Researchers in Kuwait conducted a longitudinal study among schoolchildren and found that those with high consumption of soda and milk were more likely to develop obesity than those who consumed high amounts of juice. This was surprising since juice consumption is frequently associated with being overweight.
“High soda drinking showed significant association with developing obesity. High milk consumption (more than 3 servings a day) was also significantly associated with developing obesity,” wrote the researchers in Frontiers in Endocrinology.
Their findings tallied with other studies on fruit juice and obesity, which concluded that moderate consumption of fruit juices has a lower risk of metabolic syndrome. However, the researchers also said this was unexpected.
“Considering that juice consumption is described to be associated with obesity by many, it was a surprise that compared to soda and milk, fruit juice was not found to have a significant effect on obesity.”
Sweetened beverage consumption is a concern in countries such as Kuwait, where the prevalence of obesity is high and most children drink sweetened beverages daily. The country has one of the world’s highest percentage of adults with obesity and diabetes. Since there were no known studies that have assessed the effect of beverage consumption of children on obesity in the Middle East and North African region, the researchers conducted a longitudinal cohort study to assess the relationship between the three most commonly consumed beverages – soda, milk, and juice – and the incidence of obesity among Kuwaiti children.
The study
A two-year longitudinal observational prospective analysis was conducted on 6,305 Kuwaiti children between the ages of 10 to 12 years old in 2012. All participants were enrolled in Kuwait public schools. The children’s data were obtained from the Kuwait Healthy Life Study. Participants were selected to represent each of the six Kuwait governorates.
Children had to complete a questionnaire via iPad, where they were asked to select what they usually ate and drank during breakfast, lunch, dinner and snack time. They were also asked how much they ate each time, with pictures provided to indicate portion sizes. The children were also asked if they preferred diet or regular soda and if they drank flavoured or unflavoured milk.
Total servings per day for soda, juice, and milk were then tabulated. The children were then split into three categories: Non-consumers (0 serving/day), moderate consumers (1–2 servings/day), and high consumers (≥ 3 servings/day).
The first school visit occurred in 2012, where the weight, height and BMI of each child were taken. The researchers categorised the participants as either obese or non-obese by WHO standards. The same measurements were taken during the second school visit in 2014. Based on these two visits, participants were grouped into four categories: Became obese, remained non-obese, remained obese, and became non-obese.
The children who were non-obese in 2012 and became obese in 2014 were identified as the “became obese group” (Group 1). Children in this group developed obesity during the two-year monitoring period. Children who were non-obese in 2012 and remained so in 2014 were identified as the “remained non-obese group” (Group 2). Children who were obese in 2012 and remained obese in 2014 were identified as the “remained obese group” (Group 3). Children who were obese in 2012 and became non-obese in 2014 were identified as the “became non-obese group” (Group 4).
The researchers then assessed the impact of soda, milk and juice consumption on obesity risk from 2012 to 2014. Sex, age, fitness level, and salivary biomarkers (substances found in saliva that can be used to indicate various aspects of health) were considered in their assessment – this was to account for differences in energy needs, and the impact of various factors such as metabolism rate and whether activity levels could moderate obesity risk from beverage consumption.
More to obesity than simple sugar consumption
The researchers found that children who reported high soda consumption showed significantly higher odds of being obese than those who reported with no soda consumption for every group comparison.
They also found that girls from all age groups, and children of both sexes less than 9.9 years old, had a higher tendency to develop obesity. Fitness level did not differ significantly between those who developed obesity and those who did not. Moderate consumption (1–2 servings) of juice and milk were not significantly associated with obesity. Notably, children who developed obesity during the study period reported the highest percentage of individuals with high consumption of soda.
“By this analysis, high milk consumption was also not found statistically significant with the obese. Children consuming juice did not differ significantly in the percentage of becoming obese,” said the researchers.
“Milk was only significant when we compared children who became obese (Group 1) to children who were non-obese at both visits. We did not find that consumption of milk was significantly associated with any of the other groups. Consumption of juice was also not significantly associated with any group.
“High consumption (3 or more servings) of soda and to a lesser degree, milk but not fruit juice was significantly associated with obesity development in Kuwaiti children, thus clearly indicating that there is more to obesity than simple sugar consumption. Neither high nor moderate juice consumption was significantly associated with obesity. Only high soda or milk consumption was associated with increased prevalence of obesity. Consumption of moderate amounts of any of these beverages (1–2 servings/day) was not associated with significantly increased prevalence of obesity,” concluded the researchers.
Data from this study also suggests that the combination of phosphorus with sugar in soda may synergise in the development of obesity. However, this hypothesis will require further investigation.
“Soda is an excellent source of phosphate in diet, and high phosphate or phosphorus intake association with obesity has been reported in other epidemiological studies, but the mechanism is still unclear,” said the researchers.
“We find it valuable to investigate some other ingredients added in some beverages that make them more associated with obesity. Phosphorus in soda beverages and fat in flavoured or unflavoured milk drinks are two good examples of some of these additives.”
Source: Frontiers in Endocrinology
DOI: 10.3389/fendo.2023.1174299
“Beverage consumption and obesity in Kuwaiti school children”
Authors: Muhanad Alhareky, Jo Max Goodson et al.
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