Researchers analyzed data from 8,400 children and teens ages 2 to 19 collected between 2011 and 2016 as part of the National Health and Nutrition Examination Survey, which is administered yearly by the US Centers for Disease Control and Prevention. Parents and kids were asked to recall what the children had consumed in the previous 24 hours, and the calories were added up.
One out of every 5 kids and young adults reported that they did not drink water in the day prior to the survey. Not drinking water was associated with consuming an extra 93 calories per day, on average, and 4.5% more calories from sweetened beverages such as sodas, sports drinks and juice, according to the study, published Monday in JAMA Pediatrics.
The number of extra calories consumed varied by age, as well as race and ethnicity. Caucasian children who didn't drink water got an extra 122 calories from sugary beverages, while Hispanic children consumed an extra 61 calories from these and African American kids an extra 93 calories.
The research was not designed to determine what amount of water would prevent kids from drinking sugary beverages but rather whether drinking water at all had an effect, explained Asher Rosinger, assistant professor at Pennsylvania State University and lead author of the new study.
Because of the study design, the research could not establish definite cause and effect between drinking water and consuming fewer calories, only an association, noted Dr. Natalie Muth, a practicing pediatrician and registered dietitian in Carlsbad, California, who was not involved in the research.
"Kids who drink water may have parents who limit sugary drinks and otherwise promote healthy eating, or kids who don't drink water may not have access to safe water," she added.
With the limitations in mind, Rosinger and his team stress that sugar-sweetened beverages add empty calories to children's diets and may increase the risk of weight gain, obesity and diabetes.
"I talk with my patients and their families all the time about the health harms of sugary drinks and the advantage of drinking primarily water and milk," Muth said.
The American Heart Association recommends that the diets of children over age 2 should be limited to 25 grams of added sugar each day and says children should not drink more than one 8-ounce sugary drink per week.
Despite the guidelines, a 2017 study revealed that almost two-thirds of children in the United States consumed at least one sugary beverage on any given day, and roughly 30% consumed two or more a day.
"Sugary drinks are a mainstay in many children's diets. They are inexpensive, easy to find, heavily marketed and taste sweet, so children like them," Muth said.
The American Heart Association recently joined the American Academy of Pediatrics in recommending policy changes targeted at federal, state and local lawmakers, encouraging them to implement policies that would reduce children's intake of sugary drinks.
For parents looking to encourage healthy habits, Muth recommends offering water as the first and preferred beverage choice starting at 6 months of age, limiting access to sugary drinks, modeling drinking water themselves and making drinking water more fun by infusing it with fruit, mint or a squirt of lime or lemon.
"Kids who don't drink water are more likely to get their fluids elsewhere," Muth said. "All it takes is an extra 70 calories or so per day for a child to gain excess weight and be at risk for overweight or obesity."
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