See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/10670351

Total beverage consumption and beverage choices among

children and adolescents

Article  in  International Journal of Food Sciences and Nutrition · August 2003

DOI: 10.1080/09637480120092143 · Source: PubMed

CITATIONS READS
175 520

2 authors:

Richard A Forshee Maureen Storey

U.S. Food and Drug Administration Maureen Storey, LLC
112 PUBLICATIONS   1,975 CITATIONS    42 PUBLICATIONS   1,405 CITATIONS   

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Maureen Storey on 23 June 2016.

The user has requested enhancement of the downloaded file.

International Journal of Food Sciences and Nutrition,
Volume 54, Number 4 (July 2003) 297
/307

Total beverage consumption and beverage choices among children and

adolescents

Richard A. Forshee and Maureen L. Storey

Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, 1101 King Street, Suite
611, Alexandria, VA 22314, USA

Patterns of beverage consumption among children and adolescents are related

to age, race, and gender. The relationship between body mass index (BMI) and
beverage consumption is unclear. In this paper, the total amount and the types
of beverages consumed were analyzed according to age, race, and gender.
Multivariate regression models were estimated for consumption of milk, juices,
fruit drinks/ades, and carbonated soft drinks. Descriptive and multivariate
regression analysis of children aged 6
/19 from the US Department of
Agriculture’s Continuing Survey of Food Intake by Individuals 1994
/96, 98
was performed. It was found that age, race, and gender play a significant role in
the total amount, types, and relative proportions of beverages consumed by
children and adolescents. Individuals in the first decile drink approximately
212.9 g beverages per day, whereas individuals in the tenth decile drink
2036.2 g. Boys drink more of most beverages than girls do. Older teens tend to
drink more carbonated beverages, fruit drinks/ades, and citrus juice, but less
fluid milk and non-citrus juice. White adolescent boys are heavy consumers of
most beverages, including carbonated soft drinks, milk, and fruit drinks/ades.
BMI is positively associated with consumption of diet carbonated beverages
and negatively associated with consumption of citrus juice. BMI was not
associated with consumption of milk, regular carbonated beverages, regular or
diet fruit drinks/ades, or non-citrus juices. In conclusion, total beverage
consumption and beverage choices are strongly related to age, race, and
gender. BMI was only related to consumption of diet carbonated beverages and
milk, and those relationships were weak.

Introduction

Patterns of beverage and fluid consumption nutrition policy debates. Beverage and fluid
by children and adolescents can have a strong consumption is influenced by many factors
relationship with their overall nutrition status including age, race, gender, and physical
and are relevant to several contemporary activity, but we know very little about the

Correspondence to: Maureen L. Storey. e-mail: [email protected]

ISSN 0963-7486 printed/ISSN 1465-3478 online

03/010005-10 # 2003 Taylor & Francis Ltd
DOI: 10.1080/09637480120092143
298 R. A. Forshee and M. L. Storey

consumption patterns of children and ado- relationships between beverage consumption

