Sugar-Sweetened Beverages - Extension

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Sugar-Sweetened BeveragesFact Sheet No.9.389Food and Nutrition Series HealthBy J. Clifford and K. Maloney (12/2016)In the United States, 69% of adults and32% of children age 2-19 are consideredoverweight or obese. Evidence suggeststhat consumption of sugar-sweetenedbeverages (SSB) is associated with anincrease in weight among Americans.Adults consume approximately 14.6%of total daily calories from added sugars;sugar sweetened beverages contribute toapproximately 33% of these calories.A sugar-sweetened beverage is anybeverage with added sugar, includingsodas, sweetened juices, energy drinks,sport drinks, sweetened teas, and coffeedrinks. An individual sweetened beveragecan be a major contributor of added sugarsin a daily diet. A 20 oz. cola contains over16 teaspoons of added sugar, about doublethe daily recommendation, constituting 240calories. A common name brand iced teacontains 72 grams of sugar in its 23 oz. can,for a total of 270 calories and 18 teaspoonsof added sugar.*Jessica Clifford, Research Associate and ExtensionSpecialist and K. Maloney, graduate student in the Dept ofFood Science Human Nutrition. 12/2016Typically, when calories are consumed,they create a feeling of fullness. However,a growing body of evidence suggeststhat liquid carbohydrates, such as thosefound in SSBs, do not stimulate the feelingof fullness, or create satiety followingconsumption. This may lead to higheroverall caloric intake. Additionally, thecarbohydrates in SSBs are rapidly absorbedinto the bloodstream, causing largerswings in blood glucose levels. Crashingafter a large peak in blood sugar can causean individual to seek more calories torestore glucose levels, further contributingto a pattern of high calorie intake andovereating.Sugar SweetenedBeverages and HighFructose Corn SyrupMany SSBs are made with large amountsof high fructose corn syrup, which maybe a factor in some of the disease riskassociated with high SSB consumption.Fructose is metabolized differently thanglucose, and excessive consumption offructose has been shown to increase riskfor dyslipidemia, non-alcoholic fatty liverdisease, increased abdominal fat anddecreased insulin sensitivity. These factorscan increase the risk for heart disease anddiabetes. Yet, short term studies have alsoobserved similar levels of triglycerides inthe blood after consuming pure glucose.This evidence suggests that similar effectsmay be observed in cases of regularconsumption of glucose-sweetenedbeverages as well, indicating the negativeeffects may not be limited to just highfructose corn syrup consumption.Quick Facts An individual sugarsweetened beverage can bea major contributor to addedsugars in a daily diet. Sugar sweetened beveragesdo not stimulate the feelingof fullness or create satietyfollowing consumption. Excessive consumption ofSSBs has been linked toseveral chronic diseases,including cardiovasculardisease and type 2 diabetesmellitus. There is strong evidenceto support that SSBs areassociated with increasedchildhood overweight andobesity. While excessive intake ofSSBs or other sources ofadded sugar is not advised,moderate consumption ofadded sugar can be part of abalanced diet. Colorado State UniversityExtension. 12/16.extension.colostate.edu

