Intake of Carbohydrates and Other Changes in Eating Habits

According to data from the third National Health and Nutrition Examination Survey (1988–1994) in the USA, beverages contributed 20–24% of energy across all ages of childhood and adolescence and soft drinks provided 8% of energy in adolescents. Beverage energy contributions and especially soft drink energy contribution were higher among overweight than non overweight adolescents [67]. Data from the 1994 Continuing Survey of Food Intakes by Individuals showed that energy intake was positively associated with consumption of non-diet soft drinks. The mean energy intake was 10% higher for schoolaged children who consumed soft drinks compared to those who did not [70]. Similarly, an increase of the contribution of added sugar in soft drinks to the energy intake was reported in Brazil [69]. The consumption of sugar-sweetened drinks may increase the risk for obesity in children. A prospective study on 12-year-old children in Massachusetts demonstrated that baseline consumption of sugar-sweetened drinks was associated with an increase in BMI, which could not be explained by anthropometric, demographic, dietary, and other lifestyle variables [71]. Changing eating habits are another issue: children take fewer meals at home. This is accompanied by less healthy dietary intake patterns, including less fruits and vegetables, more fried food and soft drinks, more saturated fat and a higher glycemic load [72]. Despite a general decrease of energy intake and a shift from consumption of fat to carbohydrates, there is an increase of ingestion of energy dense food [73] and added sweeteners, especially by consumption of soft drinks, which account for one third of intake of added sweeteners in the USA [74]. This shift in nutrition behavior towards high glycemic index meals could partially be responsible for the development of obesity in the respective risk groups in the USA [75]. The high intake of sugar from soft drinks may not have reached Europe yet. The German DONALD study did not reveal any significant changes in intakes of carbohydrates from beverages, though the total beverage consumption increased, but mainly due to an increased consumption of tap water, mineral water and fruit juice whereas there was no increase in the consumption of sugar sweetened soft drinks [68].