Consumption of sugar sweetened beverage in early childhood associated to higher risks of and obesity

Children at age five who consume a median intake of 250ml per day of sugar sweetened beverages (SSB) are more likely to have a higher BMI and are at increased risk of being overweight or obese at six years of age, compared to children with lower intakes at around 50ml each day.
Researchers from Singapore and France also found higher skinfold thickness (adiposity) was associated with every 100ml per day incremental increase of SSB intake.

There have been studies on SSB consumption on BMI in children aged six to 19 years, but researchers believed this is the first study examining SBB consumption patterns in Asian pre-schoolers or younger children and relating them to adiposity outcomes.

The findings were published in The British Journal of Nutrition.

Dietary assessment
The study involved 767 Singaporean children aged five. Data was taken from The Growing in Singapore Towards healthy Outcomes (GUSTO) cohort study.

Validated food frequency questionnaires were issued to the child’s primary caregiver (mostly mothers) to document SSB intake (frequency and volume).

The definition of SSB included carbonated and non-carbonated drinks and only pre-packaged fruit juices containing added sugar, as well as commonly consumed SSBs in the Singaporean population such as malted drinks, cultured milk drinks, soy based drinks and traditional drinks (e.g. barley water, chrysanthemum tea, herbal tea).

Anthropometric measures were taken at aged six, and include weight, height and four skinfold thicknesses (triceps, biceps, subscapular and supra-iliac).
Dietary assessment
The study involved 767 Singaporean children aged five. Data was taken from The Growing in Singapore Towards healthy Outcomes (GUSTO) cohort study.

Validated food frequency questionnaires were issued to the child’s primary caregiver (mostly mothers) to document SSB intake (frequency and volume).

The definition of SSB included carbonated and non-carbonated drinks and only pre-packaged fruit juices containing added sugar, as well as commonly consumed SSBs in the Singaporean population such as malted drinks, cultured milk drinks, soy based drinks and traditional drinks (e.g. barley water, chrysanthemum tea, herbal tea).

Anthropometric measures were taken at aged six, and include weight, height and four skinfold thicknesses (triceps, biceps, subscapular and supra-iliac).SSB intake
The study revealed that SSB intakes at 100ml/day increments in children aged five, were associated with higher BMI by 0.09 s.d. unit, higher SSF thickness by 0.68mm, and increased risk for overweight/obesity by 1.2 times at aged six.

Furthermore, the researchers reported a similar trend with high SSB intake tertile (median intake=~250ml) significantly associated (p<0.05) with higher BMI z-scores by 0.33 s.d. unit, and higher risk for overweight/obesity at age six years when compared to the low intake tertile (median intake=~50ml/day).
They speculated the relationship between SSB intake and obesity may be due to a poor diet.

High intakes of SSBs in preschoolers could be just markers of poor diet quality where these children were consuming high amounts of sweet foods, along with high intake of sugary beverages.

High glycaemic loads from the possible high sugar diet alone could induce hyperinsulinemia, leading to increase in fat deposition.

Another alternate mechanism linking poor diet and obesity could be through the mediation effects of the microbiome profile in the gut.

Poorer diet quality (e.g. Western dietary patterns of high-fat food and refined sugars) has been associated with a specific diversity of microbiota termed the “obesogenic microbiota”, which has been shown to display enhanced capacity for energy harvest from the diet that might lead to weight gain.
Limitation and recommendations
The researchers acknowledged a limitation in their study: “The relatively short follow-up (1 year) between SSB intakes at age 5 and adiposity outcomes at age 6 might not be sufficient for us to observe longer lasting effects of SSB on adiposity.”

However, they advised further longitudinal analyses to be conducted to better understand the mechanisms involved and the effects of SSB intake on long-term weight gain.

In conclusion, SSB intake in young childhood was associated with higher risks of adiposity and risk for overweight/obesity.

The researchers recommended public health policies working to reduce SSB consumption to focus on prevention programs targeted at young children as it acts as the foundation for future eating habits.