The Nutritional Role of Soft Drinks During Childhood and Adolescence
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Feeding from Toddlers to Adolescence: edited by Angel Ballabriga, Nestle Nutrition Workshop Series, Vol. 37. Nestec Ltd., Vevey/ Lippincott-Raven Publishers, Philadelphia, © 1996. The Nutritional Role of Soft Drinks during Childhood and Adolescence Pierre R. Guesry Nestle Research Centre, Vers-chez-les-Blanc, Lausanne, Switzerland Years ago, children were drinking milk in Scandinavian and Anglo-Saxon countries whereas in Latin countries, they were drinking either plain water or water mixed with a small amount of wine, cider, or syrup. Adolescents were gradually switching to beer, wine, or cider at an age that depended on their type of work and socioeco- nomic class. Nowadays, from north to south, west to east, and independent of their work or socioeconomic class, the great majority of children and adolescents drink soft drinks (1) during meals and between meals. This has caused changes in various nutrient intakes which have important consequences. DEFINITION Soft drinks are ready-to-use drinks, carbonated or uncarbonated, containing sugar or intense sweeteners and neither alcohol nor milk. This definition excludes water, either plain or mineral, even when flavored (but without the addition of sugar or sweeteners), and it excludes beer, cider, wine, and milk. The definition includes "sports drinks," which are increasingly consumed outside sports, and fruit juices, which are often sweetened and mixed with still or sparkling water. CONSUMPTION Most data come from the USA where very extensive surveys were conducted on teenagers in 1977 (2) and again in 1987 (3). Since we can assume that the trends shown in the American studies will hold true for the rest of the world after a lapse of a few years, the 1987 survey may give a good representation of what is happening elsewhere today. For the whole population, the consumption of all soft drinks in the USA was about 200 I/year in 1993,1401 in Mexico, 1101 in Canada, 701 in Argentina, and 601 in Saudi Arabia, with an increase varying from 5% to 30% since 1989 depend- ing on the country (4). The worldwide average consumption of carbonated soft drinks in most African, eastern European, and far eastern countries including India is 10 769 170 NUTRITIONAL ROLE OF SOFT DRINKS TABLE 1. Soft drink consumption by adolescents 12 to 19 years old in the United States in 1987 Carbonated soft drinks (ml/d) Total Coffee and tea Fruit-based drinks (ml/d) (ml/d) (ml/d) Regular Diet Boys 587 114 83 361 29 Girls 490 98 109 215 68 From U.S. Dept. of Agriculture (3). I/year (5) below the international average, and in North American countries, it is far above the international average. Most western European countries, Australia, South Africa, Argentina, Brazil, and Japan are above the international average, and Mexico has the number one per capita consumption in the world, just in front of the USA, at about 120 I/year. For boys from 12 to 19 years of age, the average total consumption (Table 1) of soft drinks in 1987 in the USA was 587 ml/day, carbonated soft drinks representing 390 ml/day, coffee and tea 114 ml/day, and fruit drinks 83 ml/day. For girls in the same survey, the average total daily consumption was only 490 ml/day, carbonated soft drinks representing 283 ml/day, broken down into 215 ml/day of regular and 68 ml/day of low-calorie drinks. The consumption of cold tea increased dramatically in Europe from 259,000 1 in 1989 to 1,296,0001 in 1994. For 1994, the annual per capita consumption varied from 1.2 1 in France to 45 1 in Switzerland. There was more detailed longitudinal information in the 1977 survey, which showed an increase in the consumption of soft drinks during a 3-day period from 40% of the 0- to 4-year-old population to 70% for males in the age range 17-18 years (Fig. 1) (6). There was a small difference of about 5% between males and females in this last age group for naturally sweetened products, and a larger difference of about 10% in favor of females for diet varieties. The average total daily consumption was 128 ml at 0-4 years, 159 ml at 5-6 years, 170 ml at 7-8 years, 222 ml at 11-12 years, 256 ml at 13-14 years, 300 ml at 15-16 years, and 332 ml at 17-18 years (Fig. 2). In the 1987 survey, the values are similar at the younger ages but increased dramatically to 587 ml/day in the 12-19 years age group. In a survey done in 1990-1991 