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Sugar-Sweetened Beverages and Health Snapple juices Adrenaline Rush ® Full Throttle MDX No Fear RockStar ® EnergyVault ® Sports Drinks Gatorade ® Powerade ® SSBs Ingredients •

Jul 07, 2020

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  • Sugar-Sweetened Beverages

    and Health

    CIA-Harvard Menus of Change®

    National Leadership Summit

    June 10, 2014  Cambridge, MA  General Session IV

    Walter C. Willett, MD, DrPH

    Department of Nutrition

    Harvard School of Public Health

  • What are Sugar-Sweetened Beverages?

    Examples

    Sodas Fruit Drinks Energy Drinks

    Coke ®

    Pepsi ®

    Mountain Dew ®

    Orange Soda

    Root Beer

    Sprite ®

    7-Up ®

    Capri Sun ®

    Fruitopia ®

    Hawaiian Punch ®

    Hi-C ®

    Kool-Aid ®

    Minute Maid ®

    Snapple juices ®

    Adrenaline Rush ®

    Full Throttle ®

    MDX ®

    No Fear ®

    RockStar ®

    EnergyVault ®

    Sports Drinks

    Gatorade ®

    Powerade ®

  • SSBs Ingredients

    • Energy: 12-14 kcal/ounce or ~120-150 kcal/12 ounce can

    • Sugars: 3.1-3.6 g/ounce (~10 tsp/12 ounce can)

    Sweetened by

    US: High fructose corn syrups

    (55% fructose and 42% glucose)

    Europe: Sucrose

    (50% fructose and 50% glucose)

  • Sugar-Sweetened Beverage Consumption

    High glycemic load

    Postprandial

    hyperglycemia &

    hyperinsulinemia

    Energy in

    liquid form

    Displacement of more

    satiating foods

    Passive calorie

    overconsumption

    when drinking to

    satisfy thirst

    Increased

    hunger

    Increased energy

    intake

    Obesity

    Metabolic Syndrome (low HDLC, high triglyceride,

    hypertension, hyperglycemia

    coagulopathy, chronic inflammation)

    Diabetes CHD

    Alteration of taste

    preferences

    Sugar

    Increased intake of sugary

    foods; decreased intake of

    vegetables, fruits, etc

    Lower intake of fiber

    micronutrients,

    antioxidants and other

    phytochemicals

    Dental caries

    Insulin

    resistance

    B-cell

    dysfunction

    Incomplete

    calorie

    compensation

    29.273

  • Nurses’ Health Study (n=121,700)

    Health Professionals Follow-up Study (n=52,000)

    Nurses’ Health Study II (n=116,000)

    Investigators: Frank Speizer, Bernie Rosner, Meir Stampfer, Graham Colditz, David

    Hunter, JoAnn Manson, Sue Hankinson, Eric Rimm, Edward Giovannucci, Alberto

    Ascherio, Gary Curhan, Charlie Fuchs, Fran Grodstein, Michelle Holmes, Frank Hu

    1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

    Diet Ocs

    Smoking

    Weight/Ht

    Med. Hist.

    Diet Diet Diet

    Blood

    Diet Diet

    1986 1988 1990 1992 1994 1996 1998 2000

    Diet Diet Diet

    Blood

    Diet

    1989 1991 1993 1995 1997 1999

    Diet Diet Diet

    0.198R

    Nails

    Nails

    Blood

  • Sugar-Sweetened Beverages and Weight Gain

    in Children and Adults:

    A Systematic Review and Meta-Analysis

    Malik et al. AJCN 2013

  • NOTE: Weights are from random effects analysis

    D+L Overall (I-squared = 91.6%, p = 0.000)

    I-V Overall

    Ludwig, 2001 (16)

    Libuda, 2008, Girls (12)

    Laurson, 2008, Girls (15)

    Carlson, 2012 (21)

    Olsen, 2012 (13)

    Mundt, 2006, Girls (9)

    Striegal-Moore, 2006 (10)

    Berkey, 2004, Girls (17)

    Johnson, 2007 (11)

    Laska, 2012, Boys (14)

    Berkey, 2004, Boys (17)

    Study

    Viner, 2006 (18)

    Laurson, 2008, Boys (15)

    Laska, 2012, Girls (14)

    Blum, 2005 (7)

    Libuda, 2008, Boys (12)

    Newby, 2004 (8)

    Vanselow, 2009 (19)

    Phillips, 2004 (20)

    Mundt, 2006, Boys (9)

    0.07 (0.01, 0.12)

    0.16 (0.15, 0.16)

    0.20 (0.10, 0.30)

    0.10 (-0.02, 0.22)

    0.60 (0.23, 0.97)

    0.20 (-0.05, 0.44)

    0.26 (-0.03, 0.55)

    -0.09 (-0.20, 0.02)

    0.04 (0.00, 0.08)

    0.03 (-0.01, 0.07)

    -0.16 (-0.59, 0.27)

    0.25 (0.05, 0.45)

    0.04 (0.00, 0.08)

    BMI (95% CI)

    0.17 (0.16, 0.18)

    -0.26 (-0.51, -0.01)

    -0.09 (-0.40, 0.22)

    -0.08 (-0.30, 0.14)

    0.03 (-0.07, 0.13)

    -0.12 (-0.59, 0.35)

    Change in

    0.08 (-0.37, 0.53)

    0.18 (0.07, 0.28)

    -0.06 (-0.13, 0.01)

    100.00

    6.86

    6.30

    1.86

    3.41

    2.64

    6.58

    8.29

    8.25

    1.47

    4.29

    8.25

    (D+L)

