Beverages - the Science

Sigrid GibsonDirector, Sig-Nurture Ltd.

Nutrition Consultants

BEVERAGES

Risks and opportunities: the science

JUICES AND 5-A-DAY

OTHER ingredients

SUGAR(S) &

OBESITY

HEALTHY OR

UNHEALTHY?

BEVERAGES

DIET QUALITY

Fact or myth?

• Only water hydrates you

• Soft drinks are the major source of sugar in the diet

• Soft drinks cause obesity and diabetes

• Low calorie beverages make you crave sweet foods

• Free sugars are worse than other sugars for tooth decay

• Fruit juice discourages fruit intake

•EFSA adequate intake • 2L for women • 2.5L for men

Median UK intakes are 2-2.5L

• US Reference intake is 3.2/ 3.7L…

Hydration: Are we getting enough liquid?

Hydration: Are we getting enough liquid?We don’t really know!- some people are under-hydrated, some of the time

elderly people heavy labourers workers with limited access to loos

Thirst is our regulator of dehydration but not overconsumption

All beverages hydrate – some better than water

Ronald J Maughan et al. Am J Clin Nutr 2016;103:717-723

©2016 by American Society for Nutrition

2 SD above mean for water control

Gibson, S., & Shirreffs, S. M. (2013). Beverage consumption habits “24/7” among British adults: association with total water intake and energy intake. Nutrition Journal, 12, 9. http://doi.org/10.1186/1475-2891-12-9

Amount and types of beverages consumed according to day of the week (mean g/d).

JUICES AND 5-A-DAY

OTHER ingredients

SUGAR(S) &

OBESITY

HEALTHY OR

UNHEALTHY?

BEVERAGES

DIET QUALITY

Beverages, sugar and obesity

Sugar Reduction The evidence for action

1. In adults, when consuming an unrestricted daily diet, increasing the percentage of total energy from sugar leads to increases in energy intake

2. Higher consumption of sugar and sugar containing foods and drinks is associated with a greater risk of dental caries

3. Consumption of sugar sweetened drinks, compared to non-sugar sweetened drinks, results in greater weight gain and increases in body mass index in children and adolescents due to increased energy consumption

4. Greater consumption of sugar sweetened drinks is associated with increased risk of type 2 diabetes

Confirms lower body weight when Low calorie/energy sweeteners replaced sugar in foods and beverages

Low energy beverage studies also showed reduced BW

Most up to date systematic review and meta-analysis

Body weight reduction when consuming Low calorie beverages vs. Sugar-sweetened beverages (Rogers et al. 2015)

Headline versus Study….

New York Daily News - ‘Diet soda is a gateway drug’.Drinkers of the no-calorie beverages are more likely to gorge on sugary, salty and fatty treats like cookies, French fries and pastries than people who drink regular soda, says a new study from the University of Illinois.

Beverage consumption in relation to discretionary food intake and diet quality among US adults 2003 to 2012 Ruopeng, An 2015 JADA

NO CHANGE IN HEALTHY EATING SCORE WITH DIET BEVERAGES

Discretionary foods

Diet beverages consumers ate 69 kcals more , of which 49 kcal was DF

SSB consumers ate 226kcal more of which 30kcal was DF

Coffee drinkers ate 108kcal more of which 60kcal was DF

JUICES AND 5-A-DAY

OTHER ingredients

SUGAR(S) &

OBESITY

HEALTHY OR

UNHEALTHY?

BEVERAGES

DIET QUALITY

NO NO YESYES

DRINK LOW CALORIE BEVERAGES?

NO YES

DRINK SUGAR SWEETENED BEVERAGES?