lescents or about the demographic factors and choice as influenced by age, gender, race/
related to beverage choices. ethnicity, and BMI (i.e. body size).
While media reports have stirred great
controversy about beverage consumption
among children and adolescents, scientists Data and methods
understand very little about total beverage
consumption and patterns that may be The data in this paper are from the US
influenced by age, gender, race/ethnicity, Department of Agriculture’s (USDA) Con-
and body size (body mass index (BMI)). tinuing Survey of Food Intake by Individuals
Most of the published literature on children’s (CSFII) 1994
/96, 98. Data used in this study
beverage consumption focuses on hypothe- were collected by the USDA and represent all
sized trade-offs, the influence of parental non-institutionalized persons older than age
beverage choices, or energy intake contribu- 2 residing in the United States. The methods
ted by beverages (Guenther, 1986; Johnson et used to collect the data have been reported
al. , 1998; Harnack et al. , 1999; Troiano et previously (US Department of Agriculture,
al. , 2000; Fisher et al. , 2001). Birch and 1998). Throughout this paper, beverage con-
associates have found that adult role models sumption data do not include water con-
sumption, which is difficult to assess. Total
are important in setting up behavioral char-
non-water beverage consumption is calcu-
acteristics that influence beverage choices
lated as the sum of fluid milk, fruit drinks/
(Fisher & Birch, 1999a,b; Fisher et al. ,
ades, carbonated soft drinks, citrus juice, and
2001; Lee et al. , 2001). Moreover, restricting
non-citrus juice. Analysis of variance with
access to palatable foods does not teach
post-hoc multiple comparisons was used to
children to moderate consumption of those determine differences in mean beverage con-
foods. sumption as influenced by race/ethnicity.
We are not aware of any published studies Multivariate regression analyses were used
examining the total beverage consumption to model the consumption of individual
and beverage choices made by children and beverage types as a function of gender, age,
adolescents. While commonsense tells us that race, and BMI. The question is complicated
older adolescents will drink more than because BMI increases as children get older,
younger children, there are no published and there are gender and race differences in
data confirming that. Moreover, there are average BMIs. For example, African-Amer-
no published data examining the total bev- ican girls have a higher average BMI. Be-
erage consumption or beverage choices that cause of these interconnected relationships,
may be influenced by gender or race. Nor are multiple regression models were used to
there any published reports that overweight control for these factors. In these analyses,
children and adolescents drink more, and different categories of beverages were the
hence consume more energy from beverages, dependent variables. The independent vari-
than children and adolescents who are not ables included BMI, age, race, and family
overweight. income. A set of dummy variables was used
Throughout this paper, beverage consump- to identify the race of the respondent, and
tion will mean fluid milk, carbonated soft separate models were estimated for boys and
drinks, fruit drinks/ades, and citrus and non- girls. The models were estimated in Stata 6
citrus juices. Alcoholic beverages, coffee, and using the survey regression procedure
tea were excluded because few children and (svyreg) to adjust for the complex sample
adolescents consume them. Liquids that design of CSFII.
might be construed as a meal, such as soups The numbers of children (age 6
/11 years)
or meal replacements, were excluded from and adolescents (age 12
/19 years), gender,
the analysis. This study has three goals: to and race/ethnicity are presented in Table 1.
examine total beverage consumption among Individuals of ‘other races’ are included in
children and adolescents, to examine their the totals of different categories but, because
beverage choices, and to understand the of the small numbers and heterogeneous mix
 Beverages among children and adolescents 299

Table 1. Description of sample (unweighted)

Non-Hispanic Non-Hispanic
white African-American Hispanic Other race Total

Male (n /1687) 1110 226 270 81 1687

Female (n /1624) 1019 274 261 70 1624
Total (n /3311) 2129 500 531 151 3311

of races and ethnicities included in the and gender. For example, the average age of
category, these data are unreliable with the individuals in the first and tenth deciles is
respect to predicting behaviors. 12.1 and 15.1 years, respectively. Moreover,
65.1% of the individuals in the first decile are
female, whereas only 19.5% in the tenth
Results decile are female.
It is not surprising that adolescents drink
The data illustrated in Figure 1 show marked significantly more beverages than children do
differences in total beverage consumption and that boys of all ages tend to drink more
between boys and girls, and beverage choices than girls do. Young boys (age 6
/11 years)
across deciles of intake among individuals drink more than young girls do: 776 and 692
aged 6
/19 years. Individuals in the first g/day, respectively. Average intake of all
decile drink approximately 212.9 g beverages beverages by adolescent (12
/19 years) boys
per day, whereas individuals in the tenth and girls is 1196 and 799 g/day, respectively.
decile drink 2036.2 g. The figure also shows There are differences in total beverage con-
that the mean consumption of all beverages sumption among children and adolescents of
generally increases across the deciles of total different races/ethnicities. Data presented in
consumption. Some of this increase in total Figures 2 and 3 show differences in total
beverage consumption is a function of age beverage consumption by white, African-

Figure 1. Total consumption and beverage choices of all children aged 6
/19 years.
300 R. A. Forshee and M. L. Storey

Figure 2. Total beverage consumption of boys and girls aged 6
/11 years.