    8.57

    3.19

    %

    2.41

    3.88

    6.86

    1.27

    Weight

    1.36

    6.64

    7.64

    0.07 (0.01, 0.12)

    0.16 (0.15, 0.16)

    0.20 (0.10, 0.30)

    0.10 (-0.02, 0.22)

    0.60 (0.23, 0.97)

    0.20 (-0.05, 0.44)

    0.26 (-0.03, 0.55)

    -0.09 (-0.20, 0.02)

    0.04 (0.00, 0.08)

    0.03 (-0.01, 0.07)

    -0.16 (-0.59, 0.27)

    0.25 (0.05, 0.45)

    0.04 (0.00, 0.08)

    BMI (95% CI)

    0.17 (0.16, 0.18)

    -0.26 (-0.51, -0.01)

    -0.09 (-0.40, 0.22)

    -0.08 (-0.30, 0.14)

    0.03 (-0.07, 0.13)

    -0.12 (-0.59, 0.35)

    Change in

    0.08 (-0.37, 0.53)

    0.18 (0.07, 0.28)

    -0.06 (-0.13, 0.01)

    100.00

    6.86

    6.30

    1.86

    3.41

    2.64

    6.58

    8.29

    8.25

    1.47

    4.29

    8.25

    (D+L)

    8.57

    3.19

    %

    2.41

    3.88

    6.86

    1.27

    Weight

    1.36

    6.64

    7.64

    Inverse association Positive association

    -0.97 0.00 0.97-0.97

    Change in BMI (95% CI) per 1 serving per day increase in SSB during the time period specified in each study, from prospective cohort studies in children

    Children: All Cohort Studies

  • NOTE: Weights are from random effects analysis

    D+L Overall (I-squared = 74.6%, p = 0.003)

    Sichieri, 2008 (62)

    I-V Overall

    Study

    Ebbeling, 2006 (63)

    Ebbeling, 2012 (64)

    de Ruyter, 2012 (65)

    James, 2004 (61)

    -0.17 (-0.39, 0.05)

    0.10 (-0.06, 0.26)

    -0.12 (-0.22, -0.02)

    Difference, BMI (95% CI)

    -0.14 (-0.54, 0.26)

    -0.57 (-1.12, -0.02)

    -0.36 (-0.55, -0.17)

    -0.10 (-0.29, 0.09)

    Weighted Mean

    100.00

    25.64

    %

    (D+L)

    14.88

    10.23

    24.63

    24.62

    Weight

    -0.17 (-0.39, 0.05)

    0.10 (-0.06, 0.26)

    -0.12 (-0.22, -0.02)

    Difference, BMI (95% CI)

    -0.14 (-0.54, 0.26)

    -0.57 (-1.12, -0.02)

    -0.36 (-0.55, -0.17)

    -0.10 (-0.29, 0.09)

    Weighted Mean

    100.00

    25.64

    %

    (D+L)

    14.88

    10.23

    24.63

    24.62

    Weight

    intervention reduces weight intervention increases weight

    0.00-1.12 1.12

    Children: RCTs

    Weighted mean difference in BMI change (95% CI) between intervention and control regimens from RCT’s in children. Interventions evaluated the effect of reducing SSB.

  • NOTE: Weights are from random effects analysis

    D+L Overall (I-squared = 70.2%, p = 0.001)

    Study

    French, 1994, Women (23)

    Palmer, 2008 (25)

    Barone Gibbs, 2012 (27)

    Chen, 2009 (26)

    Mozaffarian, 2011 (29)

    French, 1994, Men (23)

    I-V Overall

    Stookey, 2008 (28)

    Nooyens, 2005 (24)

    0.22 (0.09, 0.34)

    weight, kg (95% CI)

    0.13 (-0.18, 0.44)

    0.17 (0.03, 0.32)

    2.12 (0.78, 3.46)

    1.09 (0.46, 1.72)

    0.11 (0.09, 0.13)

    0.17 (-0.11, 0.45)

    1 year change in

    0.12 (0.10, 0.14)

    0.60 (0.17, 1.04)

    0.12 (0.00, 0.24)

    100.00

    (D+L)

    10.00

    19.80

    0.83

    3.39

    26.79

    %

    11.36

    Weight

    6.26

    21.57

    0.22 (0.09, 0.34)

    weight, kg (95% CI)

    0.13 (-0.18, 0.44)

    0.17 (0.03, 0.32)

    2.12 (0.78, 3.46)

    1.09 (0.46, 1.72)

    0.11 (0.09, 0.13)

    0.17 (-0.11, 0.45)

    1 year change in

    0.12 (0.10, 0.14)

    0.60 (0.17, 1.04)

    0.12 (0.00, 0.24)

    100.00

    (D+L)

    10.00

    19.80

    0.83

    3.39

    26.79

    %

    11.36

    Weight

    6.26

    21.57

    Inverse association Positive association

    0.00-3.46 3.46

    Adults: Change vs. Change

    1-year change in weight (kg) per 1 serving per day increase in SSB, from prospective cohort studies in adults using a change vs. change analysis strategy

  • Changes in Food and Beverage Consumption and Weight

    Changes Every 4 Years, According to Study Cohort

    (Mozaffarian D et al., NEJM 2011) 23.059

  • NOTE: Weights are from random effects analysis

    D+L Overall (I-squared = 0.0%, p = 0.780)

    Aeberli, 2011 (70)

    Maersk, 2012 (68)

    Tordoff, 1990, Women (69)

    I-V Overall

    Reid, 2010 (67)

    Reid, 2007 (66)

    Tordoff, 1990, Men (69)

    Study

    0.85 (0.50, 1.20)

    0.30 (-1.12, 1.72)

    Weighted Mean

    0.66 (-2.25, 3.57)

    0.7