Download Sugar Sweetened Beverages, Obesity

OBESITY:
SUGAR-SWEETENED
BEVERAGES, OBESITY
AND HEALTH
EVIDENCE BRIEF
This evidence brief forms part of the Australian National
Preventive Health Agency’s evidence brief series which aims
to disseminate information and inform dialogue relating to
high priority preventive health issues.
This evidence brief was prepared by The Boden Institute
of Obesity, Nutrition, Exercise & Eating Disorders and the
Menzies Centre for Health Policy, University of Sydney
for the Australian National Preventive Health Agency.
This brief is written in plain English to appeal to a wide
audience. A more detailed technical paper supports the
evidence presented in this brief and is available upon
request from [email protected]
© Commonwealth of Australia 2014
This work is copyright. Apart from any use permitted under the
Copyright Act 1968, no part may be reproduced by any process without
prior permission from the Australian National Preventive Health Agency.
Published by the Australian National Preventive Health Agency
Enquiries about the content of this report should be directed to:
Australian National Preventive Health Agency
GPO Box 462 Canberra ACT 2601
Telephone: (02) 6289 2879
Email: [email protected]
This report is available for download at www.anpha.gov.au
This evidence brief was prepared by The Boden Institute of Obesity, Nutrition,
Exercise & Eating Disorders and the Menzies Centre for Health Policy, University of Sydney for the Australian National Preventive Health Agency.
EVIDENCE BRIEF
OBESITY:
SUGAR-SWEETENED
BEVERAGES, OBESITY
AND HEALTH
APRIL 2014
CONTENTS
Summary1
Terminology
2
Beverages in the Australian diet
3
The health effects of sugar-sweetened beverages
4
Obesity
4
Poor Nutition
4
Dental caries and tooth erosion
5
Other health conditions
5
Consumption of sugar-sweetened beverages
6
Market research data
6
Adults’ consumption of sugar-sweetened beverages
7
Children’s consumption of sugar-sweetened beverages
8
How much sugar-sweetened beverage do children drink?
9
Contribution to energy intake
Trends in consumption of sugar-sweetened beverages
Factors affecting consumption
10
11
14
Socioeconomic status
14
Cultural background
15
Availability of soft drinks
15
Personal and parenting factors
15
How can consumption of sugar-sweetened beverages be reduced?
16
What we need to understand better
17
Conclusion18
References20
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
SUMMARY
•The amount and variety of beverages consumed
by Australians has increased dramatically in recent
decades. Many of these drinks are defined as
‘discretionary’ beverages by the current Australian
Dietary Guidelines as they do not contribute
significantly to nutrition. Sugar sweetened
beverages make up a considerable proportion
of the calories coming from these beverages
•Sugar-sweetened beverages are associated with a
range of health problems, including obesity, tooth
erosion and decay and problems with bone density,
which could lead to osteoporosis
•Many Australians drink high levels of sugarsweetened beverages, especially soft drinks
AUSTRALIA
IS NOW A
TOP 10
GLOBAL
CONSUMER OF
•Australia is in the top 10 global markets for sugar
sweetened beverages based on per capita
consumption
•There is sufficient evidence of the potential health benefits of reducing sugar-sweetened beverage
consumption to warrant action. Many health agencies and governments throughout Australia
and the world have made specific recommendations around limiting the intake of such drinks.
A range of strategies has been proposed to monitor the situation and assess interventions
CONSUMER OF
AUSTRALIA
TOP 10
IS NOW A
GLOBAL
•Despite possible recent improvements, high consumption of sugar-sweetened beverages
remains an issue across all ages, with consumption higher for males than females,
and highest among adolescent and young adult males
• National dietary data do not allow precise measures, but in general:
- consumption of soft drinks rose rapidly in the three decades prior to 2000
- per capita consumption may be levelling out or decreasing in recent times
-recently some adults (but not children) have begun replacing sugar-sweetened drinks
with artificially sweetened drinks
16,500 AUSTRALIAN
SCHOOL KIDS
•There are variations in consumption across the Australian population levels with low
socioeconomic status groups and Aboriginal and Torres Strait Islander people having
higher intakes
HIGHER
CONSUMPTION
MORE DENTAL
DISEASE
i R
efers to drinks sweetened with sugar substitutes, either artificial (synthetic) or natural. These have in common a sweetness
many times that of sugar and are sometimes referred to as “intense sweeteners”.
16,500 AUSTRALIAN
SCHOOL KIDS
+
HIGHER
CONSUMPTION
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
=
1
M
D
D
TERMINOLOGY
The 2013 Australian Dietary Guidelines refer to the need to avoid or limit “Discretionary choices”
– i.e. foods and beverages that are not an essential or necessary part of our dietary patterns.
Discretionary foods and beverages are high in kilojoules, saturated fat, added sugars, added salt
or alcohol. If chosen, they should be consumed only sometimes and in small amounts.
Within the data used to inform this report, the term ‘sugar-sweetened beverages’ is defined
differently in different surveys and by different researchers. It usually encompasses sugarsweetened soft drinks as well as cordials, sugar-sweetened fruit drinks, sports drinks, iced teas
and energy drinks. It sometimes includes flavoured milks, milkshakes and smoothies and very
occasionally 100% fruit juice. In Australia, the added sugar is predominantly sucrose.
Sugar-sweetened beverages do not include artificially sweetened (or sometimes termed
“intense sweeteners”) versions of those drinks.
A number of newer beverages such as play and vitamin waters, iced frappes and iced lattes
have not been captured in previous surveys but are sweetened with sugar and thus would
be considered as sugar sweetened beverages.
Intake of sugar-sweetened beverages is expressed in millilitres wherever possible, although
survey data often reports intake in terms of grams (1ml = 1g).
Consumption is expressed as either ‘per capita’, meaning the average intake per person on
a whole population basis, or ‘per consumer’, referring to only those who consume the drink
in question.
There is often confusion around terms used to describe frequency of consumption of foods and
beverages1. Within this report the term ‘occasionally’ means consumption of once per week or
less, ‘regularly’ means consumption of more than one but less than three times per week and
frequently means consumption of three or more times per week.
