Using doubly labeled water to validate associations between sugar-sweetened beverage intake and body mass among White and African-American adults

BACKGROUND: Evidence is mixed regarding sugar-sweetened beverage (SSB) intake and adiposity among adults, perhaps because of reporting bias. OBJECTIVE: The objective of this study is to determine the impact of reporting bias on any associations between increased SSB intake and overweight/obesity. DESIGN: Beverage intake and overweight/obese status (body mass index >= 25 kgm(-2)) were examined among adults from a dietary assessment and doubly labeled water study (n = 250). Four web-based, 24-h recalls assessed dietary intake. SSB intake was categorized as no intake, 1-99 kcals per day and >99 kcals per day. Logistic regression models adjusted for total caloric intake, age, race, education and diet quality compared SSB intake with overweight/obese status. To investigate dietary self-reporting bias, analyses were replicated in a subset of 'true reporters': those with self-reported total caloric intake within 25% of total energy expenditure per doubly labeled water assessments (n = 108). RESULTS: One-half of participants were overweight/obese; more overweight/obese participants consumed SSB than normal-weight participants (69% vs 47%; P<0.001). Intake of other beverages did not differ by adiposity. Less number of White participants (48%) consumed SSB compared with African-American participants (68%; P = 0.002). Compared with no intake, SSB intake up to the median intake doubled the risk of being overweight/obese (odds ratio: 2.1, 95% confidence interval: 1.0-4.3; P = 0.046) and SSB intake over the median more than doubled the risk (odds ratio: 2.6, 95% confidence interval: 1.2-6.0; P = 0.018). When limited to true reporters, SSB intake significantly increased the risk of being overweight/obese by nearly fourfold. CONCLUSION: Underreporting of SSB intake may be attenuating true associations of SSB intake and the risk of being overweight/obese.