Figure 3. Total beverage consumption of boys and girls aged 12
/19 years.
 Beverages among children and adolescents 301

American, and Hispanic children and ado- Except for citrus and non-citrus juices,
lescents. White boys aged 6
/11 years drink differences in beverage choices among ado-
significantly more than African-American lescents become more exaggerated, especially
boys, but not more than Hispanics; young between genders and among races/ethnicities
girls drink about the same amount regardless (Table 3). Milk consumption falls in adoles-
of race/ethnicity. Among adolescents, white cence, and carbonated soft drink and fruit
boys drink significantly more than African- drinks/ades consumption increases. White
American or Hispanic boys, and white girls teenage boys and girls drink significantly
drink more than African-American girls, but more milk than African-American teenagers.
not Hispanic girls. White adolescent boys drink significantly
Except for consumption of citrus and non- more carbonated soft drinks than do Afri-
citrus juices, beverage choices and consump- can-American or Hispanic adolescent boys.
tion of some beverages is linked to age, White adolescent girls drink significantly
gender, and race/ethnicity. Milk is the pre- more of this beverage than African-Amer-
dominant beverage of choice among young ican girls, but not more than Hispanic
boys and girls of all races/ethnicities studied, adolescent girls do. African-American ado-
followed by carbonated soft drinks, fruit lescent girls drink about 60% less carbonated
drinks/ades, citrus juices, and non-citrus soft drinks, but 60% more fruit drinks/ades
juices (Table 2). There are, however, some than white and Hispanic adolescent girls.
differences in level of consumption across In general, African-American females
race/ethnicity. Young white boys and girls drink less milk than others do. Young
African-American girls drink 209 g/day,
drink significantly more milk than do Afri-
which drops one-half during adolescence.
can-American boys and girls. Hispanic girls
On average, African-American adolescent
drink significantly more milk than African-
girls drink 103 g (3.4 oz) of milk per day.
American girls, but there was no difference in
Because average milk consumption among
milk consumption between African-Ameri-
African-American adolescent girls was so
can and Hispanic boys. low, we examined the frequency data for
Among the younger children, race/ethni-
patterns of consumption. We found an
city was linked to consumption of fruit apparent ‘all-or-none’ phenomenon in this
drinks/ades but not carbonated soft drinks. group of girls. About one-half (48.8%) of
African-American children drink signifi- African-American adolescent girls reported
cantly more fruit drink/ades than do white drinking no milk on the days of the survey,
children, but not more than Hispanic chil- and 89% of this group reported drinking less
dren. than one cup. This contrasts with their

Table 2. Beverage choices (g/day) among boys and girls aged 6
/11 years

Milk Soda Fruit ade Citrus juice Non-citrus juice Total

Boys (n /748)
White 344a 215a 135a 61a 37a 838a
African-American 255b 175a 201b 42a 38a 742b
Hispanic 335a,b 201a 150a,b 54a 38a 799a,b
Other race 308a,b 201a 176a,b 41a 34a 787a,b
Total 327 206 150 56 37 816

Girls (n /712)
White 284a 205a 126a 51a 49a 748a
African-American 209b 160a 179b 58a 33a 661a
Hispanic 314a 160a 119a,b 51a 34a 718a
Other race 282a,b 131a 68a 70a 24a 592a
Total 276 188 131 53 44 724

a,b
Means within gender in the same column bearing different superscripts differ significantly (p B/0.05).
302 R. A. Forshee and M. L. Storey