2 S
ucrose or sugar has two components – glucose and fructose. Sucrose commonly known as table or granulated sugar and is produced from sugar
beet or sugar cane for use in processed foods. Fructose occurs naturally in fruit, honey and some vegetables. But the main sources of fructose in the
typical western diet are processed foods and beverages that contain added sugar. In some countries, notably the United States, a sweetener known
as high-fructose corn syrup (HFCS) is used to sweeten many processed foods, but HFCS is not a common source of fructose in the Australian diet.
The issues associated with fructose consumption are not explored in this brief.
2
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
BEVERAGES IN THE AUSTRALIAN DIET
Beverages supply around 80% of the water required by the body each day2, and as such play
a crucial role in maintaining hydration. However, an increasingly larger proportion of this water
is coming from discretionary beverages, many of which contain very little nutrition but provide
a significant amount of sugar and energy.
Sugar-sweetened beverages and fruit drinks are the major discretionary beverages consumed in
Australia and at a time of a high prevalence of chronic disease and weight problems throughout
the community, the contribution of these products to the energy intake, diet quality and weight
status of Australians needs to be explored. Many major national health agencies, including the
US Centers for Disease Control and Prevention3, the UK National Institute for Health and Clinical
Excellence4, the Australian National Health and Medical Research Council7 and Health Canada5
recommend that people limit their intake of sugar-sweetened beverages.
CURRENTLY THERE IS NO CLEAR GUIDANCE ON AN
UPPER LIMIT FOR SUGAR SWEETENED BEVERAGES
Currently there is no clear guidance on an upper limit for sugar sweetened beverages. It is also
not clear what proportion of total energy intake derived from sugar sweetened beverages is
acceptable within a healthy diet. However, the 2013 Australian Dietary Guidelines6 make it clear
that discretionary items can only be consumed sometimes and in small amounts, in physically
active people.
The US expert Beverage Guidance Panel recommended that to meet the US Dietary Guidelines,
adults should consume no or very limited amounts of sugar-sweetened beverages
(0 – 240 ml per day).7
In March 2014, the World Health Organization released for consultation its draft guideline on sugar
intake for adults and children. The guideline recommended that total free (added) sugar intake
should not exceed 10% of dietary energy intake but also suggested it would be preferable that
intake be reduced to 5% of energy intake to limit its contribution to dental caries.8 If the 5% level
is adopted it would equate to a total intake of less than 25g of added sugar for the average adult
which is less than the sugar found in a cup of soft drink.
The Communication on Obesity Action for Child Health (COACH) Reference Group – a collaboration
of 13 key professional and NGO health groups in Australia – recommended that sugar-sweetened
and carbonated beverages be consumed by children only once a week or less.9
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
3
HAD A SOFT DRINK
ON DAY OF SURVEY
THE HEALTH EFFECTS OF
OF CHILDREN
SUGAR-SWEETENED BEVERAGES
OVER AGE 9
1/3
HAD A SOFT DR
ON DAY OF SUR
There is substantial evidence that a high consumption of sugar-sweetened beverages is linked with
weight gain and obesity, increased risk of diabetes and heart disease, and poor dental health.
Obesity
There is evidence that a high intake of sugar-sweetened
beverages is associated with an increase in body weight and
obesity in both adults and children.10,11 This is supported by
research commissioned by the World Health Organization
since the review of literature undertaken for the National
Health and Medical Research Centre’s (NHMRC) Australian
Dietary Guidelines in
2011.12-14 For example, one review concluded that people
who increased the added sugars in their diet (in drinks and in
other forms) tended to gain weight, while those who reduced
the added sugars tended to lose weight.13 It has been
estimated that sugar-sweetened beverages accounted for
at least one-fifth of the weight gained between 1977 and
2007 in the US population.14
EVIDENCE
GROWING:
HIGHER
CONSUMPTION OF
HEALTH
PROBLEMS
Consideration of research on this issue needs to be mindful
of both the quality and rigour of the evidence and the potential conflicts of interest arising from
industry funding, as assessments have shown the conclusions of reviews may be influenced by the
source of funding.15,16
EVIDENCE
GROWING
: HIGHER
CONSUMPTION OF
Poor nutrition
Most sugar-sweetened beverages are said to contain ‘empty calories’ – that is, they have little to
no nutrient value. In some cases, it appears they replace healthier food choices and leave those
who drink an excessive amount of sugar-sweetened beverages with a reduced intake of the
nutrients they require. For example, a high intake of soft drinks is associated with lower intakes
of vitamins, minerals and dietary fibre.17-19 In children, soft drinks can replace milk.20, 21 and be
associated with poor intake of protein, calcium, magnesium, phosphorus and Vitamin A which
has potential to impact the health and development of children.22
4
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
HEAL
PROBL
TOP 10
IS NOW A
CONSUMER OF
Dental caries and tooth erosion
Evidence has consistently shown that the
high acidity of many sugar-sweetened drinks,
particularly soft drinks and sports drinks, can
be a factor in dental erosion, as well as the
sugar itself contributing to tooth decay.23, 24
A recent study of 16,500 Australian school
children found that higher consumption of
sugar-sweetened beverages was associated
with children having more dental disease in
both the deciduous and permanent teeth.25
The Australian Dental Association discourages
the frequent consumption of soft drinks, diet
soft drinks, sports drinks and fruit juices due
to their high sugar content and/or acidity,
while not defining frequent.26
16,500 AUSTRALIAN
SCHOOL KIDS
HIGHER
CONSUMPTION
MORE DENTAL
DISEASE
Other health conditions
+
People who drink sugar-sweetened beverages are more likely than others to have:
16,500 AUSTRALIAN
• a greater risk of developing diabetes27
SCHOOL KIDS
HIGHER
CONSUMPTION
• chronic conditions such as cardiovascular disease, high blood pressure and metabolic syndrome 28,29
• bone fractures, low bone density and osteoporosis30
=
Some sugar-sweetened beverages contain caffeine. This creates additional but complementary
health issues as caffeine intake is associated with kidney stones in adults, and with poor sleep,
bedwetting and anxiety in younger children.31
1999
45
LITRES
1969
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
5
DISEASE
+
16,500 AUSTRALIAN
=
HIGHER
CONSUMPTION
MORE
DENTAL
SCHOOL KIDS
DISEASE
CONSUMPTION OF
LITRES
SUGAR-SWEETENED BEVERAGES
120
PER CAPITA CONSUMPTION
It is difficult to present a clear picture of the dietary patterns of Australians as dietary intake data
have not been collected in a systematic or consistent manner within Australia.
