Changes in water and sugar-containing beverage consumption and body weight outcomes in children

An intervention study showed that promoting water consumption in schoolchildren prevented overweight, but a mechanism linking water consumption to overweight was not substantiated. We investigated whether increased water consumption replaced sugar-containing beverages and whether changes in water or sugar-containing beverages influenced body weight outcomes. In a secondary analysis of the intervention study in Germany, we analysed combined longitudinal data from the intervention and control groups. Body weight and height were measured and beverage consumption was self-reported by a 24-h recall questionnaire at the beginning and end of the school year 2006/2007. The effect of a change in water consumption on change in sugar-containing beverage (soft drinks and juices) consumption, change in BMI (kg/m(2)) and prevalence of overweight and obesity at follow-up was analysed using regression analyses. Of 3220 enroled children, 1987 children (mean age 8.3 (SD 0.7) years) from thirty-two schools were analysed. Increased water consumption by 1 glass/d was associated with a reduced consumption of sugar-containing beverages by 0.12 glasses/d (95% CI -0.16, -0.08) but was not associated with changes in BMI (P = 0.63). Increased consumption of sugar-containing beverages by 1 glass/d was associated with an increased BMI by 0.02 (95% CI 0.00, 0.03) kg/m(2) and increased prevalence of obesity (OR 1.22; 95% CI 1.04, 1.44) but not with overweight (P = 0.83). In conclusion, an increase in water consumption can replace sugar-containing beverages. As sugar-containing beverages were associated with weight gain, this replacement might explain the prevention of obesity through the promotion of water consumption.