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Karen Weber Cullen, DrPH, RD, Ld, Danielle M. Ash, MS, RD, Ld, Carla Warneke, MS and Carl de Moor, PhD

Karen Weber Cullen is with the Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Tex. Danielle M. Ash is with Blessing Hospital, Quincy, Ill. Carla Warneke and Carl de Moor are with the Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston.

Correspondence: Requests for reprints should be sent to Karen Weber Cullen, DrPH, RD, LD, Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX 77030 (e-mail: kcullen{at}bcm.tmc.edu).

	INTRODUCTION

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
Soft drinks supply about 20% to 24% of calories for 2- to 19-year-olds¹ and contribute to excess calorie consumption^2–4 and tooth decay.⁵ Noncarbonated sports drinks and fruit drinks also provide sugar and calories. The average American consumed 55.9 gallons of soft drinks and 6.1 gallons of fruit drinks in 1999.⁶ Soft drink consumption was negatively related to milk and fruit juice consumption,³ but the relationship between beverage consumption and consumption of other food groups is unknown. Here we describe the intake of sweetened beverages, fruits, vegetables, and calories by children in grades 4 through 6.

	METHODS

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
This study was approved by the University of Texas M. D. Anderson Cancer Center institutional review board. Informed consent was obtained. As described elsewhere, parochial school students in grades 4 through 6 in Houston, Tex, completed food records in the classroom for 3 to 7 days.⁷ The food records were hand-coded to obtain servings of fruits, high-fat and regular vegetables, and beverages (milk, 100% fruit juice, soft drinks, and fruit-flavored drinks).⁸ Servings of soft drinks and fruit-flavored drinks were added together as "sweetened beverages." Caloric intake was obtained by means of Nutrition Data Systems software, version 2.91 (University of Minnesota, Minneapolis). No diet drinks were consumed, and water consumption was not recorded.

We calculated mean daily fruit, vegetable, soft drink, fruit-flavored drink, and total sweetened beverage consumption; percentage of total beverages accounted for by sweetened beverages; and calories. We evaluated differences in beverage consumption in ounces, ounces per 1000 calories (to control for food intake), and as a percentage of beverage intake and differences in consumption by tertiles of sweetened beverage intake.

	RESULTS

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
Of the 504 students (207 boys and 297 girls) who participated, 25% were African American, 32% were European American, 33% were Mexican American, and 10% were Asian American. They completed a mean of 4.3 days of food records. Average daily intake of total beverages was 20 (± 9.6) ounces; 51% of daily intake consisted of sweetened beverages.

Mexican-American students reported the highest soft drink consumption, African American students reported the highest fruit-flavored drink consumption, and African American and Mexican American students reported the highest total sweetened beverage consumption (Table 1). Sixth-grade students consumed more soft drinks and sweetened beverages than fourth-grade students. Students whose parents had a high school education or less consumed more soft drinks and total sweetened beverages than students whose parents had more education.

	DISCUSSION

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

Fruit consumption was approximately 57% lower for those students in the highest tertile of soft drink consumption and 62% lower (one half serving) in the highest tertile of sweetened beverage consumption, compared with fruit consumption by those in the lowest tertiles. Phytochemicals found in fruit reduce risks for chronic diseases.¹¹ Low consumption in childhood may persist into adulthood.¹² Perhaps sweetened beverage consumption is a marker for poor dietary habits or reflects meal sources with few fruit selections and many high-fat food selections (e.g., fast-food restaurants). No other reports have evaluated the relationship between sweetened beverage consumption and food intake. This warrants further research with longitudinal studies, because of the obesity problem and chronic disease risks.^9,10,13

African American and Mexican American students consumed the most fruit-flavored and soft drinks. The proportion of children in this study who consumed soft drinks was similar to that found in national data.^3,14 Differences in beverage consumption by ethnicity have been noted,^3,15 and higher soft drink consumption with higher age has been documented.^3,7,14

In the present study, lower parental education was associated with higher consumption of soft drinks and sweetened beverages. National data showed no differences in soft drink consumption by income,¹⁶ but fruit-flavored drink consumption was highest for those at the lowest income level. Future research on the influence of family income on children’s beverage consumption is warranted, particularly since low-income children and adults have high rates of obesity.^9,10,13

Limitations of this study include the fact that dietary data were self-reported and the limited generalizability of the sample (fourth- to sixth-grade parochial school students from one city). The cross-sectional nature of the data limits our ability to attribute causality (e.g., choosing sweetened beverages reduces fruit intake). Future research should determine whether similar differences exist in other population groups and whether parental beverage consumption habits influence children’s habits. Water is a popular drink, and future studies should measure consumption of water as well as other beverages.