1969
1969
1999
120
LITRES
LITRES
45
45
1999
LITRES
Published national data on consumption of sugar sweetened beverages for Australian adults is
almost 20 years old, although data from the 2011-12 Australian National Nutrition and Physical
Activity Survey is to be released in Mid 2014. The most recent published data come from the
2007 Australian National Children’s Nutrition and Physical Activity Survey32, a small number of
state-based surveys, a survey by Food Standards Australia New Zealand in 200333, local research
studies, and by extrapolating from selectedPER
industry
and market research data.
CAPITA CONSUMPTION
Even when all the data are combined, the level of confidence around the measure of sugarsweetened beverage consumption remains low and our understanding of recent trends in
consumption is limited, particularly among adults.
Market research data
1997:
2011:
23% market for sugar-sweetened
We do know that in international terms, Australia is aDIET
substantial
beverages. Australia is in the top 10 nations for per capita 77%
sales of soft drinks34 and in the
top five nations for per capita purchase of Coca Cola products.35
120
DIET
33%
Annual sales of soft drinks have increased substantially over
the past five decades, with apparent
66%
consumption increasing from 45 litres per capita in 1969 to 120 litres per capita in 1999.36
Market research finds that total sugar sweetened LITRES
beverages sales continue to increase,
PER CAPITA CONSUMPTION
although at a slower rate, and the types of drinks being consumed is changing.
1999
LITRES
1969
45
23%
77%
2011:
1.6 BILLION
LITRES
PER CAPITA CONSUMPTION
DIET
33%
66%
120
LITRES
1997:
DIET
It appears that the sales of diet soft drinks have increased, from 23% of the soft drink market in
OFsales
SOFT
DRINK
1997 to 33% in 2011. At the same time
of sugar-sweetened
soft drinks are increasing less
quickly suggesting per capita consumption of sugar sweetened versions may be stable or declining
slightly.37-40 However, sugar sweetened beverages sales remain at very high levels.
THAT’S 75 LITRES
Projected data from supermarket sales provided
by the beverage industry suggest that 1,627,701,086
7.6KG
DIETSUGAR
23%
2,485KJ
ENERGY
litres of sugar sweetened beverages were sold
in Australia
in 2011 and this excludes cordials,
77%
PER
to PERSON
around 75 litres sold each year for every adult and
fruit drinks and sweetened milk.40 This equates
DIET
child in Australia which would contribute 7.6 kg sugar
per
year or 2,485 kj per week to their diet.
33%
SOLD IN 2011
1997:
2011:
1.6 BILLION
1997:
66%
LITRES OF SOFT DRINK WAS SOLD
IN AUSTRALIA 2011
2011:
DIET
23%
33%
THAT’S 75 LITRES 7.6KG
SUGAR
2,485KJ
PER
PERSON
77%
66%
EACH YEAR
EACH YEAR
PER WEEK
6
DIET
1.6 BILLION
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
Adults’ consumption of sugar-sweetened beverages
National survey data from 1995 indicate that sugar sweetened beverage consumption by adults
varies significantly with age.41 The highest consumers of soft drinks were males aged 19–24,
with 58% consuming an average of 800 ml per day on the day of the survey. The next highest
consumers were males aged 25–44, with 34% consuming an average of 642 ml, and females
aged 19–24, with 36% consuming an average of 562 ml. The ‘percentage consuming’ and
‘amounts consumed’ decreased with increasing age among adult males and females (Figure 1).
Similar patterns emerge from the 2009-2010 Victorian Health Monitor Survey. Forty-three percent
of adults reported consuming soft drinks regularly, 47% fruit juices and fruit drinks regularly,
12% cordial regularly, and 4% reported consuming sports or energy drinks regularly. Similarly,
males drank more sugar-sweetened beverages than females, and consumption among adults
declined with age.42
Recent data from NSW indicate that 30% of adults report consuming more than 6 cups per week
(with 15% consuming 11 or more cups a week) of sugar sweetened beverages. About half of
adults never or rarely consume soft drinks, cordials or sports drinks.43
FIGURE 1: SUGAR-SWEETENED SOFT DRINK (ML/DAY) CONSUMPTION BY ADULTS, BY AGE AND SEX
900
VOLUME CONSUMED (mL)
800
700
600
500
400
300
200
100
0
MALE
FEMALE
19-24
MALE
FEMALE
25-44
AGE GROUP (YEARS)
MALE
FEMALE
45-64
— PER CAPITA
MALE
FEMALE
65+
— PER CONSUMER
Source: Data from the 1995 National Nutrition Survey (39): analysis Public Health Nutrition Group, Boden Institute, University of Sydney.
45
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
40
7
900
Children’s 800
consumption of sugar-sweetened beverages
VOLUME CONSUMED (mL)
700is available on the food and beverage intake of Australian children than for adults
More information
as there have been more recent national and state surveys of children’s diets. The 2007 Australian
600
National Children’s Nutrition and Physical Activity Survey found that sugar-sweetened beverages
make a sizeable
contribution to the overall beverage intake of children.32 In addition, almost half
500
of all children reported drinking fruit juice on the day they were surveyed.32
400
As they grow older, children become more likely to drink soft drinks and sports drinks, while the
300
proportion of children
drinking other drinks remains fairly stable with age. About a third of children
over 9 years reported drinking soft drinks on the day they were surveyed (Figure 2).32
200
Few children regularly drink energy drinks (0.5% of 16-18 year olds) and sports drinks
(3.5% of 14-16100
year olds) (Figure 2).
0
The overall consumption
of softFEMALE
drinks rises
steeply
with age,
in terms
of both
absolute
volume
MALE
MALE
FEMALE
MALE
FEMALE
MALE
FEMALE
and contribution to energy intake. It also rises for fruit juice and sports drinks, while remaining
19-24
25-44
45-64
65+
fairly stable for other drinks, such as cordial, fruit drinks and energy drinks (Figure 3).
