Objective: To estimate the net caloric impact from replacing sugar-sweetened beverages (SSBs) with alternatives in children and adolescents in naturalistic settings.
Design: Secondary analysis based on nationally representative cross-sectional study.
Setting: Fixed-effect regression analysis of 2 nonconsecutive 24-hour dietary recalls from the 2003-2004 National Health and Nutrition Examination Survey data.
Participants: Children and adolescents 2 to 19 years of age (N = 3098).
Main exposures: Within-person beverage consumption between 2 surveyed days.
Main outcome measures: The association between changes in the consumption of SSBs and other beverages and changes in total energy intake (TEI) of the same individual.
Results: Each additional serving (8 oz) of SSB corresponded to a net increase of 106 kcal/d (P < .001; 95% confidence interval [CI], 91 to 121 kcal/d), holding other beverages constant. Increases were also seen (all P < .001) for each additional serving of whole milk (169 kcal/d; 95% CI, 143 to 195 kcal/d), reduced-fat milk (145 kcal/d; 95% CI, 118 to 171 kcal/d), and 100% juice (123 kcal/d; 95% CI, 90 to 157 kcal/d). No net increases in TEI were seen for water (8 kcal/d; P = .27; 95% CI, -6 to 22 kcal/d) or diet drinks (47 kcal/d; P = .20; 95% CI, -23 to 117 kcal/d). Substituting SSBs with water was associated with a significant decrease in TEI, controlling for intake of other beverages, total beverage and nonbeverages, and fast-food and weekend effects. Each 1% of beverage replacement was associated with 6.6-kcal lower TEI, a reduction not negated by compensatory increases in other food or beverages. We estimate that replacing all SSBs with water could result in an average reduction of 235 kcal/d.
Conclusion: Replacing SSB intake with water is associated with reductions in total calories for all groups studied.