No soft drinks SSB LCB Both LCB only Both LCB and SSB (BB)SSB onlyNo soft drinks (NC)

Consumption of low calorie beverages is associated with energy and nutrient intakes and diet qualityGibson, Horgan et al. (2016, Nutrients)

• Recent UK data (NDNS 2008-2011)• Detailed 4-day dietary records • 1590 adolescents (16+) and adults • Classified into one of four groups

 Results

Energy intake

LCB and NC had significantly lower energy intakes than SSB and BB (difference of ~ 250kcal)

Free sugars* (NMES)significantly lower in LCB and NC

vs. SSB & BB(9% vs. 14% of energy from NMES)

P<0.0001

P<0.0001

Gibson et al. (2016, Nutrients)

Beverage group

mean consumption (g/d) no soft drinks (NC) LCB only SSB only Both (BB)

598 216 476 300

Total beverages 1679 1807 1821 1850Meat And Meat Products 167 181 193 211Fish 46 42 34 31Fruit 110 105 88 74Vegetables 147 137 129 112Sugary foods (total) 73 71 78 73

(Gibson et al, Nutrients, 2016)

Compared with SSB consumers, adults drinking Low calorie beverages ate more fruit and vegetables and fish, and no more sugary foods

CHOICE trial Does LCB intake affect dietary consumption

patterns?

Overweight adults substituted caloric beverages with either water or LCB for 6months

Both intervention groups showed beneficial changes in energy intakes and dietary patterns.

Consuming LCBs, compared with water, did not increase preferences for sweet foods and beverages

Piernas, Tate et al. 2013

JUICES AND 5-A-DAY

OTHER ingredients

SUGAR(S) &

OBESITY

HEALTHY OR

UNHEALTHY?

BEVERAGES

DIET QUALITY

Crowe- White et al. 2015 Crit Rev Food Sci Nutr Impact of 100% Fruit Juice Consumption on Diet and Weight Status of Children: An Evidence-based Review

22 studies

Fruit Juice

• Evidence did not support an association between 100% FJ consumption and weight/adiposity

• Children consuming 100% FJ have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium(8 studies)

Fruit Juice and 5 a DAY in UK• 42% consumed FJ during the survey.

• Average intake was 58g/d (139g/d among consumers)

• But 35% of consumers drank more than 150ml/day.• • Consumers had higher energy and sugar intakes (13.6 vs.

11.1) than non-consumers.

• Intakes of potassium, folate, and vitamin C were significantly higher among FJ consumers for whom FJ provided more than 10% of folate and potassium and half their vitamin C.

Gibson et al. , in preparation

61% of teenagers and 34% of adults consume less than 3 portions of fruit and vegetables a day

How to help these?

Data extracted from NDNS 2008-2012 Gibson et al., unpublished

Fruit juice contributes to fruit and vegetable consumption

Gibson & Ruxton, unpublished

FJ consumers are less at risk of missing F&V targets

More likely to achieve 5 a dayLess likely to have <3 a day

Teenagers P<0.001 (Chi-Square)

FJ consumers are less at risk of missing F&V targets

More likely to achieve 5 a dayLess likely to have <3 a day

P<0.001 (Chi-Square)

Industry response to sugar targetsReformulation• New product launches • Gradual reduction in some brands • Pack size changes (250ml)

PromotionFocus on low/no sugar Price incentivesWork with cinemas & fast food chains

Labelling: FOP energy and sugars

7%Cals

JUICES AND 5-A-DAY

OTHER ingredients

SUGAR(S) &

OBESITYHEALTHY

OR UNHEALTHY?

BEVERAGES

DIET QUALITY

Other risks/opportunities

Caffeine• EFSA opinion (2015) - 400 mg per day is considered safe for adults

(200mg for pregnant/lactating women). Not enough evidence for a safe limit in children and adolescents.

• 200mg = approx. 2 cups of coffee – (huge variation according to type) or 6 cans of Cola or 4 cans of diet cola or 4 cups of tea.

• Energy drinks can contain around 80 mg in 250ml.

• 12th April EFSA approved 4 health claims for caffeine: • endurance performance, endurance capacity, alertness,

concentration

How much caffeine is in your drinks?

Unauthorised health claims?

• Helps with weight loss

• Super charges your immune system

• Increases energy and endurance

• Enhances mood and memory

• Stimulates metabolism

• Naturally detoxfies

JUICES AND 5-A-DAYSmall amounts OK

OTHER ingredientsCaffeine within limits

Sweeteners all approved

SSB if overconsumed

might encourage excess ENERGY intake and

OBESITY

Low calorie alternatives help manage intake

HEALTHY OR

UNHEALTHY?

BEVERAGES

DIET QUALITY

Depends on beverage and food choice

We all need to drink….............