AGE GROUP (YEARS)
— PER CAPITA
— PER CONSUMER
FIGURE 2: P
ROPORTION OF CHILDREN CONSUMING SUGAR-SWEETENED BEVERAGES
(%) BY AGE GROUP
45
40
PERCENTAGE
35
30
25
20
15
10
5
0
2-3
AGE GROUP (YEARS)
4-8
9-13
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
14-16
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
Source: Australian National Children’s Nutrition and Physical Activity Survey 2007 – analysed by Public Health Nutrition Group,
Boden Institute, University of Sydney
200
8
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
15
10
5
0
LITRES
OF SOFT DRINK
SOLD IN 2011
2-3
4-8
9-13
14-16
AGE GROUP (YEARS) — SOFT DRINK
— FRUIT JUICE
FIGURE 3: A
VERAGE AMOUNT OF SUGAR-SWEETENED
BEVERAGES
CONSUMED
— FRUIT
DRINK (ML/DAY)
DRINK
— SPORTS
PER CAPITA, BY AGE GROUP ON DAY OF
SURVEY
— CORDIAL
— ENERGY DRINK
THAT’S 75 LITRES
7.6KG SUGAR
2,485KJ ENERGY
PER PERSON
200
ML PER DAY
150
100
50
1.6 BILLION
LITRES OF SOFT DRINK WAS SOLD
0
-50
2-3
IN AUSTRALIA 2011
4-8
9-13
14-16
T’S 75 LITRES 7.6KG SUGAR 2,485KJ PER PERSON
AGE GROUP (YEARS)
EACH YEAR
EACH YEAR
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
PER WEEK
Source: Australian National Children’s Nutrition and Physical Activity Survey 2007 – analysed by Public Health Nutrition Group,
Boden Institute, University of Sydney
700
600
ML PER DAY
500
400
300
200
100
0
1/3 OVER AGE 9
OF CHILDREN
HAD A SOFT DRINK
ON DAY OF SURVEY
2-3
4-8
AGE GROUP (YEARS)
9-13
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
14-16
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
* Regularly = on day of survey
OF CHILDREN
16
HAD A SOFT DR
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
9
10
5
0
2-3
AGE GROUP (YEARS)
4-8
9-13
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
14-16
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
How much sugar-sweetened beverages do children drink?
Most state and national surveys show that half of all children report consuming sugar-sweetened
beverages regularly. An examination of the pattern of consumption among those children who
report consuming sugar-sweetened beverages (rather than by all children within in the 2007
200 Children’s Nutrition and Physical Activity Survey32 reveals interesting patterns.
Australian National
ML PER DAY
Sports drinks are consumed by only 2% of all children, but those who do consume them,
150
have a large amount each day – more than 600 ml among children older than 9 (Figure 4).
Also of concern100
is the consumption of sugar-sweetened beverages by 2-3 year olds. On the day
of the Australian National Children’s Nutrition and Physical Activity Survey in 2007, soft drinks were
consumed by about 10% of 2–3 year olds, 20% of 4–8 year olds and 33% of those aged 9 and
50
older.32 While few pre-school children consume sports drinks and energy drinks, those who do so,
consume between 200 and 250 ml/day.
0
Also of concern is the disproportionate intake of sugar-sweetened beverages by those aged
14-16. The average daily consumption, for those who consumed them, was 620 ml of sports drink,
-50
570 ml of soft drink and 5602-3
ml of cordial (Figure
ml of milk and
4-8 4). This compares
9-13 with 390 14-16
32
913 ml of water. The average daily intake among those who consumed soft drinks increased
with age, ranging from 204 ml (about two thirds of a can) for 2–3 year olds to 571 ml (about one
AGE GROUP (YEARS) — SOFT DRINK
— FRUIT JUICE
and a half cans) for 14–16 year olds.32
— FRUIT DRINK — SPORTS DRINK
— CORDIAL
— ENERGY DRINK
FIGURE 4: AVERAGE AMOUNT CONSUMED (ML/DAY) PER CONSUMER, BY AGE GROUP
700
600
ML PER DAY
500
400
300
200
100
0
2-3
AGE GROUP (YEARS)
4-8
9-13
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
14-16
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
Source: Australian National Children’s Nutrition and Physical Activity Survey 2007 – analysed by Public Health Nutrition Group,
Boden Institute, University of Sydney
16
10
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
14
-50
2-3
4-8
AGE GROUP (YEARS)
9-13
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
14-16
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
Most surveys find that in young children, boys and girls consume similar amounts of soft drinks.
From the age of 12, consumption increases significantly and males consume more soft drinks
than females.
700
Contribution
600 to energy intake
ML PER DAY
In the 2007 Australian National Children’s Nutrition and Physical Activity Survey, total sugar500
sweetened drinks (which include soft drinks, cordials, fruit drinks, flavoured milks, made up
beverages, sports
400and energy drinks together with fruit juices) contributed, on average, 4.8%
of the overall energy intake of 2-3 year olds and 8.9% for 14-16 year old children. Among the
300
younger children
fruit juice made the largest contribution to energy intake from beverages,
while soft drinks
made
the greatest contribution to energy intake in older children.32
200
However, sugar-sweetened beverages make an even greater contribution to the energy intake
100
of those who consume them. Flavoured milk, fruit juices and fruit drinks each contribute 10-15%
of the energy intake
0 of those who drink them. Soft drinks, energy drinks and sports drinks each
contribute 5-10% of the energy
is a substantial
2-3 intake of those
4-8who drink them
9-13(Figure 5). That
14-16
contribution to energy intake at a time when childhood obesity is a pressing issue.
AGE GROUP (YEARS)
— SOFT DRINK
— FRUIT DRINK
— CORDIAL
— FRUIT JUICE
— SPORTS DRINK
— ENERGY DRINK
FIGURE 5: CONTRIBUTION TO ENERGY INTAKE (%) IN CHILDREN BY CONSUMER. BY AGE GROUPS
16
14
ENERGEY INTAKE (%)
12
10
8
6
4
2
0
2-3
4-8
AGE GROUP (YEARS)
9-13
14-16
— FRUIT JUICE
— SOFT DRINK
— ENERGY DRINK — SPORTS DRINK
— FLAVOURED MILK
Source: Australian National Children’s Nutrition and Physical Activity Survey 2007 – analysed by Public Health Nutrition Group,
Boden Institute, University of Sydney
80
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
11
14
ENERGEY INTAKE (%)
12
10
8
6
4
Trends in consumption of sugar-sweetened beverages
2
Because of the lack of regular national surveys, data to measure changes over time for sugar
0
sweetened beverage consumption in adults is not available and is limited in children. However,
2-3
4-8
9-13
14-16
available data suggests there may have been a small reduction in consumption of sugarsweetened beveragesAGE
in recent
years
by women—but
not DRINK
by men, at least
in NSW.
