Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 344

based on artiicially sweetened drinks or sodas. Nationally representative surveys from the 1990s
estimated that artiicially sweetened sodas accounted for approximately 4%-18% of the total car-
bonated beverage intake in children (French et al. 2003; Striegel-Moore et al. 2006). Artiicially
sweetened soft drink consumption appears to be increasing in children, both with age and over time
(Kral et al. 2008; Blum et al. 2005).
11.5.2 Observational Studies of artiicial Sweeteners and Weight Gain in Children
Brown et al. (2010) reviewed the current literature on artiicial sweetener consumption in
children and its health effects and identiied 18 studies. Data from large, epidemiologic studies
support the existence of an association between artiicially sweetened beverage consumption and
weight gain in children. Randomized controlled trials in children are very limited and do not clearly
demonstrate either beneicial or adverse metabolic effects of artiicial sweeteners. They reported
that it is important to examine possible contributions of these common food additives to the global
rise in pediatric obesity and diabetes.
The majority of pediatric epidemiologic studies have found a positive correlation between weight
gain and artiicially sweetened beverage intake. Blum et al. (2005) examined beverage consumption
and BMI Z -scores in 164 elementary school-aged children in a longitudinal study, where increased
diet soda consumption was positively correlated with follow-up BMI Z -score after 2 years. Similar
results were reported by Berkey et al. (2004), who examined the relationship between BMI and diet
soda consumption in over 10,000 children (aged 9-14 years) of Nurses' Health Study II participants
over the course of 1 year. Artiicially sweetened beverage intake was signiicantly correlated with
weight gain in boys but not in girls during the study period. A long-term prospective study of 1203
children in England found that artiicially sweetened beverage consumption at ages 5 and 7 was
correlated both with baseline BMI and fat mass at age 9 (Johnson et al. 2007). Another longitudinal
study of 2371 girls (aged 9 and 10) participating in the National Heart, Lung and Blood Institute
Growth and Health Study showed that diet and regular soda consumption was signiicantly associ-
ated with increase in daily energy intake but not with BMI (Striegel-Moore et al. 2006; Yang 2010).
The correlation between diet soda and BMI was not signiicant.
A much smaller study of 177 children aged 3-6 years by Kral et al. (2008) showed no associa-
tion between diet soda consumption and the risk of obesity.
Forshee and Storey (2003) analyzed data from a nationally representative sample of U.S. children
between 6 and 19 years of age (a cross-sectional study looking at 3111 children) and found that BMI
was positively correlated with diet soda consumption. These results were consistent with the ind-
ings of Giammattei et al. (2003) in 385 sixth and seventh graders, which showed that both diet and
sugar-sweetened soda intake were positively correlated with BMI Z -score and percentage body fat.
However, a study of 2- to 5-year-old children by O'Connor et al. (2006) using National Health
and Nutrition Examination Survey (NHANES) data did not show an association between artii-
cially sweetened beverage consumption and BMI in this age group. However, increased beverage
consumption was associated with an increase in the total energy intake of the children. This noted
difference between the total energy intake and mean BMI might have multiple explanations. First,
the prevalence of overweight in this age group ( N = 124; 10.7%) may be too low to detect an associa-
tion between increased energy intake and increased BMI. Second, they may be capturing children
who are too young to see an effect of increased total energy intake on BMI.
Prospectively studying preschool children beyond 2-5 years of age, through their adiposity
rebound (approximately 5.5-6 years) to determine whether there is a trajectory increase in their
BMI, may help clarify the role of beverage consumption in the total energy intake and weight status.
Because the mean adiposity rebound occurs at approximately 5.5-6 years (Whitaker et al. 1998), it
is possible that if preschool children were followed through their adiposity rebound, then it might be
found that the increased energy intake may translate into an increase in BMI after age 6.