in a college in Michigan (7), 82% of boys were consuming soft drinks, among which 8% were diet varieties, whereas 72% of the girls were consuming soft drinks, 28% of which were diet varieties. In a survey done in Germany in 1992 (Euromonitor, February 1993), 82.6% of 14- to 19-year-olds were consuming soft drinks in western Germany and 78.2% in eastern Germany, suggesting an increasing uniformity of soft drink consumption in the coun- try as a whole. Consumption increased with household income, the opposite of what was observed in USA (2). Soft drink consumption is increasing steadily. In the USA (Fig. 3), the average consumption of all soft drinks in young adults increased between 1977 and 1985 from NUTRITIONAL ROLE OF SOFT DRINKS 171 Males & Females • ••••• Females 70 Males 60 50 •\ regular o ho Q. S 30 _ V\ i 20 10 '.diet 0-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19-24 25-34 35-44 45-54 55-64 65+ Years of Age FIG. 1. Percentage of population, classification by age/sex, consuming soft drinks (regular and artificially sweetened) at least once during 3 surveyed days. (Reproduced from J Am Diet Assoc 1985:85:352-4, with permission.) 763 ml to 1051 ml, and carbonated sodas from 294 ml to 491 ml. In France, it increased from 29 I/year in 1988 to 35 I/year in 1992 for the whole population, and in Japan from 57.6 I/year in 1981 to 93.5 I/year in 1991. More generally, in the European Community, consumption has increased from 183 1 per capita per year in 1989 to 200 1 in 1993. Among the carbonated soft drinks, the most popular all across Europe are the colas, with preferences ranging from 52% in Germany to 84% in Italy; colas are followed by orangeade, varying from 10% in the UK to 49% in Italy, and then by 172 NUTRITIONAL ROLE OF SOFT DRINKS 600 - ml/day '587 500 -• 400 300 t USA 1987 20(1 USA 1977 !• 1976 100 4- I I I I I I I I I I I I 2 4 6 8 10 12 14 16 18 20 years of age FIG. 2. Average daily consumption of soft drinks. 491 500 -j- ml/day 474 400 4- Coll'cc and lea 300 4- 294 l-'ruil based Juices 200 4- Carbonated Soft Drinks 100 87 1977 1985 FIG. 3. Evolution of soft drinks consumption in the USA between 1977 and 1985 in young adults (19-34 years of age). NUTRITIONAL ROLE OF SOFT DRINKS 173 lemonade, from 10% in Italy to 23% in France. Among the fruit-based drinks, orange is by far the most popular everywhere in Europe, followed by apple, tropical fruits, and pineapple. COMPOSITION The average composition of the most commonly consumed soft drinks is summa- rized in Table 2. Among these, colas of various brands usually have a similar composi- tion. The total carbohydrate in regular varieties is around 110 g/1, with 40 g sucrose, 35 g glucose, and 35 g fructose per liter (8). The sodium content ranges from 15 to 50 mg/1, potassium 10 mg/liter, phosphorus 300 mg/liter, and calcium 60 mg/1. Caffeine content is 125 mg/1. pH is low at 2.4 and titrable acidity quite high (10 ml NaOH N/l). There are now varieties in which the carbohydrates are replaced by intense sweeteners, usually aspartame at a concentration of about 400 mg/1. Benzoates and sorbates are allowed and used as preservative agents for carbonated soft drinks. Lemonades are usually less sweet and contain only about 60 g/1 of carbohydrate, half as sucrose and the rest split equally between glucose and fructose. In contrast, Lucozade is sweeter and contains 160 g/1 of CHO, but no sucrose. Unsweetened orange juice contains 81 g/1 of CHO, half as sucrose and the rest as glucose and fructose. It also contains 1.8 g/1 of potassium (9). Unsweetened apple juice contains 100 g/1 of CHO made up of 63% fructose, 26% glucose, and 11% sucrose. Apple juice also contains 1.1 g/1 of potassium. Industrial ready-to-drink teas and coffees contain about 90 g/1 of CHO and 100 to 200 mg/1 of caffeine, respectively, for iced tea and coffee. TABLE 2. Approximate composition of the most commonly consumed soft drinks Sweeteners Sucrose Glucose Fructose Intense Sodium Potassium Phosphorus Caffeine (g/D (g/i) (g/i) (g/i) (mg/l) (mg/l) (mg/l) pH (mg/l) Colas classic 40 35 35 0 15-50 10 300 2.4 125 light 0 0 0 0.4 15-50 10 300 2.4 Lemonades regular 30 15 15 0 15-50 10 light 0 0 0 0.4 15-50 10 Orange juice 40 20 20 0 20 1800 160 4 0 Apple juice 10 30 60 0 20 1100 60 5 0 Iced teas regular 40 25 25 0 0 200 20 120 light 0 0 0 0.4 0 200 20 120 Coffees regular 40 25 25 0 0 300 30 100-200 light 0 0 0 0.4 0 300 30 100-200 / 74 NUTRITIONAL ROLE OF SOFT DRINKS TABLE 3.