This is implied
GROUP
(YEARS)
SOFT
— FRUIT
JUICE
by an increase in the proportion of women meeting
a
target
of
drinking
less
than
2
cups per week
— ENERGY DRINK — SPORTS DRINK
43
FLAVOURED
of soft drink, cordial and sports drink per week. —There
has beenMILK
no change in men (Figure 6).
FIGURE 6: PROPORTION OF ADULTS (%) CONSUMING 2 OR FEWER CUPS OF SOFT DRINK,
CORDIAL AND SPORTS DRINK PER WEEK IN NSW, 2006-2010
80
ADULT POPULATION (%)
70
60
50
40
30
20
10
0
2006
2007
AGE GROUP (YEARS)
2008
— MEN
2009
2010
— WOMEN
Source: Data from NSW Population Health Surveys – NSW Health. Analysed by Public Health Nutrition Group, Boden Institute, University of Sydney
The consumption of sugar-sweetened beverages by children appears to have declined between
the 1995 and 2007 national surveys, although the decline is likely to be overstated for a number
of reasons, including
600 that the 2007 survey was carried out in autumn and winter, when soft drink
consumption is lower, while the 1995 survey was carried out throughout the year.41
VOLUME (ML)
500
This apparent decline
is most pronounced in younger children, although it occurs across
all ages (Figure 7).
12
400
300
200
EVIDENCE BRIEF
100- OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
ADULT POPULATION (%)
70
60
50 2007 consumption of fruit juice remained fairly stable while that of fruit drink
Between 1995 and
and cordial appears to have declined. Reported consumption of soft drinks declined, especially
40
in younger age groups. Consumption of sports and energy drinks increased from a low base,
32,41
especially in children
30 over 9 years.
However among those who consumed sugar-sweetened beverages, the individual intake
20
consumed remained stable.32,41 This suggests that fewer children are consuming sugar-sweetened
beverages each 10
day, but may also reflect a change in the way parents report the intake of their
children in response to growing health warnings about sugar-sweetened beverages.
0
A reduction in the frequency
of consumption
drink was also
recorded in2010
the WA Child and
2006
2007 of soft 2008
2009
44
Adolescent Physical Activity and Nutrition Survey between 2003 and 2008. However, in an ACT
AGE GROUP
— MEN
— WOMEN
survey of year 6 schoolchildren,
the(YEARS)
number of times
that children
reported usually consuming
Coca-Cola and other sugar drinks was unchanged between 2006 and 2009.45
FIGURE 7: CHILDREN’S CONSUMPTION (ML/DAY) OF SUGAR-SWEETENED BEVERAGES IN 1995 AND 2007
600
VOLUME (ML)
500
400
300
200
100
0
1995
2007
2-3
AGE (YEARS)
1995
2007
4-8
1995
2007
9-13
1995
14-16
— SPORTS/ENERGY DRINKS
— SOFT DRINKS
— CORDIAL
— FRUIT DRINK
— FRUIT JUICE
Source: 1995 National Nutrition Survey and 2007 Children’s Survey – analysed by Public Health Nutrition Group, Boden Institute, University of Sydney
60
OMEN (%)
TYPE OF GRAPH NOT CONSISTENT WITH OTHER STYLES
80
50
40
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
13
VOLUME (ML)
500
400
300
200
FACTORS
AFFECTING CONSUMPTION
100
Socioeconomic
status
Evidence from a number
of different surveys shows a clear socioeconomic gradient in the
0
1995
2007
1995
2007
1995
consumption of sugar-sweetened
beverages,
particularly
soft1995
drinks, 2007
with the most
disadvantaged
2-3
4-8
9-13
14-16
groups drinking more.32,46,47
AGEof(YEARS)
— SPORTS/ENERGY
For example, one survey
women in Western
Sydney foundDRINKS
that those with less formal education
SOFT
DRINKS
were far more likely to drink soft drinks —
than
those
with university degrees (56% v 13%) Figure 8.48
— CORDIAL
— FRUIT DRINK
— FRUIT JUICE
FIGURE 8: PROPORTION (%) OF WOMEN DRINKING SOFT DRINKS, BY EDUCATION
PROPORTION OF WOMEN (%)
60
50
40
30
20
10
0
UNIVERSITY
HSC/TAFE
NOT HSC
EDUCATION LEVEL
Source: Wen et al. 2010
There was also a strong social gradient in reported soft drink consumption within the 2010 National
Secondary Students’ Diet and Physical Activity survey.49
Another survey of adolescents found that the availability of sugar-sweetened beverages at
home varied among socioeconomic groups, with children of mothers with less educational
qualifications having easier access to sugar-sweetened beverages than children of better
educated mothers.50
14
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
Cultural background
There is some variation in sugar-sweetened beverage consumption according to cultural background.
According to one phone survey, adolescents and young adults of Aboriginal and Torres Strait Islander
backgrounds drink more sugar-sweetened beverages than their non-Indigenous peers.
The proportion consuming sugar-sweetened beverages was higher (72% v 50%) and the volume
per consumer per day was 249 ml compared with 128ml in non-indigenous young people.33
In the NSW Schools Physical Activity and Nutrition Survey, there was a tendency for older children
of Middle Eastern background to have more soft drinks, and children of Asian backgrounds fewer.47
Availability of soft drinks
A large proportion of sugar sweetened beverages are purchased for consumption in the home but
their availability in other venues also influences consumption. A breakdown of the soft drink market
in the USA showed that 48% of all soft drinks consumed are bought in supermarkets,
20% in restaurants, fast food outlets and bars, 12% in convenience store and service stations
and 11% through vending machines.51
A survey of parents as part of the 2007 Australian National Children’s Nutrition and Physical Activity
Survey found that most soft drink consumed by young children is bought from supermarkets,
with about 17% bought from school canteens and fast food outlets.52 About 60% of soft drink is
consumed at home.52
THE STRONGEST PREDICTOR OF THE LEVEL OF SOFT
DRINK CONSUMPTION AMONG NSW SCHOOL
CHILDREN WAS ITS AVAILABILITY WITHIN THE HOME
The strongest predictor of the level of soft drink consumption among NSW schoolchildren was its
availability within the home.53
There is also strong evidence that indicates that larger serving sizes of sugar sweetened beverages
can promote overconsumption.54
Personal and parenting factors
Children’s consumption patterns are influenced by significant others, and children are more likely
to drink soft drink regularly if:
• their parents drink it
• their friends drink it
• they watch a lot of TV55
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
15
HOW CAN CONSUMPTION OF
SUGAR-SWEETENED BEVERAGES BE REDUCED?