Table 3. Beverage choices (g/day) among boys and girls aged 12
/19 years

Milk Soda Fruit ade Citrus juice Non-citrus juice Total

Boys (n /941)
White 329a 671a 183a 81a 29a 1406a
African-American 189b 407b 321b 86a 24a 1132b
Hispanic 284a,b 454b 181a 85a 21a 1106b
Other race 220a,b 352b 69a 56a 50a 860b
Total 299 593 195 81 28 1305

Girls (n /909)
White 197a 431a 122a 64a 36a 954a
African-American 103b 263b 205b 67a 26a 741b
Hispanic 194a 372a,c 120a 89a 16a 858a,b
Other race 157a,b 273b,c 61a 65a 51a 728b
Total 178 387 134 68 33 893

a,b
Means within gender in the same column bearing different superscripts differ significantly (p B/0.05).

childhood choices, showing that only 13% of 12
/19 year age range, 69.2% of boys and
young African-American girls drank no 62.2% of girls consume some carbonated soft
milk. In comparison, about one-third of drinks. The remaining children did not report
white and Hispanic adolescent girls report any consumption of carbonated soft drinks
no milk consumption on the days of the (US Department of Agriculture, 1999).
survey. The heaviest consumers of carbonated soft
We also examined the distribution of drinks are white adolescent boys who con-
carbonated soft drink and fruit drink/ades sume about 671 g (1.8 /12-oz cans) per day.
consumption among children and adoles- The boys in the 90th percentile of consump-
cents. Consumption of carbonated soft tion drink 1364 g or about 3.7 /12-oz cans
drinks was the same among boys and girls per day.
of different races, with an average of 206 and
188 g/day (6.6 and 6.1 oz/day), respectively.
Regression analysis
About 36% of young white and Hispanic
boys and girls report drinking no carbonated In the regression analysis, we examined
soft drinks, whereas nearly one-half of Afri- multiple factors that may influence total
can-American boys and girls did not drink beverage consumption and beverage choices,
them. as shown in Table 4.
Among the teenagers, between 12 and 14% The race/ethnicity differences in beverage
of white and Hispanic boys drank no carbo- consumption discussed in the previous sec-
nated soft drinks, but nearly 28% of African- tion are confirmed after controlling for BMI,
American adolescent boys reported drinking age, and family income. In general, African-
none. Approximately 18% of white adoles- American children drink less fluid milk and
cent girls reported no carbonated soft drink carbonated soft drinks but more fruit drinks/
consumption, but 29% of African-American ades than white children. The race/ethnicity
and 25% of Hispanic girls reported drinking differences in beverage consumption re-
none. mained even after the inclusion of family
As an internal validity check, we compared income in the model. That strongly suggests
our findings on the frequency of beverage that the race/ethnicity differences in beverage
consumption with the USDA CSFII Table consumption are not a function of differ-
Sets. As expected, our findings are consistent ences in family income.
with those reported by the USDA. The Family income, as measured by income as
USDA reports that 47.1% of boys 6
/11 years a percent of the poverty line, has very little
of age and 44.8% of girls 6
/11 years of age association with beverage consumption. Boys
consume some carbonated soft drinks. In the and girls in higher income families consume
Table 4. Unstandardized regression coefficients and t -ratios of beverages consumed by boys and girls

Regular carbonated soft Diet carbonated soft Regular fruit drinks and Diet fruit drinks and
Variable Milk drinks drinks ades ades Citrus juice Non-citrus juice Total beverages

