Paper
A double-blind randomized trial in school children on the effects of sugar-sweetened or sugar-free beverages on body weight and body fatness
Published Oct 3, 2013 · J. Ruyter
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Abstract
Background The increased number of children who are overweight or obese is a major health problem, and coincides with an increase in the consumption of sugar-sweetened beverages. Liquid calories are thought to be more fattening than solid calories because they do not lead to a sense of satiety. Therefore children may not reduce their intake of calories from other foods with a resultant increase in total energy intake and weight gain. We designed the Double-blind, Randomized Intervention study in Kids (DRINK) to examine the effect of masked replacement of sugar-containing by sugar-free beverages on body weight, fat accumulation, satiety, liking and wanting. Methods As preparation for DRINK, 89 children tasted 7 sugar-free (artificially-sweetened) and 7 matched sugar-sweetened beverages. The children liked both types equally well but were able to discriminate between the two in 49% of the tests. However, 33% of the 49% correct responses were made by chance alone. We therefore considered the 14 beverages eligible for DRINK. However, we selected 3 pairs out of the 7 tested pairs for practical reasons. DRINK was an 18-month trial involving 641 mostly normal-weight children from 4 to 11 years who were habitual consumers of sugar-sweetened beverages. Children were randomly assigned to receive 250 ml per day of a sugar-free, artificially-sweetened beverage (sugar-free group) or a similar sugar-sweetened beverage that provided 104 kcal (sugar group). Beverages were distributed through schools. We performed body, and sensory measurements at 0, 6, 12 and 18 months. At 18 months, 26% of the children had stopped consuming the beverages. Results Replacing sugar-containing beverages with sugar-free beverages reduced weight gain and fat accumulation. The BMI z score increased on average by 0.02 SD units in the sugar-free group, and by 0.15 SD units in the sugar group, mean difference -0.13 (95% confidence interval (CI) for the difference, -0.21 to -0.05). Weight increased by 6.35 kg in the sugar-free group as compared with 7.37 kg in the sugar group, mean difference -1.01 (95% CI for the difference, 1.54 to -0.48). Also, skinfold thicknesses (mm), waist-to-height ratio and fatmass (kg) according to impedance increased significantly less in the sugar-free group than in the sugar group, −2.2 (95% CI −4.0 to −0.4), −0.4 (95% CI −1.0 to −0.0), and −0.57 (95% CI −1.02 to −0.12) respectively. The difference in satiety between both groups was not statistically significant; the adjusted odds ratio for a 1 point increase on a 5-point scale in satiety in the sugar group versus the sugar-free group was 0.77 at 1 minute (95% CI, 0.46 to 1.29), and 1.44 at 15 minutes after intake (95% CI, 0.86 to 2.40). The sugar-group liked and wanted their beverage slightly more than the sugar-free group, adjusted odds ratio 1.63 (95% CI 1.05 to 2.54) and 1.65 (95% CI 1.07 to 2.55), respectively. Conclusion We showed that masked replacement of sugar-containing beverages with sugar-free beverages reduced weight gain and fat accumulation, and produced similar degrees of satiety. A plausible explanation is that the removal of liquid sugar was indeed not sensed by satiating mechanisms and was therefore incompletely compensated for by the increased consumption of other foods. Sugar-free beverages may therefore contribute to reducing weight gain in children.
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