Sugar-SweetenedBeverages andDiseaseExcessive SSB consumptionhas been linked to several chronicdiseases, including cardiovasculardisease and type 2 diabetesmellitus. In some instances, thisrelationship has been shown toexist independent of weight statusor total caloric intake. Therefore,moderating SSB consumption canbe important to overall health andwellbeing.ObesityHigh consumption of SSBsincreases the risk for overweightand obesity. Some evidencesuggests that this relationshipexists independent of the caloricintake, signifying that SSBdigestion and metabolism maybe digested differently than otherforms of sugar. In one study,researchers followed participantsfor an average of 4 years, and theyfound that daily consumption ofSSBs was linked to a 37% increasedrisk for development of obesity.Obesity has been linked to anincreased risk of developing manychronic diseases, including heartdisease, stroke, type 2 diabetes,cancer, osteoarthritis, sleepapnea, reproductive problems,and gallstones. Additionally,obesity-related healthcare costsare estimated to be 147 billionper year, constituting 9.1% of totalhealthcare costs.Metabolic SyndromeMetabolic syndrome is a clusterof risk factors that increase the riskfor cardiovascular disease, diabetesand stroke. These risk factorsinclude: Abdominal adiposity High triglyceride levels Low HDL cholesterollevels High blood pressure High fasting blood sugarAccording to the NationalHeart, Lung, and Blood Institute,metabolic syndrome may surpasssmoking to become the leadingrisk factor for heart disease in theUnited States. Studies have foundthat greater SSB consumptionhas been linked to higher risk formetabolic syndrome. The high sugarcontent of these beverages can causeincreased fat production by the liver,increasing abdominal adiposity andtriglyceride levels, and detrimentallyimpacting levels of HDL and LDLcholesterol. These beverages alsohave a high glycemic load, increasinginsulin resistance and raising bloodsugar levels.Heart DiseaseIn the Nurses’ Health Study,women who consumed two or moreSSBs per day had a 35% increasedrisk of heart disease comparedto those who rarely consumedsweetened beverages, even afteraccounting for lifestyle factors,such as smoking, physical activity,and body mass index (BMI). Lowto moderate consumption of SSBs(1-2 per day) has been shown tonegatively impact the markers ofcardiovascular disease, increasingthe expression of atherogenicLDL particles, which promotethe formation of arterial plaques.Plaques are a buildup of cholesterol,fats, and other substances invessel walls, which is often theprecursor to cardiovascular disease.It also increases other markers ofinflammation, such as C-reactiveprotein, which plays a role in thedevelopment of atherosclerosisand further increases the risk forcardiovascular disease. Researchersalso observed that SSB consumptionraised fasting glucose levels, whichis associated with insulin resistanceand increased risk for heart disease.The effects of SSB consumption onheart disease has been observedindependent of factors such as BMI,total energy intake, and incidence ofdiabetes.DiabetesConsumption of SSBs increasesthe risk of developing type IIdiabetes mellitus. According to datagathered during the Nurses’ HealthStudy II, women who consumedone or more SSBs per day had an83% higher relative risk of developingdiabetes when compared to those whorarely consumed sweetened drinks. Otherstudies have supported the findingsthat SSB consumption increases risk forthis chronic disease. These studies havedemonstrated that BMI is a mitigatingfactor for the effect of SSBs, though thereis evidence that BMI only accounts for aportion of the increased risk for type IIdiabetes development.CancerThus far, a direct relationship betweensugar-sweetened beverage intakeand cancer has not been observed.However, overweight and obesity hasbeen associated with several forms ofcancer, including cancers of the breast,colon, rectum, endometrium, esophagus,kidneys, and pancreas. Therefore, thestrong link between obesity and SSBsmay indicate an indirect link betweenconsumption and cancer risk.Gout and Kidney ProblemsSSB consumption has been linked tohigh levels of uric acid in the body. Thismay be due to the fact that SSBs are highin fructose, a compound known to raiseuric acid levels. Heightened levels of uricacid has been known to cause gout andthe formation of certain types of kidneystones. Therefore, individuals who areprone to either of these conditions shouldconsider decreasing consumption of SSBs.Additionally, SSB consumptionhas been linked to declining kidneyfunction and higher incidence of chronickidney disease. This may be due to theheightened levels of uric acid. SSBs havealso been linked to an increase in urinealbumin, known as microalbuminuria,another risk factor for kidney disease.Diabetes, hypertension, and kidneystones are additional known risk factorsfor kidney disease and may furthercontribute to the association betweenSSBs and declining kidney function.OsteoporosisThere have been concerns about therelationship between SSBs and bonehealth. Consumption of soda has beenlinked to decreasing bone density andincreased risk for osteoporosis andfractures. This is due to the high levels ofphosphate found in some sodas, whichcan have a deleterious effect on bones.