Boys
Body mass in- 0.0 (/0.01) 4.8 (1.29) 1.6 (1.99)* /1.9 (/0.81) 0.5 (0.41) /1.3 (/1.54) 0.7 (1.03) 4.2 (1.05)
dex
Age /7.1 (/2.49)* 51.3 (10.52)* /0.7 (/0.67) 3.5 (1.18) 3.1 (2.13)* 3.8 (2.65)* /1.9 (/2.48)* 52.1 (8.32)*
Income 0.2 (1.33) 0.3 (1.26) 0.1 (2.33)* /0.1 (1.29) 0.1 (1.67) 0.2 (2.84)* 0.1 (3.21)* 0.7 (3.03)*
African- /97.0 (/2.56)* /148.1 (/3.74)* /22.7 (/3.78)* 120.3 (2.47)* /24.3 (/3.59)* 4.6 (0.35) 5.4 (0.78) /160.8 (/2.97)*
American
Hispanic /33.2 (/0.97) /107.0 (/2.31)* /18.9 (/3.17)* 16.9 (0.88) /8.8 (/0.92) 14.7 (1.42) /3.5 (/0.54) /143.7 (/2.48)*
Other race /82.0 (/1.77) /165.3 (/2.82)* /21.2 (/3.18)* /25.2 (/0.87) /18.3 (/1.63) /19.3 (/1.05) 15.0 (1.50) /319.4 (/3.45)*
Constant 378.7 (5.70)*
/352.8 (
/4.55)*
/11.0 (
/0.72) 152.9 (3.76)*
/28.1 (
/1.37) 11.0 (0.43) 23.5 (1.63) 184.6 (2.11)*

Girls
Body mass in- /4.2 (/3.69)* 0.4 (0.21) 2.8 (2.42)* /1.4 (/1.42) 0.7 (1.59) /0.5 (/0.99) /0.5 (/0.77) /2.7 (/0.88)

Beverages among children and adolescents

dex
Age /11.5 (/5.75)* 23.2 (7.99)* 1.6 (2.14)* 1.0 (0.48) 0.5 (0.68) 1.5 (1.69) /1.3 (/1.29) 15.0 (4.13)*
Income 0.0 (/0.58) /0.1 (/0.66) 0.1 (3.38)* 0.0 (/0.33) 0.0 (1.06) 0.1 (2.00)* 0.0 (1.47) 0.1 (1.27)
African- /81.7 (/4.49)* /92.0 (/3.22)* /28.1 (/3.07)* 67.7 (3.76)* 7.4 (0.90) 8.7 (0.63) /7.1 (/0.81) /124.4 (/3.43)*
American
Hispanic 0.4 (0.02) /20.1 (/0.53) /22.5 (/1.90) /8.2 (/0.61) /2.0 (/0.40) 21.6 (2.07)* /16.0 (/2.00)* /49.3 (/1.27)
Other race /27.7 (/0.80) /133.9 (/3.35)* 13.3 (0.40) /63.2 (/2.94)* 1.4 (0.09) 10.3 (0.57) 5.5 (0.39) /198.0 (/2.74)*
Constant 472.4 (13.10)* 13.2 (0.25) /62.4 (/2.46)* 129.8 (4.24)* /12.8 (/1.16) 30.2 (1.95) 57.9 (3.65)* 627.8 (10.36)*

*Indicates the coefficient is statistically significant at the p B/0.05 level.