In this study, students with high sweetened beverage consumption reported low fruit and high calorie intakes. Consumption of more healthful beverages, such as low-fat milk or water, should be encouraged at home and at meals consumed away from home.

	Acknowledgments

 
This research was conducted while Karen Weber Cullen was with the University of Texas M. D. Anderson Cancer Center, Houston, Tex, and was supported in part by the Cooperative State Research, Education, and Extension Service, US Department of Agriculture, under Agreement No. 9700578. This project was also funded in part by the US Department of Agriculture, Agricultural Research Service, under Cooperative Agreement No. 58– 6250–6001.

Human Participant Protection
The research protocol was approved by the institutional review board of the University of Texas M. D. Anderson Cancer Center.

	Footnotes

 
Peer Reviewed

Note. The views expressed here are those of the authors and do not necessarily reflect those of the US Department of Agriculture.

K. W. Cullen conceptualized the study, oversaw its implementation, and wrote the brief. D. M. Ash, C. Warneke, and C. de Moor participated in data analyses and manuscript preparation.

Accepted for publication February 18, 2002.

	References

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
1. Troiano RP, Briefel RR, Carroll MD, Bialostosky K. Energy and fat intakes of children and adolescents in the United States: data from the National Health and Nutrition Examination Surveys. Am J Clin Nutr. 2000;72:1343S–1353S.[Abstract/Free Full Text]

2. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357:505–508.[Medline]

3. Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc. 1999;99:436–441.[Medline]

4. DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord. 2000;24:794–800.[Medline]

5. Larsen MJ. Prevention by means of fluoride of enamel erosion as caused by soft drinks and orange juice. Caries Res. 2001;33:229–234.

6. What America’s drinking. Available at: http://www.beverageworld.com. Accessed September 4, 2001.

7. Cullen KW, Baranowski T, Rittenberry L, et al. Child-reported family and peer influences on fruit, juice and vegetable consumption: reliability and validity of measures. Health Educ Res. 2001;16:187–200.[Abstract/Free Full Text]

8. Cullen K, Baranowski T, Baranowski J, Hebert D, de Moor C. Behavioral or epidemiologic coding of fruit and vegetable consumption from 24-hour dietary recalls: research question guides choice. J Am Diet Assoc. 1999;99:849–851.[Medline]

9. Park MK, Menard SW, Schoolfield J. Prevalence of overweight in a triethnic pediatric population of San Antonio, Texas. Int J Obes Relat Metab Disord. 2001;25:409–416.[Medline]

10. Ballew C, Kuester S, Gillespie C. Beverage choices affect adequacy of children’s nutrient intakes. Arch Pediatr Adolesc Med. 2000;154:1148–1152.[Abstract/Free Full Text]

11. Potter, JD. Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research; 1997.

12. Lytle LA, Seifert S, Greenstein J, McGovern P. How do children’s eating patterns and food choices change over time? results from a cohort study. Am J Health Promot. 2000;14:222–228.[Medline]

13. Centers for Disease Control. Update: prevalence of overweight among children, adolescents, and adults—United States, 1988–1994. MMWR Morb Mortal Wkly Rep. 1997;46:199–202.

14. US Department of Agriculture, Agricultural Research Service. Table Set 17: Food and Nutrient Intakes by Children 1994–96, 1998. Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/pdf/scs_all.pdf (PDF file). Accessed September 4, 2001.

15. US Department of Agriculture, Agricultural Research Service. Table Set 16:Food and Nutrient Intakes by Hispanic Origin and Race, 1994–96. Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/pdf/origin94.pdf. Accessed September 4, 2001.

16. US Department of Agriculture, Agricultural Research Service. Table Set 14: Food and Nutrient Intakes by Income, 1994–96. Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/pdf/income.pdf (PDF file). Accessed September 4, 2001.

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