Reducing consumption of sugar-sweetened beverages is likely to contribute to a reduction in
ill-health and a reduction in obesity. This could be achieved at limited cost to the community
and, in terms of dietary behaviour change, is one of the more straight-forward issues to tackle.
Sugar-sweetened beverages such as soft drinks, cordials and sports drinks are easy to identify
and define; they do not constitute an integral part of a meal; consumption requires a conscious
decision; and there are direct substitutes. These drinks are of limited nutritional value and there
is general acceptance by health professionals of the value of reducing their consumption. As well,
measures to reduce the consumption of sugar-sweetened beverages can be relatively inexpensive.
It is possible to reduce the intake of sugar-sweetened beverages, and reducing consumption
can lead to weight loss.56
Strategies to reduce consumption which are currently being explored by national and international
health agencies and organisations include:
• Decreasing demand for sugar-sweetened beverages
- limiting the marketing of sugar-sweetened beverages to children
-increasing the price of sugar-sweetened beverages and reducing the price of
healthier alternatives
•Tackling the widespread availability of sugar sweetened beverages and improving access
to more appropriate alternatives
- reducing or restricting the serving size of sugar-sweetened beverages
-reducing or limiting the availability of sugar-sweetened beverages in the home, in schools
and in community settings
-improving access to and availability of alternatives to sugar-sweetened beverages such
as water and low fat milk
•Providing targeted information and education for the public around the problems of consuming
sugar-sweetened beverages and how to reduce intake
-providing clear guidance on the volume of sugar-sweetened beverages which would be
acceptable within a healthy diet
- encouraging people to replace sugar-sweetened beverages with water
-encouraging health professionals to raise the issue of sugar-sweetened beverages as part
of routine interactions when indicated
16
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
WHAT WE NEED TO
UNDERSTAND BETTER
The evidence base around the problems of sugar sweetened beverages consumption is strong.
As more research and evidence is accumulated, additional effective strategies for community-wide
action will also become clearer. Research into a wider range of effective strategies to help reduce
the consumption of sugar-sweetened beverages should be further supported.
What is apparent, however, is that Australia needs dietary and nutritional surveys of both adults
and children to be carried out more regularly. Without this, policymakers will formulate policy based
on limited evidence or may fail to formulate any influential policy action.
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
17
CONCLUSION
There is overwhelming evidence that the high consumption of sugar-sweetened beverages
represents a significant nutritional problem within Australia and that action to reduce their
consumption is warranted.
Sugar sweetened beverages make a relatively large contribution to the energy intake of many
Australians. They are discretionary beverages which supply little or no nutrition while being
energy dense.
THERE IS A GROWING BODY OF EVIDENCE THAT
LINKS HIGHER LEVELS OF CONSUMPTION OF
SUGAR-SWEETENED BEVERAGES WITH A RANGE
OF HEALTH PROBLEMS
There is a growing body of evidence that links higher levels of consumption of sugar-sweetened
beverages with a range of health problems. A number of recent, comprehensive reviews
have shown that higher levels of consumption of sugar-sweetened beverages are associated
with weight gain and the development of obesity. Higher levels of sugar sweetened beverage
consumption (especially soft drinks) have also been linked to a range of other conditions such
as type 2 diabetes, cardiovascular disease, metabolic syndrome, osteoporosis and dental caries.
Sugar-sweetened beverages also displace healthier foods and drinks from the diet.
Currently there is no specific guidance for the community on how much sugar-sweetened
beverages could be consumed without negative health consequences and what proportion
of total energy intake they could contribute. However, expert consensus suggests consumption
should be limited.
The lack of regular national large scale dietary intake surveys makes it difficult to accurately
determine the consumption of sugar-sweetened beverages in Australia. Nonetheless, it is possible
to gain an understanding of current sugar-sweetened beverage consumption patterns and trends
by examining a wide range of information.
Australians are high consumers of sugar-sweetened beverages such as soft drink both at an
individual and population level. Around half of all Australians consume soft drinks and other sugarsweetened beverages regularly and, on a per capita basis, we are among the top 10 consuming
nations in the world. Consumption levels have increased dramatically over the past five decades
and remain high although there is some indication that they may be levelling off or declining slightly,
especially in children.
18
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
0
AL
OF
In general, males consume more sugar-sweetened beverages than females at every age and
adolescents and young adults have the highest levels of consumption of sugar-sweetened
beverages. The mean average intake of soft drink among adolescent consumers reported on the
day of the 2007 Australian National Children’s Nutrition and Physical Activity Survey was close to
600 ml, and sugar-sweetened beverages contributed, on average, 8.9% of the total energy intake
of this age group.32
There are social variations in consumption patterns. Consumption of soft drinks is highest among
the most socio-economically disadvantaged adults, some ethnic groups and is substantially higher
among Aboriginal and Torres Strait Islander people.
There is sufficient evidence of the potential benefits of reducing sugar-sweetened beverage
consumption to warrant action on this issue, and many health agencies throughout the world have
made specific recommendations around limiting sugar-sweetened beverage intake. A range of
strategies have been proposed by national and international health agencies and organisations
which should be explored and evaluated.
OBAL
SUMER OF
IAN
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
19
REFERENCES
REFERENCES
1. Watson WL, Chapman K, King L, Kelly B, Hughes C, Yu Louie JC, et al. How well do
Australian shoppers understand energy terms on food labels? Public health nutrition. 2013
Mar;16(3):409-17. PubMed PMID: 22464021. Epub 2012/04/03. eng.