303
304 R. A. Forshee and M. L. Storey

slightly more diet carbonated soft drinks. For whom would not be above the 85th percentile
boys, family income also has a slight positive using the new, age-specific guidelines. A
association with consumption of citrus juice second important limitation of the earlier
and non-citrus juice. All of the family income research is that it did not disaggregate total
associations are very weak. carbonated soft drink consumption into
Age has a negative association with con- regular and diet carbonated soft drink con-
sumption of fluid milk and a positive asso- sumption.
ciation with consumption of carbonated soft The Centers for Disease Control and
drinks. A year of age is associated with Prevention have established age and gender-
consumption of 7 g fewer of milk for boys specific growth charts that specify the 85th
and 12 g fewer of milk for girls. A year of age percentile of BMI as the threshold for being
is associated with consumption of 51 g more at risk of overweight (Kuczmarski et al .,
(1.6 oz) of regular carbonated soft drink for 2000). We therefore estimated separate mod-
boys and 23 g more (0.7 oz) of regular els in which the continuous variable for BMI
carbonated soft drink for girls. Consumption was transformed to a binary variable indicat-
of diet carbonated soft drinks also increases ing whether the individual was below the
slightly for older girls (1.6 g or about one- 85th percentile of BMI (non-overweight) or
twentieth of an ounce for each year of age). at or above it for their age and gender. This
Older boys drink slightly more diet fruit further tested whether children with a high
drinks/ades and citrus juice but slightly less BMI consumed more beverages. The results
non-citrus juice. were nearly identical to the results of the
BMI has little or no association with continuous model. Controlling for the other
beverage consumption in these models. In factors in the model, girls with BMI above
other words, heavier individuals do not drink the 85th percentile consumed 24 g fewer of
more beverages than lighter individuals. milk. The 85th percentile BMI variable was
After controlling for age, race/ethnicity, and not statistically significant among girls for
family income, BMI has no statistically any of the other beverages. Boys in the 85th
significant relationship with any of the bev- percentile of BMI did not consume more
erages for boys. For girls, BMI has a slight milk, regular carbonated soft drinks, fruit
drinks/ades, or citrus juices than non-over-
negative association with milk consumption
weight boys did. Boys above the 85th per-
and a slight positive association with con-
centile consumed 12 g more (0.4 oz) of diet
sumption of diet carbonated soft drinks.
carbonated soft drinks and 12 g more non-
Each point of BMI is associated with 4 g
citrus juices.
fewer milk consumption and 3 g more diet
carbonated soft drink consumption. These
predicted associations amount to about one- Discussion
tenth of an ounce per BMI point.
Preliminary research that we reported The present study investigated various influ-
showed that children above the 85th percen- ences on total consumption and choices of
tile of BMI consumed about 2 oz more of beverages. As expected, age and gender
total carbonated soft drinks than did those influenced total beverage consumption */
below the 85th percentile. That preliminary older individuals drink more than younger
research had several limitations that have individuals, and boys drink more of most
been improved in this version. Most impor- beverages than girls. Differences in total
tantly, at the time that research was pre- beverage consumption and choices among
sented, age-specific BMI guidelines were not individuals of different races/ethnicities have
available, so the 85th percentile for age not been reported previously and were un-
ranges was used. Since age, BMI, and total expected. Overall, this study shows that, with
carbonated soft drink consumption are all one exception, white children and adoles-
positively correlated, a disproportionate cents drink more beverages than their Afri-
number of the children above the 85th can-American counterparts. The reasons for
percentile were older children, some of this are unknown and should be explored
 Beverages among children and adolescents 305

