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Substitution of Sugar-Sweetened Beverages with Other Beverage Alternatives: A Review of Long-Term Health Outcomes

ATLANTA (June 1, 2015) — “Substitution of Sugar-Sweetened Beverages with Other Beverage Alternatives: A Review of Long-Term Health Outcomes”, published in the Journal of the Academy of Nutrition and Dietetics, describes a systematic review of prospective cohort studies and randomized controlled trials (RCTs) that examined long-term health outcomes between sugar-sweetened beverages (SSBs) and substitutions with low calorie alternatives for SSBs in children and adults. Six cohort studies and 4 RCTs were included in this review.

In these studies, the types of SSBs examined varied between studies but all included carbonated beverages with sugar. Water, coffee, tea, fruit juices, milk, and artificially sweetened beverages (ASBs) were the common beverage alternatives used. Total energy intake, body weight, and composition were examined in studies involving either children or adults while type 2 diabetes, blood pressure, and stroke were evaluated in studies of adult participants.

Substituting water or low-calorie beverages for all SSBs was associated with a decrease in total energy intake, body weight, waist circumference, and percent body fat. On the other hand, substitution with caloric beverages such as 100% juice or milk was not associated with a decrease in energy intake, body weight, or body composition. The authors state that “the available evidence suggests a favorable effect of replacing [sugar-sweetened beverages] SSBs with low-calorie alternatives such as water, coffee/tea, and [artificially sweetened beverages] ASBs on long-term body weight, supported by two cohort studies and three RCTs. While the results for type 2 diabetes, stroke, and cardiometabolic risk factors appear to be beneficial, the evidence is inadequate for strong conclusions to be developed.”

The limitations of this study include a predominantly U.S. based population with limited generalizability of the study findings, differences in the definition of SSBs between the studies, reliance on self-reported intake, and the possibility of unmeasured confounding factors. Nonetheless, the review is strengthened by a low risk of bias and inclusion of good quality studies.  The authors conclude that “the overall consensus of our review was that SSB substitution with beverage alternatives such as water and low-calorie beverages may have beneficial effects on long-term body weight management.” Please note,  registered dietitians and nutritionists can obtain continuing professional education credit for reading the article and taking the journal article quiz offered  by  the Academy of Nutrition and Dietetics.

Miaobing Zheng, Margaret Allman-Farinelli, PhD, Berit Lilienthal Heitmann, PhD, Anna Rangan, PhD. Substitution of Sugar-Sweetened Beverages with Other Beverage Alternatives: A Review of Long-Term Health Outcomes.  Elsevier Inc. March 04, 2015. Doi: 10.1016/j.jand.2015.01.006

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