Reducing Sugar-sweetened Beverage Consumption Among Children
Condition: Pediatric Obesity; Diet, Food, and Nutrition
MeSH terms: Pediatric Obesity
Study type: Interventional

Summary: 
      Lowering sugar-sweetened beverage (SSB) consumption is a central component of lifestyle
      behavior change aimed at preventing and managing obesity, yet effective reduction of SSB
      intakes has been met with many challenges. While their palatability, accessibility,
      publicity, affordability, and social acceptability contribute to frequent and sustained SSB
      consumption, their caffeine and sugar content may further encourage continued intake.
      Although adverse health consequences of excessive SSB consumption are well documented, the
      extent to which their pleasant taste (due primarily to their sugar content) and
      post-ingestive effects (due to their sugar and/or caffeine content) positively reinforce
      consumption among children has not been elucidated. The purpose of this study is to conduct a
      pilot intervention to examine the feasibility of removing caffeinated SSBs from the child
      diet and to explore whether caffeinated SSB removal induces withdrawal symptoms in 8-11
      (3rd-5th grade) year old children. Participants will be randomly assigned to replace their
      usual caffeinated SSB consumption with either caffeinated SSBs, caffeine-free SSBs or
      sparkling water provided by the study team for two weeks.
    

Detailed description: 
      Sugar-sweetened beverages (SSBs) significantly contribute to sugar and calorie intakes, and
      their consumption is associated with metabolic disease. Sweetened beverages also account for
      the majority of pediatric caffeine consumption. It is well-established that habitual caffeine
      use leads to dependence in adults and evidence for sugar dependence has been documented.
      However, caffeine and/or sugar dependence related to sweetened beverage consumption has not
      been evaluated, and determinants of their consumption among youth are severely understudied.
      It is critical to elucidate whether they may be physiologically or psychologically dependent
      on these beverages, particularly SSBs, which contain both caffeine and sugar.

      The purpose of this study is to conduct a pilot study where caffeinated SSB's are replaced
      with caffeinated SSBs provided by the study team (control) or with caffeine-free and
      unsweetened alternatives (also provided by the study team) for 2 weeks, among children who
      habitually consume caffeinated SSBs.

      Lowering SSB consumption is a central component of lifestyle behavior change aimed at
      preventing and managing obesity, yet effective reduction of SSB intakes has been met with
      many challenges. While their palatability, accessibility, publicity, affordability, and
      social acceptability contribute to frequent and sustained SSB consumption, their caffeine and
      sugar content may further encourage continued intake. Although adverse health consequences of
      excessive SSB consumption are well documented, the extent to which their pleasant taste (due
      primarily to their sugar content) and post-ingestive effects (due to their sugar and/or
      caffeine content) positively reinforce consumption among children has not been elucidated.
      This is particularly important to study among children from low-income and minority
      backgrounds, as these children have the highest rates of SSB intake and the highest
      prevalence of obesity.

      Specific Aims and Hypotheses:

        1. Examine the feasibility of an intervention to remove caffeinated SSB from the child
           diet. We hypothesize that caffeinated SSB avoidance will be feasible among children, but
           that compliance will be lowest among those assigned to sparkling water, devoid of both
           caffeine and sugar. Compliance with beverage assignments will be assessed using daily
           online questionnaires and weekly dietary recalls.

        2. Explore the extent to which caffeinated SSB removal induces withdrawal symptoms. We
           hypothesize that replacement of caffeinated SSBs with caffeine-free SSBs, or sparkling
           water will induce withdrawal symptoms compared to control (usual caffeinated SSB
           consumption). Participants will complete a child-adapted version of the validated
           Caffeine Withdrawal Symptoms Questionnaire (CWSQ) at baseline and daily (online) during
           the intervention.
    

Intervention name(s): Commercially-available caffeine-free soda; Carbonated water; Regular soda
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Subjects are asked to consume caffeine-free soda daily for two weeks; Subjects are asked to consume unsweetened, carbonated water daily for two weeks; Subjects are asked to consume regular soda daily for two weeks
Intervention MeSH terms: Caffeine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: sugar-sweetened beverages; caffeine withdrawal; beverages; obesity