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Key findings:

Masked replacement of beverages containing sugar with sugar-free alternatives significantly reduced weight gain and body fat in normal weight children People who are at risk for gaining weight may turn to artificial sweeteners in an attempt to reduce caloric intake, although this by itself is insufficient in combating weight gain

Primer: The increased prevalence of obesity in children has coincided with a large increase in the consumption of sugar-sweetened beverages. Since sugar-laden beverages do not lead to an increased sense of satiety, they are considered to be more fattening than solid food. Increased consumption of sugared beverages may not coincide with a reduction in total caloric intake, so total energy intake and weight gain may result. Results of hitherto available trials are inconclusive, possibly owing to a combination of small sample sizes, a lack of adequate placebos, a short duration of study, and a lack of individual randomization.

For further reading regarding the link between sugared beverages and weight, please see the following studies:

O’Connor TM, Yang SJ, Nicklas TA. Beverage intake among preschool children and its effect on weight status. Pediatrics 2006;118(4):e1010-e1018. Dubois L, Farmer A, Girard M, Peterson K. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc 2007;107:924-34.

This [randomized controlled] study: Published recently in NEJM, a double-blind, randomized controlled trial explored whether the masked substitution of sugar-sweetened beverages with sugar-free alternatives would reduce weight gain in children. A total of 641 children were randomly assigned to one of two groups: 1) children who would consume one 250 mL can of sugar-containing drink each day or 2) children who would consume one 250 mL can of sugar-free drink each day – both manufactured to be identical in taste and appearance. Compared to the sugar-free group, children in the group consuming sugar-sweetened beverages experience significantly higher increases in BMI and weight gain. Adverse events encountered during the study were minor (e.g. headache, abdominal discomfort, allergy, weight concern).

In sum: This study demonstrated that replacing a sugar-containing beverage with a sugar-free alternative significantly reduced both body fat and weight gain in healthy children, who were masked to the type of beverage they received. This study improves on previous randomized controlled trials by improving blinding.

The participants in this study were healthy, Dutch children of normal weight, with the large majority being white. Thus, this study may have limited applicability to children of other ethnic groups or obese children. Although baseline characteristics were quite similar between the two groups, one main difference was in parental level of education, a factor that may be significant in influencing weight loss. Nevertheless, children in the United States consume, on average, three-times the amount of calories from sweetened-beverages than those consumed in this trial, so the association of sugar-laden beverages and the prevalence of obesity may be more significant in the general population. Assessment of the effects of sugared beverages on obesity is difficult since their consumption tends to be a microcosm of one’s diet.

Click to read the original study (NEJM)

By JDP and AC

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