages to the homes of overweight and obese children to displace SSBs . DESIGN We r and omly assigned 98 children aged 8 - 10 y who regularly consumed SSBs  to intervention and control groups . During a 16-wk intervention , children were instructed to drink 3 servings/d ( approximately 200 g per serving ) of the milk delivered to their homes and to not consume SSBs .  Body composition was measured by dual-energy X-ray absorptiometry . Data were analyzed by multiple regression analysis according to the intention-to-treat principle . RESULTS For the intervention group , milk consumption increased by a mean ( + /- SEM ) of 452.5 + /- 37.7 g/d ( P < 0.0001 ) , and consumption of SSBs  decreased by -711.0 + /- 33.7 g/d ( P < 0.0001 ) . For the control group , milk consumption did not change , and consumption of SSBs  increased by 71.9 + /- 33.6 g/d ( P = 0.04 ) . Changes in percentage body fat , the primary endpoint , did not differ between groups . Nevertheless , the mean ( + /- SE ) accretion of lean body mass was greater ( P = 0.04 ) in the intervention ( 0.92 + /- 0.10 kg ) than in the control ( 0.62 + /- 0.11 kg ) group . The increase in height was also greater ( P = 0.01 ) in the intervention group ( 2.50 + /- 0.21 cm ) than in the control group ( 1.77 + /- 0.20 cm ) for boys but not for girls . CONCLUSION Replacing habitual consumption of SSBs with milk may have beneficial effects on lean body mass and growth in children , despite no changes in percentage body fat . This trial was registered at clinical trials.gov as NCT00149695 The rise in pediatric obesity since the 1970s has been well established in the United States and is becoming a major concern worldwide . As a potential means to help slow the obesity epidemic , low-calorie sweeteners ( LCS ) have gained attention as dietary tools to assist in adherence to weight loss plans or prevention of excess weight gain . Observational studies tend to show positive correlations between LCS consumption and weight gain in children and adolescents . Although the data are intriguing , these epidemiologic studies do not establish that LCS cause weight gain , because there are likely many lifestyle and genetic differences between children and families who choose to consume LCS and those who do not . Short-term r and omized controlled trials have shown LCS use to be BMI neutral or to have modest weight-reducing effects in overweight and obese adolescents . The long-term effects of LCS in children and adolescents are unknown . Some compelling research is currently underway and may provide needed insight into the potential role of LCS in weight management . The paucity of data regarding the effects of LCS use in children and adolescents creates challenges in decision-making for health care providers and parents Background : Substituting sweeteners with non-nutritive sweeteners ( NNS ) may aid in glycaemic control and body weight management . Limited studies have investigated energy compensation , glycaemic and insulinaemic responses to artificial and natural NNS . Objectives : This study compared the effects of consuming NNS ( artificial versus natural ) and sucrose ( 65 g ) on energy intake , blood glucose and insulin responses . Methods : Thirty healthy male subjects took part in this r and omised , crossover study with four treatments : aspartame- , monk fruit- , stevia- and sucrose-sweetened beverages . On each test day , participants were asked to consume a st and ardised breakfast in the morning , and they were provided with test beverage as a preload in mid-morning and ad libitum lunch was provided an hour after test beverage consumption . Blood glucose and insulin concentrations were measured every 15 min within the first hour of preload consumption and every 30 min for the subsequent 2 h. Participants left the study site 3 h after preload consumption and completed a food diary for the rest of the day . Results : Ad libitum lunch intake was significantly higher for the NNS treatments compared with sucrose ( P=0.010 ) . The energy ' saved ' from replacing sucrose with NNS was fully compensated for at subsequent meals ; hence , no difference in total daily energy intake was found between the treatments ( P=0.831 ) . The sucrose-sweetened beverage led to large spikes in blood glucose and insulin responses within the first hour , whereas these responses were higher for all three NNS beverages following the test lunch . Thus , there were no differences in total area under the curve ( AUC ) for glucose ( P=0.960 ) and insulin ( P=0.216 ) over 3 h between the four test beverages . Conclusions : The consumption of calorie-free beverages sweetened with artificial and natural NNS have minimal influences on total daily energy intake , postpr and ial glucose and insulin compared with a sucrose-sweetened beverage Objective : The dietary intake of fructose-rich sugar-sweetened beverages ( SSB ) may have a significant role in raising serum uric acid ( SUA ) levels as well as the risk of contracting gout and cardiovascular risk factors . Our objective was to investigate the impact of SSB intake on SUA , body mass index ( BMI ) and systolic blood pressure ( SBP ) among adolescents in Taiwan . Methods : We evaluated data from 2727 representative adolescents who were multistage sample d from 36 Junior High schools in Taiwan . We cross-sectionally collected demographic , physical , dietary and anthropometric variables , and prospect ively measured clinical outcomes . Data were analyzed using multiple regression and logistic models adjusted for covariates . Results : We found that 87.7 % of adolescents were SSB drinkers , with 25.1 % drinking > 500 ml per day of such beverages . Increased SSB intake was associated with increased waist and hip circumferences , body fat , BMI , SBP and SUA . As compared with non-drinkers , SSB drinkers had a 3.2–4.9 elevated risk of obesity . The prevalence of hyperuricemia in heavy SSB  users ( 40.2–49.4 % ) was appreciably greater than that for non-users ( 24.2 % ) . Adolescents who consumed > 500 ml per day of heavy high-fructose corn syrup ( HFCS ) containing beverages had a 0.42 mg dl−1 higher SUA level and a 2.0–2.1 increased risk of developing hyperuricemia than non-drinkers . The consumption of HFCS-rich beverages was also found to interact with obesity in determining higher levels of SUA ( 2.2–2.4 mg dl−1 increases ) . Conclusion : High SSB consumption has a notable effect on increased levels of BMI and SUA . The intake of HFCS-rich beverages and BMI were likely to interactively strengthen SUA levels among obese adolescents BACKGROUND St and ard behavioral obesity treatment produces poor long-term results . Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy . In addition , important behaviors might differ for short- vs long-term weight control . OBJECTIVE Our aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months . DESIGN We performed secondary analysis of data collected during a r and omized weight-loss intervention trial with 48-month follow-up . PARTICIPANTS We studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition ( WOMAN ) Study . MAIN OUTCOME MEASURES We measured changes in weight from baseline to 6 and 48 months . STATISTICAL ANALYSES PERFORMED Linear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight . Analyses were conducted in the combined study population and stratified by r and omization group . RESULTS At 6 months in the combined population , weight loss was independently associated with decreased desserts ( P<0.001 ) , restaurant eating ( P=0.042 ) , sugar-sweetened beverages ( P=0.009 ) , and fried foods ( P<0.001 ) , and increased fish consumption ( P=0.003 ) . Results were similar in intervention participants ; only reduced desserts and fried foods associated with weight loss in controls . At 48 months in the combined population , weight loss was again associated with decreased desserts ( P=0.003 ) and sugar-sweetened beverages ( P=0.011 ) , but also decreased meats/cheeses ( P=0.024 ) and increased fruits/vegetables ( P<0.001 ) . Decreased meats/cheeses predicted weight loss in intervention participants ; desserts , sugar-sweetened beverages , and fruits/vegetables were independently associated in controls . CONCLUSIONS Changes in eating behaviors were associated with weight change , although important behaviors differed for short- and long-term weight change and by r and omization group . Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes BACKGROUND Consumption of sugar-sweetened beverages may cause excessive weight gain . We aim ed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents . METHODS We r and omly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups . The experimental group received a 1-year intervention design ed to decrease consumption of sugar-sweetened beverages , with follow-up for an additional year without intervention . We hypothesized that the experimental group would gain weight at a slower rate than the control group . RESULTS Retention rates were 97 % at 1 year and 93 % at 2 years . Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups ( 1.7 servings per day ) , declined to nearly 0 in the experimental group at 1 year , and remained lower in the experimental group than in the control group at 2 years . The primary outcome , the change in mean body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) at 2 years , did not differ significantly between the two groups ( change in experimental group minus change in control group , -0.3 ; P=0.46 ) . At 1 year , however , there were significant between-group differences for changes in BMI ( -0.57 , P=0.045 ) and weight ( -1.9 kg , P=0.04 ) . We found evidence of effect modification according to ethnic group at 1 year ( P=0.04 ) and 2 years ( P=0.01 ) . In a prespecified analysis according to ethnic group , among Hispanic participants ( 27 in the experimental group and 19 in the control group ) , there was a significant between-group difference in the change in BMI at 1 year ( -1.79 , P=0.007 ) and 2 years ( -2.35 , P=0.01 ) , but not among non-Hispanic participants ( P>0.35 at years 1 and 2 ) . The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years ( -0.5 % , P=0.40 ) . There were no adverse events related to study participation . CONCLUSIONS Among overweight and obese adolescents , the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention design ed to reduce consumption of sugar-sweetened beverages , but not at the 2-year follow-up ( the prespecified primary outcome ) . ( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; Clinical Trials.gov number , NCT00381160 . ) OBJECTIVE To examine how advergames , which are online computer games developed to market a product , affect consumption of healthier and less healthy snacks by low-income African American children . DESIGN Cross-sectional , between-subjects examination of an advergame in which children were rewarded for having their computer character consume healthier or less healthy foods and beverages . Children were r and omly assigned to 1 of the following 3 conditions : ( 1 ) the healthier advergame condition , ( 2 ) the less healthy advergame condition , or ( 3 ) the control condition . SETTING Urban public elementary schools . PARTICIPANTS Thirty low-income , African American children aged 9 to 10 years . Main Exposure Children in the treatment conditions played a less healthy or a healthier version of an advergame 2 times before choosing and eating a snack and completing the experimental measures . Children in the control group chose and ate a snack before playing the game and completing the measures . MAIN OUTCOME MEASURES The number of healthier snack items children