further, especially with regard to proper beverages, including carbonated soft drinks,
hydration for everyday activity and during milk, and fruit drinks/ades; on average, they
strenuous physical activity. drink the equivalent of about 1.8 /370 g
Beverage choices were notably different cans of carbonated soft drinks per day,
depending on race/ethnicity. While young compared with 1.0 /370 g cans and 1.2 /
boys and girls of all races/ethnicities drink 370 g cans for African-American and Hispa-
more milk than any other beverage, African- nic adolescent boys, respectively.
American children drink less milk than white Beverage consumption data are similar
or Hispanic children. Young white boys and between the two largest, federally funded
girls consume about 1.4 and 1.2 servings of dietary surveys */ NHANES III and CSFII.
milk per day, whereas young African-Amer- Troiano et al . (2000) examined data from the
ican boys and girls drink 1.0 and 0.8 servings NHANES survey and reported that bev-
per day, respectively. Young Hispanic girls erages are a significant source of total energy
might be considered the most avid milk for 6- to 11-year-old children and for 12- to
consumers, with few of them eschewing 19-year-old adolescents, contributing 20
/
milk entirely */ 7.4% reported drinking no 22% of energy intake in these age groups.
milk. On the other hand, 13
/14% of young These authors noted that milk contributed
African-American children report drinking 50% or more of the energy from beverages
no milk. for children younger than 12 years of age.
It was surprising that African-American Among adolescents, carbonated soft drinks
adolescent girls drank so few beverages as a provided 8% of the total energy intake
whole, and so little milk in particular. This is (Troiano et al. , 2000). Moreover, an erratum
a concern not only for future bone health, of research published by Cavadini et al.
but also because calcium consumption may (2001) showed that adolescent boys and girls
be important in reducing the risk of hyper- drink about 1.4 /370 g cans and 0.9 /370 g
tension */ a serious condition that is more cans of soft drinks per day, respectively. Our
prevalent in African-Americans. Proper hy- analysis of the CSFII survey data is nearly
dration is another concern unless African- identical with these findings; that is, on
American adolescent girls are consuming average, adolescent boys and girls consume
enough water to compensate for the lack of about 1.5 /370 g cans and 1.1 /370 g cans
other fluid intake. of carbonated soft drinks per day, respec-
Among the beverage alternatives, carbo- tively, which is about 8% of the total daily
nated soft drinks are the second or third energy intake.
choice of young children, depending on race/ Energy intake must be balanced with
ethnicity. On average, young boys and girls energy expenditure if individuals, whether
drink 206 g (6.6 oz) and 188 g (6.2 oz) of they are growing or not, are to avoid excess
carbonated soft drinks per day, which repre- weight gain. Recently, Johnson & Frary
sents about 4% of total daily energy intake, (2001) reviewed the few studies that directly
or about 77 and 72 kcal, respectively. This examine the role of added sugars and carbo-
amount of caloric intake might easily be nated soft drinks in rising rates of overweight
balanced with even a modest level of physical among children and adolescents. Harnack et
activity during recess, physical education al. (1999) found greater energy intake among
classes at school, or after-school activity 6- to 12-year-old children who drank 9 oz or
programs. more of soft drinks than those who did not
During adolescence, milk consumption drink them. The authors did not report BMI
falls, becoming the second most consumed or activity levels of these children, and
beverage (on a gram basis) following carbo- included only carbonated soft drinks and
nated soft drinks. Older teens tend to drink total energy in the analysis. In an 18-month
more carbonated beverages, fruit drinks/ longitudinal study, Ludwig et al. (2001)
ades, and citrus juice, and less fluid milk noted that middle-school children who con-
and non-citrus juice. White adolescent boys, sumed more carbonated soft drinks were
in particular, are heavy consumers of most more likely to become at risk of overweight
306 R. A. Forshee and M. L. Storey

*/ at or above the age-specific and gender- consumption and choices. Controlling for
specific 85th percentile of BMI. The authors, these factors and BMI are therefore critical
however, did not assess the beverage con- to understanding the relationship with bev-
sumption habits of the children whose BMI erage consumption.
changed to below the 85th percentile, and This analysis refutes widespread specula-
hence would no longer be classified as at risk tion that carbonated soft drinks are respon-
of overweight. The multivariate regression sible for the increase in overweight among
models reported here show no association children and adolescents. While some indivi-
between age-specific and gender-specific duals may consume large amounts of carbo-
BMI and regular carbonated soft drink nated soft drinks and/or fruit drinks/ades, it
consumption, but there is a positive associa- does not appear to be the typical consump-
tion between BMI and diet carbonated soft tion pattern. Moreover, the reasons for con-
drinks. suming larger than average amounts of these
It is not clear how much energy should be beverages should be explored, especially
derived from beverages for children and among children and adolescents who are
adolescents for proper hydration and nutri- engaged in strenuous physical activity.
ent contributions to the diet. To provide Careful monitoring of children’s beverage
perspective, two servings of reduced fat intake is nevertheless warranted because
(2%) milk plus one serving of orange juice caloric contributions must be balanced with
provide 328 kcal energy, which is approxi- energy expenditure. In addition, consump-
mately 12% of total energy for adolescent tion of milk should be encouraged through
boys. Adding the caloric contribution of continuation of strong promotional efforts,
1.5 /370 g servings (210 kcal) of a regular but most importantly through parental role
carbonated soft drink brings the total con- models. But draconian policies aimed at
sumption to 538 kcal */ approximately 19% curtailing consumption of carbonated soft
of total energy intake. The energy contribu- drinks and fruit drinks/ades are imperma-
tion by these beverages appears to be reason- nent solutions that will fail to coerce children
able for an individual engaged in even a and adolescents, in particular, to reject soft
modest level of physical activity. drinks.
As we previously testified, the US Dietary
Guidelines for Americans Committee, age,
gender, and race/ethnicity are non-modifiable
and strong predictors of BMI among chil- Acknowledgements */An earlier version of this research that
was presented at the Federation of American Societies for
dren and adolescents. This present study Experimental Biology, San Diego, CA, April, 2000. The
shows that these non-modifiable factors are research presented in this manuscript was supported by a
also strong predictors of total beverage grant from the National Soft Drink Association.