2. Campbell SM. Hydration needs throughout the lifespan. Journal of the American College of
Nutrition. 2007 Oct;26(5 Suppl):585S-7S. PubMed PMID: 17921469. Epub 2007/10/27. eng.
7. Popkin BM, Armstrong LE, Bray GM, Caballero B, Frei B, Willett WC. A new proposed
guidance system for beverage consumption in the United States. The American journal of
clinical nutrition. 2006 Mar; 83(3):529-42. PubMed PMID: 16522898. Epub 2006/03/09. eng.
9. Wilde A, Gill T, Swinburn B. The Communication on Obesity Action for Child Health (COACH)
Reference Group – Effective Communication on childhood obesity prevention by nongovernment organisations and agencies – Statement on developing consistent, clear and
evidence-based messages. 2007.
3. US Department of Health and Human Services. Rethink your drink. Centers for Disease Control
and Prevention; [December 17 2013]. Available from: http://www.cdc.gov/nccdphp/dnpa/
nutrition/pdf/rethink_your_drink.pdf
4. UK National Institute for Health and Clinical Excellence. Obesity: Guidance on the prevention,
identification, assessment and management of overweight and obesity in adults and children.
London: NICE, 2010.
6. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra:
National Health and Medical Research Council, 2013.
8. World Health Organization Nutrition Guidance Expert Advisory Group (NUGAG) Draft Guideline:
Sugars intake for adults and children. Geneva, WHO, 2014.
5. Health Canada. Eating Well with Canada’s Food Guide. Government of Canada; 2011.
Available from: http://publications.gc.ca/pub?id=402429&sl=0
10. Joint WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of Chronic Diseases.
Geneva: World Health Organisation, 2003.
11. United States Department of Agriculture. Nutrition Evidence Library: Evidence-based
systematic reviews to inform Federal nutrition policy and programs [November 2013].
Available from: http://www.nel.gov/conclusion.cfm?conclusion_statement_id=250271
12. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children
and adults: a systematic review and meta-analysis. The American journal of clinical nutrition.
2013 October 1, 2013.
13. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and
meta-analyses of randomised controlled trials and cohort studies. BMJ (Clinical research ed).
2013;346:e7492. PubMed PMID: 23321486.
14. Woodward-Lopez G, Kao J, Ritchie L. To what extent have sweetened beverages contributed
to the obesity epidemic? Public health nutrition. 2011 Mar;14(3):499-509. PubMed PMID:
20860886. Epub 2010/09/24. eng.
15. Bes-Rastrollo M, Schuze M, Ruiz-Canela, Martinez-Gonzalez M. Evidence about sugarsweetened beverages and weight gain: is the potential financial conflicts of interest biasing the
conclusions?: a systematic review. Annals of Nutrition & Metabolism. 2013;63(Suppl 1):185.
16. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition
and health: a systematic review and meta-analysis. American journal of public health. 2007
Apr;97(4):667-75. PubMed PMID: 17329656. Pubmed Central PMCID: PMC1829363.
Epub 2007/03/03. eng.
20
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
REFERENCES
17. Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents:
nutritional consequences. Journal of the American Dietetic Association. 1999 Apr;99(4):436-41.
PubMed PMID: 10207395. Epub 1999/04/20. eng.
18. Ballew C, Kuester S, Gillespie C. Beverage choices affect adequacy of children’s nutrient
intakes. Archives of pediatrics & adolescent medicine. 2000 Nov;154(11):1148-52. PubMed
PMID: 11074858. Epub 2000/11/14. eng.
19. Marshall TA, Eichenberger Gilmore JM, Broffitt B, Stumbo PJ, Levy SM. Diet quality in young
children is influenced by beverage consumption. Journal of the American College of Nutrition.
2005 Feb;24(1):65-75. PubMed PMID: 15670987. Epub 2005/01/27. eng.
20.Cook T, Rutishauser I, Seelig M. Comparable data on food and nutrient intake and physical
measurements from the 1983, 1985 and 1995 national nutrition surveys. Canberra: Australian
Food and Nutrition Monitoring Unit, 2001.
22.Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink
consumption in 6- to 13-year-old children. The Journal of pediatrics. 2003 Jun;142(6):604-10.
PubMed PMID: 12838186. Epub 2003/07/03. eng.
22.Guenther PM. Beverages in the diets of American teenagers. Journal of the American Dietetic
Association. 1986 Apr;86(4):493-9. PubMed PMID: 3958400. Epub 1986/04/01. eng.
23.Al-Dlaigan YH, Shaw L, Smith A. Dental erosion in a group of British 14-year-old, school
children. Part I: Prevalence and influence of differing socioeconomic backgrounds. British
dental journal. 2001 Feb 10;190(3):145-9. PubMed PMID: 11236918. Epub 2001/03/10. eng.
24.Sohn W, Burt BA, Sowers MR. Carbonated soft drinks and dental caries in the primary
dentition. Journal of dental research. 2006 Mar;85(3):262-6. PubMed PMID: 16498075.
Epub 2006/02/25. eng.
25.Armfield JM, Spencer AJ, Roberts-Thomson KF, Plastow K. Water fluoridation and the
association of sugar-sweetened beverage consumption and dental caries in Australian children.
American journal of public health. 2013 Mar;103(3):494-500. PubMed PMID: 23327241.
Epub 2013/01/19. eng.
26.Australian Dental Association. Policy Statement 1.2. 2— Diet and Nutrition 2007.
[28th August 2007].
30.Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP. Colas, but not other
carbonated beverages, are associated with low bone mineral density in older women:
The Framingham Osteoporosis Study. The American journal of clinical nutrition. 2006
Oct;84(4):936-42. PubMed PMID: 17023723. Epub 2006/10/07. eng.
28.Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, et al. Soft drink consumption
and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged
adults in the community. Circulation. 2007 Jul 31;116(5):480-8. PubMed PMID: 17646581.
Epub 2007/07/25. eng.
29.Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage
consumption and risk of coronary heart disease in women. The American journal of clinical
nutrition. 2009 Apr;89(4):1037-42. PubMed PMID: 19211821. Pubmed Central PMCID:
PMC2667454. Epub 2009/02/13. eng.