selected and ate and how much children liked the game . RESULTS Children who played the healthier version of the advergame selected and ate significantly more healthy snacks than did those who played the less healthy version . Children reported liking the advergame . CONCLUSIONS Findings suggest that concerns about online advergames that market unhealthy foods are justified . However , advergames may also be used to promote healthier foods and beverages . This kind of social marketing approach could tip the scales toward the selection of higher- quality snacks , thereby helping to curb the obesity epidemic Objective The objective of this study is to assess population -level trends in children 's dietary intake and weight status before and after the implementation of a  provincial school nutrition policy in the province of Nova Scotia , Canada . Method Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population -level study with grade 5 students in 2003 ( n = 5215 ) and 2011 ( 5508 ) , prior to and following implementation of the policy . We applied r and om effects regression methods to assess the effect of the policy on dietary and health outcomes . Results In 2011 , students reported consuming more milk products , while there was no difference in mean consumption of vegetables and fruits in adjusted models . Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption . Despite significant temporal decreases in dietary energy intake and increases in diet quality , prevalence rates of overweight and obesity continued to increase . Conclusion This population -level intervention research suggests a positive influence of school nutrition policies on diet quality , energy intake and healthy beverage consumption , and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity Relatively little research has assessed the association between obesogenic behaviors in parents and their children . The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing , sugar-sweetened beverage intake , and fast food intake between mothers and their preschool aged children . We studied baseline data among 428 participants in High Five for Kids , a r and omized controlled trial of behavior change among overweight and obese children of ages 2 - 6.9 years . The main exposures were whether mothers viewed TV/videos < 1 h/day , drank < 1 serving/day of sugar-sweetened beverages , and ate fast food < 1 time/week . The main outcomes were whether children met these goals for the same behaviors . Using multivariate logistic regression adjusted for maternal and child characteristics , we estimated odds ratios of children meeting the behavioral goals . The majority of mothers ate fast food < 1 time/week ( 73 % ) and drank < 1 serving/day of sugar-sweetened beverages ( 73 % ) , while few mothers viewed < 1 h/day of TV/videos ( 31 % ) . Most children met the fast food goal ( 68 % ) , but not the goals for sugar-sweetened beverages ( 31 % ) or TV/video viewing ( 13 % ) . In adjusted models , the odds ratios for a child meeting the goal were 3.2 ( 95 % confidence interval ( CI ) 1.7 , 6.2 ) for TV/video viewing , 5.8 ( 95 % CI 2.8 , 12.0 ) for sugar-sweetened beverage intake , and 17.5 ( 95 % CI 9.8 , 31.2 ) for fast food intake if their mothers met the goal for the same behavior . Obesogenic behaviors of mothers and preschool aged children were strongly associated . Our findings lend support to obesity prevention strategies that target parental behavior and the family environment A  preschool-based intervention to improve children ’s self-regulation  improves self-regulation but has no effect on child BMI or obesity-related behaviors . OBJECTIVES : To determine the effect of an intervention to improve emotional and behavioral self-regulation in combination with an obesity-prevention program on the prevalence of obesity and obesity-related behaviors in preschoolers . METHODS : This was a cluster-r and omized intervention trial in Head Start ( HS ) classrooms conducted in each of 4 academic years from 2011 to 2015 . Participants ( 697 children ; 49 % boys ; mean age : 4.1 ± 0.5 years ; 48 % white , 30 % African American , 12 % Hispanic ) were r and omly assigned by classroom to 1 of 3 intervention arms : ( 1 ) HS + Preschool Obesity Prevention Series ( POPS ) + Incredible Years Series ( IYS ) ( HS enhanced by the POPS [ program targeting evidence -based obesity-prevention behaviors ] and the IYS [ program to improve children ’s self-regulation ] ) , ( 2 ) HS+POPS , or ( 3 ) HS . Primary outcomes were changes in prevalence of obesity , overweight/obesity , BMI z score , and teacher-reported child emotional and behavioral self-regulation ; secondary outcomes were dietary intake , outdoor play , screen time , and parent nutrition knowledge and nutrition self-efficacy . RESULTS : HS+POPS+IYS improved teacher-reported self-regulation compared with HS+POPS ( P < .001 ) and HS ( P < .001 ) , but there was no effect on the prevalence of obesity ( 16.4 % preintervention to 14.3 % postintervention in HS+POPS+IYS versus 17.3 % to 14.4 % in HS+POPS [ P = .54 ] versus 12.2 % to 13.0 % in HS [ P = .33 ] ) . There was no effect of HS+POPS compared with HS alone ( P = .16 ) . There was no effect on other outcomes except for sugar-sweetened beverage intake ( HS+POPS+IYS result ed in a greater decline than HS ; P = .005 ) . CONCLUSIONS : An intervention for parents and children to improve  HS preschoolers ’ emotional and behavioral self-regulation in combination with an obesity-prevention curriculum did not reduce obesity prevalence or most obesity-related behaviors
The current evidence does not demonstrate conclusively that NSB consumption has uniquely contributed to obesity or that reducing NSB consumption will reduce BMI levels in general .
Nutritively sweetened beverages ( NSBs ) may play a role in the obesity epidemic .