Applied nutritional investigation Is sugar-sweetened beverage consumption associated with increased fatness in children? Laura Johnson, M.Sc. a, *, Adrian P. Mander, Ph.D. a , Louise R. Jones, B.Sc. b , Pauline M. Emmett, Ph.D. b , and Susan A. Jebb, Ph.D. a a MRC Human Nutrition Research, Cambridge, United Kingdom b Department of Social Medicine, University of Bristol, Bristol, United Kingdom Manuscript received March 22, 2007; accepted May 16, 2007. Abstract Objective: We assessed whether sugar-sweetened beverage (SSB) consumption increases fatness in British children. Methods: Data from a subsample of the Avon Longitudinal Study of Parents and Children were analyzed. Diet was assessed at ages 5 y (n = 521) and 7 y (n = 682) using 3-d diet diaries. Beverages were categorized into SSB, low energy, fruit juice, milk, and water. Fat mass was measured at age 9 y using dual-energy x-ray absorptiometry. The association between consumption of SSB at each age and fatness was examined using linear regression adjusted for potentially confounding variables. Results: SSB accounted for 15% of all drinks consumed and 3% of total energy intake at both ages. There was no evidence of an association between SSB consumption at 5 or 7 y of age and fatness at age 9 y. There was a small positive correlation between low-energy drinks at age 5 and 7 y and fatness at 9 y (age 5 y,  = 0.21, P  0.001; age 7 y,  = 0.16, P  0.001), which was explained by existing overweight status at ages 5 and 7 y. Conclusion: In this cohort of British children there was no evidence of an association between SSB consumption at age 5 or 7 y and fatness at age 9 y. The positive relation between consumption of low-energy beverages and fatness at 9 y, which was explained by overweight status at 5 and 7 y, suggests that heavier children may consume low-energy beverages as part of an ineffective weight- control program. © 2007 Elsevier Inc. All rights reserved. Keywords: Avon Longitudinal Study of Parents and Children (ALSPAC); Sugar-sweetened beverage; Fat mass; Children Introduction In 2004 it was estimated that 10% of all children world- wide were overweight or obese (defined by International Obesity Task Force [IOTF] criteria [1]); this equates to 155 million overweight children, 30 million of whom were obese [2]. The 2004 Health Survey for England showed that 27% of children younger than 11 y are overweight or obese (defined by body mass index [BMI] 85th U.K. BMI per- centiles) [3]. There are serious health and social conse- quences to excess weight in childhood in the short and long term [4]. Obesity results from a complex interplay of ge- netic, behavioral, and environmental influences on metabo- lism, diet, and activity. To prevent more children becoming obese, effective evidence-based prevention programs need to be designed, which focus on risk factors that are amena- ble to change. The World Health Organization has implicated the con- sumption of sugar-sweetened beverages (SSBs) as a “prob- able contributor” to the obesity epidemic [5]. The National Food Survey in the United Kingdom documented a five-fold increase in household consumption of SSBs between 1974 and 1999, from 180 to 976 g/wk [6]. A similar trend was observed in the United States, where the average daily consumption of SSBs by children (6 to 17 y of age) more than doubled between 1977 and 1998, from 150 to 350 g/d (5 to 12 oz/d) [7]. Experimental studies in adults support This analysis was funded by a Ph.D. studentship awarded to Laura John- son, M.Sc., by the U.K. Medical Research Council. The U.K. Medical Re- search Council, the Wellcome Trust, and the University of Bristol provide core support for the Avon Longitudinal Study of Parents and Children. * Corresponding author. Tel: +01223-426356; fax: +01223-437515. E-mail address: laura.johnson@mrc-hnr.cam.ac.uk (L. Johnson). Nutrition 23 (2007) 557–563 www.elsevier.com/locate/nut 0899-9007/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.nut.2007.05.005