27.Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages
and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes care. 2010
Nov;33(11):2477-83. PubMed PMID: 20693348. Pubmed Central PMCID: PMC2963518.
Epub 2010/08/10. eng.
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
21
REFERENCES
31.Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of
symptoms and signs, incidence, severity, and associated features. Psychopharmacology. 2004
Oct;176(1):1-29. PubMed PMID: 15448977. Epub 2004/09/28. eng.
32.Analysis by PHN from Boden Institute University of Sydney. The 2007 National Children’s
Nutrition and Physical Activity Survey The Australian National University: Australian social
science data archive; 2009 [August 2009]. Available from: http://www.assda.edu.au/.
33.Food Standards Australia New Zealand. Consumption of intense sweeteners in Australia and
New Zealand - Roy Morgan Research Report. Canberra: Food Standards Australia
New Zealand, 2003.
34.Euromonitor International. Euromonitor International: Country Sector Briefing - Carbonates Australia. Chicago: Euromonitor International Inc, 2006.
35.The Coca Cola Company. 2010 Annual review: Advancing our global momentum. Atlanta:
International Coca Cola Company, 2010.
36.Commonwealth Department of Health and Aged Care, Australian Institute of Health and
Welfare. National Health Priority Areas Report: Cardiovascular health, A report on heart,
stroke and vascular disease. Canberra: Australian Institute of Health and Welfare 1998.
37.Levy G, Tapsell L. Shifts in purchasing patterns of non-alcoholic, water-based beverages
in Australia, 1997–2006. Nutrition & Dietetics. 2007;64(4):268-79.
38.Ibis World. Soft Drink Manufacturing in Australia: Market Research Report: summary
[21 November 2013]. Available from: http://www.ibisworld.com.au/industry/default.
aspx?indid=1859
39.Neilsen. Aussies are spending more on beverages, but drinking less 2013 [November 2013].
Available from: http://www.nielsen.com/au/en/news-insights/press-room/2012/aussies-arespending-more-on-beverages--but-drinking-less.html
40. Levy GS and Shrapnel WS (2014) Quenching Australia’s thirst: a trend analysis of water-based
beverage sales from 1997 to 2011. Nutrition & Dietetics doi: 10.1111/1747-0080.12108
41.Australian Bureau of Statistics. National Nutrition Survey Nutrient Intakes and Physical
Measurements Australia 1995. Canberra: Australian Bureau of Statistics, 1998.
42.Victorian Department of Health. The Victorian Health Monitor Food and Nutrition report.
Melbourne: State Government of Victoria, 2012.
43.NSW Centre for Epidemiology and Research. 2010 Report on Adult Health from the
New South Wales Population Health Survey. Sydney: NSW Department of Health, 2011.
44.Martin K, Rosenberg M, Miller M, French S, McCormack G, Bull F, et al. Move and Munch Final
Report. Trends in physical activity, nutrition and body size in Western Australian children and
adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) 2008.
Perth: Government of Western Australia, 2008.
45.ACT Epidemiology Branch, Health Directorate Population Health Division. The report on the
ACT Year 6 Physical Activity and Nutrition Survey. Canberra: ACT Government, 2012
46.Clifton P, Chan L, Moss C, Miller M, Cobiac L. Beverage intake and obesity in Australian
children. Nutrition & Metabolism. 2011;8(1):87. PubMed PMID: doi:10.1186/1743-7075-8-87.
47.Hardy L. SPANS 2010 - NSW Schools Physical Activity and Nutrition Survey. Sydney:
NSW Ministry of Health, 2011.
48.Wen LM, Flood VM, Simpson JM, Rissel C, Baur LA. Dietary behaviours during pregnancy:
findings from first-time mothers in southwest Sydney, Australia. The international journal
of behavioral nutrition and physical activity. 2010;7:13. PubMed PMID: 20181084.
Pubmed Central PMCID: PMC2830165. Epub 2010/02/26. eng.
22
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
REFERENCES
49.Cancer Council and Heart Foundation of Australia. 2009/10 National Secondary Students’ Diet
and Physical Activity survey; Prevalence of Meeting Healthy Eating Guidelines in Australian
Secondary Students [5 December 2013]. Available from: http://www.cancer.org.au/content/
pdf/CancerControlPolicy/Publications/MediaMaterials/Dietary_habits_research_memo_
NaSSDA_updated.pdf
50.MacFarlane A, Crawford D, Ball K, Savige G, Worsley A. Adolescent home food environments
and socioeconomic position. Asia Pacific journal of clinical nutrition. 2007;16(4):748-56.
PubMed PMID: 18042538. Epub 2007/11/29. eng.
51.National Policy and Legal Analysis Network Prevention of Childhood Obesity Breaking Down
the Chain: A Guide to the soft drink industry. Washington: Public Health Law and Policy, 2011.
52.Hafekost K, Mitrou F, Lawrence D, Zubrick SR. Sugar sweetened beverage consumption by
Australian children: implications for public health strategy. BMC public health. 2011;11:950.
PubMed PMID: 22192774. Pubmed Central PMCID: PMC3260330. Epub 2011/12/24. eng.
53.Denney-Wilson E, Crawford D, Dobbins T, Hardy L, Okely AD. Influences on consumption
of soft drinks and fast foods in adolescents. Asia Pacific journal of clinical nutrition.
2009;18(3):447-52. PubMed PMID: 19786394. Epub 2009/09/30. eng.
55.Grimm GC, Harnack L, Story M. Factors associated with soft drink consumption in schoolaged children. Journal of the American Dietetic Association. 2004 Aug;104(8):1244-9. PubMed
PMID: 15281041. Epub 2004/07/29. eng.
56.Tate DF, Turner-McGrievy G, Lyons E, Stevens J, Erickson K, Polzien K, et al. Replacing caloric
beverages with water or diet beverages for weight loss in adults: main results of the Choose
Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. The American
journal of clinical nutrition. 2012;95(3):555-63.
54.Steenhuis, IH and Vermeer, WM. Portion size. Review and framework for interventions.
International Journal of Behavioral Nutrition and Physical Activity, 2009; 6:58
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
23
NOTES
24
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
NOTES
EVIDENCE BRIEF - OBESITY: SUGAR-SWEETENED BEVERAGES, OBESITY AND HEALTH
25
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