Furthermore, SSBs can displace milkconsumption, decreasing the intake ofcalcium and vitamin D, key nutrients inbone health. In the US, soda consumptionis highest among adolescents and youngadulthood, a time in life when calciumintake is crucial for bone deposition andwhen maximum bone density can bereached. A diminished level of maximumbone density can lead to higher risk forhip fracture and osteoporosis later in life.remember that excessive consumptionof artificial sweeteners can causeundesirable side effects, such as diarrheaand headaches.Sugar-SweetenedBeverages and ChildrenThere is strong evidence to supportthat SSBs are associated with increasedchildhood overweight and obesity. Thislink has been observed in both child andadolescent populations. One study foundthat children between ages 2.5-4.5 whoregularly consume SSBs were 2.4 timesmore likely to be overweight or obesethan children who did not consume SSBs.Daily consumption of SSBs was shownto increase the risk of overweight orobesity by 4.8 times among adolescents.Overweight in childhood has been linkedto an increased likelihood for overweightand obesity in adulthood. Additionally,increasing weight status in children hasbeen associated with increased childhoodincidence of type 2 diabetes (previouslyconsidered “adult-onset” diabetes).Not only have SSBs been associatedwith obesity in children, but they havealso been linked to overall decreasedhealth status. In a multi-ethnic studywith children age 8-15, SSB consumptionwas linked to higher triglyceride levelsand decreased HDL levels. In addition,high fructose consumption in childrenhas been linked to increased markers ofinflammation and decreased LDL particlesize. Small LDL particles are known to bethe more atherosclerotic. Atherosclerosisis a narrowing and hardening of bloodvessels, and causes an increased risk forheart attack, stroke, and vascular disease.Additionally, SSB consumption hasbeen linked to higher risk of metabolicsyndrome among adolescents.What about 100% FruitJuice?Fruit juices are often similar in sugarcontent, similar to SSBs. Therefore, similarconcerns exist regarding excessive juiceconsumption and chronic disease risk.However, it is important to note that100% fruit juice will also be a source ofsome vitamins and minerals, which aretypically absent from SSBs. While 100%fruit juice counts as a serving of fruit,eating whole fruit is the preferred methodof consuming these nutrients, becausejuice is a more concentrated source ofsugar and does not contain the fibertypically found in fruit. It should also benoted that fruit drinks are not the sameas 100% fruit juice. Fruit drink productsoften contain added sugar, and contain asmaller percentage of fruit juice, thereforeoffering less of the benefits that can beattributed to a 100% juice product.Similar to SSBs, fruit juice shouldbe consumed in moderation. Considerdiluting juice with water, forming a 50:50ratio, in order to decrease the sugarcontent while still enjoying the flavor.According to the Dietary Guidelines forAmericans, adults should consume lessthan half of their recommended servingsof fruit from juice. This means that intakeof 100% juice (without added sugars)should not exceed one cup per day for a2000 calorie diet.that consumption of these beverages ismore common among people who areconcerned about their weight. There issome evidence that artificially sweetenedbeverages may decrease weight gain,but only when used as a substitution forexisting SSB consumption. Additionally,higher rates of type II diabetes have beenassociated with higher consumptionof artificial sweeteners, though thisassociation is largely explained by othervariables, such as health status, diet, andBMI. Nonetheless, it is also important toremember that excessive consumptionof artificial sweeteners can causeundesirable side effects, such as diarrheaand headaches.Artificially SweetenedBeveragesSome observational studies haveobserved a relationship between theconsumption of beverages madewith artificial sweeteners and loweroverweight/obesity. However, thisrelationship may be due to the fact thatWhat are the recommendations for juice consumption forchildren?According to the American Academy of Pediatrics, the amount of juice that can behealthfully consumed depends on age. Daily fruit juice consumption should be limitedto:Birth to 6 months of ageNo fruit juice (unless to alleviate constipation)6 to 12 months4 to 6 ounces (served in a cup to avoid tooth decay)1 to 6 yearsUp to 6 ounces7 years and olderNo more than 8-12 ounces

Added Sugar Consumptionas part of a Balanced DietWhile excessive intake of SSBs or othersources of added sugar is ill-advised,moderate consumption of added sugarcan be part of a balanced diet. Accordingto the 2015 Dietary Guidelines forAmericans, as well as recommendationsby the World Health Organization, addedsugars should be limited to a maximum of10% of total daily calories.Alternatives to SugarSweetened BeveragesReducing consumption of sugarsweetened beverages is a good way toimprove health and decrease caloricintake. Below are alternatives to drinkinga sugar-sweetened beverage: Water infused with fresh fruit,mint, or cucumber instead of asugary fruit drink Unsweetened herbal iced teainstead of sweetened iced tea Soda water with a squeeze ofcitrus instead of soda A low-fat plain latte instead of asugary coffee drink or energydrink Chocolate flavored tea instead ofhot chocolate with added sugar A fruit smoothie with low-fatyogurt instead of a milkshake If substitutes won’t do, try a dietvariety or decrease the size andfrequency of SSB consumptionWhat does 10% of total daily calories mean?To determine what 10% of daily calories looks like, begin by figuring out the dailycaloric needs of an individual based on weight, age, gender, and activity level. Forhelp determining energy needs, the Mayo Clinic has an online tool to calculate anestimate of caloric needs.Once total caloric need has been determined, calculate 10% of this value (.10 xtotal calories). Next, divide this number by 4 (there are 4 calories per 1 gram ofsugar). This converts calories of added sugar to grams, making it easier to comparethe grams of sugar listed on a label to the total suggested amount of added sugar.For example, a moderately active, middle-aged woman who is 5'5" and weighs135 lbs needs about 1800 calories a day. This means that she should consume nomore than 180 calories, or 45 grams, per day from added sugars. This is theamount of added sugar found in a single 12oz. can of root beer.(1800 x .10 180 calories from sugar -- 180/4 45 grams of sugar)

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beverages (SSB) is associated with an increase in weight among Americans. Adults consume approximately 14.6% of total daily calories from added sugars; sugar sweetened beverages contribute to approximately 33% of these calories. A sugar-sweetened beverage is any beverage with added sugar, including sodas, sweetened juices, energy drinks,

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