A Trial of Sugar-Free or Sugar-Sweetened Beverages and Body Weight in Children

Study Questions:

Does replacement of sugar-containing beverages with noncaloric beverages affect weight and adiposity among normal-weight children?


The investigators enrolled normal-weight children (ages 4 years, 10 months to 11 years, 11 months) in an 18-month trial. Participants were randomly assigned to one of two groups. A double-blind randomized study design was used, with one group receiving a 250 ml (8 oz) per day sugar-free artificially sweetened beverage, and the other group receiving a 250 ml beverage containing sugar, which provided 104 kcal/drink. Participating children received a box at school that contained canned drinks, one for each day of the week with one spare. Drinks were consumed during the morning school break and then at home during weekends and holidays. Body weight, height, skinfold thickness, waist circumference, and arm to leg electrical impedance were collected at baseline, and 6, 12, and 18 months. Body mass index (BMI) z score was the primary outcome of interest. Urinary sucralose levels were measured to assess adherence.


A total of 641 children were included in this trial. At baseline, children consumed an average of 1.02 ± 20 sugar-containing beverages in the classroom at the 10 a.m. break, and 1.50 ± 1.40 sugar-containing beverages during the weekends. BMI z score increased significantly more over the 18-month trial among the children randomized to the sugar-containing drink (0.15 ± 1.06 standard deviation [SD] vs. 0.02 ± 0.41 SD, p = 0.001). Weight also increased more in the group randomized to sugar-containing drinks compared to those randomized to the sugar-free drinks (7.37 ± 3.35 kg vs. 6.35 ± 3.07 kg, p < 0.0001). Secondary endpoints including skinfold thickness, fat mass, and waist-to-height ratio increased to a significantly lesser degree among children randomized to the sugar-free drinks compared to children receiving the sugar-containing drinks.


The investigators concluded that replacement of sugar-containing beverages with sugar-free beverages can reduce weight gain and fat accumulation among normal-weight children.


The investigators conducted a well-designed trial to examine the effects of substituting sugar-free beverages for sugar-containing beverages. Significant benefits in weight and fat mass were observed. Generalization to children in other countries would be of interest. If the consumption of sugar-containing beverages is higher among children in the United States, the potential for significant reductions in weight and fat mass may have significant public health implications.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD and Pediatrics and Prevention

Keywords: Child, Skinfold Thickness, Waist Circumference, Body Mass Index, Sucrose, Electric Impedance, Sweetening Agents, Body Weight, Adiposity, Beverages, Weight Gain, Holidays

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