References
Cavadini C, Siega-Riz AM & Popkin BM (2001): U.S. Guenther PM (1986): Beverages in the diets of American
adolescent food intake trends from 1965 to 1996. West. J. teenagers. J. Am. Diet Assoc. 86, 493
/499.
Med. 175, 235. Harnack L, Stang J & Story M (1999): Soft drink
Fisher JO & Birch LL (1999): Restricting access to palatable consumption among US children and adolescents: nutri-
foods affects children’s behavioral response, food selec- tional consequences. J. Am. Diet Assoc. 99, 436
/441.
tion, and intake. Am. J. Clin. Nutr. 69, 1264
/1272. Johnson RK & Frary C (2001): Choose beverages and foods
Fisher JO & Birch LL (1999): Restricting access to foods to moderate your intake of sugars: the 2000 Dietary
and children’s eating. Appetite 32, 405
/419. Guidelines for Americans */ what’s all the fuss about? J.
Fisher J, Mitchell D, Smicklas-Wright H & Birch LL (2001): Nutr. 131, 2766S
/2771S.
Maternal milk consumption predicts the tradeoff between Johnson RK, Panely C & Wang MQ (1998): The association
milk and soft drinks in young girls’ diets. J. Nutr. 131, between noon-time beverage consumption and the diet
246
/250. quality of school-aged children. J. Child Nutr. Manage. 2,
95
/100.
 Beverages among children and adolescents 307

Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal Troiano RP, Briefel RR, Carroll MD & Bialostosky K
KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, (2000): Energy and fat intakes of children and adolescents
Johnson CL (2000): CDC Growth Charts: United States, in the United States: data from the national health and
Advance data from vital and health statistics, No. 314. nutrition examination surveys. Am. J. Clin. Nutr. 72,
Hyattsville, MD: National Center for Health Statistics 1343S
/1353S.
[http://www.cdc.gov/nchs/data/ad/ad314.pdf], accessed 11 US Department of Agriculture (1998): 1994
/96 Continuing
December 2001. Survey of Food Intakes by Individuals and 1994
/96 Diet
Lee Y, Mitchell DC, Smiciklas-Wright H & Birch LL (2001): and Health Knowledge Survey and related materials (CD-
Diet quality, nutrient intake, weight status, and feeding ROM). Beltsville, MD: Agricultural Research Service.
environments of girls meeting or exceeding recommenda- US Department of Agriculture (1999): Food and Nutrient
tions for total dietary fat of the American Academy of
Intakes by Children 1994
/96, 1998 , Table 15B. ARS Food
Pediatrics. Pediatrics 107, E95.
Surveys Research Group, Beltsville, MD: Agricultural
Ludwig DS, Peterson KE & Gortmaker SL (2001): Relation
Research Service [http://www.barc.usda.gov/bhnrc/food-
between consumption of sugar-sweetened drinks and
childhood obesity: a prospective, observational analysis. survey/home.htm] (‘products’ page), accessed 11 Decem-
Lancet 357, 505
/508. ber 2001.

View publication stats