Association Between Sugary Drink Consumption and Lipid Levels in Children's Electronic Health Records

• Published in: Obesity (Silver Spring, Md.) Md.), 2021-12, Vol.29, p.60-61
• Main Authors: Iyer, Ankitha, Hsu, Fang-Chi, Bonnecaze, Alex, Skelton, Joseph, Palakshappa, Deepak, Lewis, Kristina
• Format: Article
• Language: English
• Subjects: Electronic health records; High density lipoprotein; Lipids
• ISSN: 1930-7381; 1930-739X

Background: Sugar-Sweetened Beverage (SSB) and Fruit Juice (FJ) consumption may increase cardiometabolic risk. Whether such associations are present in children and how much they are mediated by adiposity is unclear. Methods: We used an electronic health record (EHR) dataset from a health system that engages in routine screening for sugary drink consumption to study the cross-sectional association of SSB/FJ intake with child/adolescent lipid levels. 2018-2021 SSB/FJ and lipid data from patients 10-17y were extracted from the EHR. We built linear regression models treating high vs. low SSB/FJ consumption as the independent variable, and triglycerides (TG), high-density lipoprotein (HDL), lowdensity lipoprotein (LDL), and total cholesterol (TC) as dependent variables. Models were adjusted for age, sex, race, fasting status, and clinic type. Models were then repeated with adjustment for BMIz, and mediation analysis was conducted, as adiposity was on the hypothesized causal pathway from SSB/FJ consumption to dyslipedemia. Results: Of 2,816 screened patients; 689 (24%) were high SSB/FJ consumers. Compared to low SSB/FJ consumers, high consumers were more likely to be male (53.6% vs. 46.3%), racial/ethnic minorities (79.4% vs. 63%), and with higher BMIz (1.4 vs. 1.1). In models not adjusted for BMIz, high SSB/FJ consumption was associated with higher TG (+9.1mg/dL (95% CI, 1.9, 15.3; p = 0.004)) and lower HDL (-1.9 (95% CI, -2.9, -1.0; p < 0.001)), but not with total cholesterol or LDL. Adjusting for BMIz attenuated the associations (TG (+5.7 mg/dL (95% CI, -0.4, 11.9; 0.07) ; HDL (-1.1 (95% CI, -2.0, -0.3; 0.01)) and, accordingly, mediation analyses confirmed that some of the variability in TG and HDL due to SSB-FJ consumption was attributable to BMIz. Conclusions: In a unique EHR-based dataset, we observed that high sugary drink intake was associated with differences in child lipid levels that may predict future cardiovascular risk, a relationship partially mediated by adiposity. These findings support the need for interventions to promote healthier beverage consumption habits during childhood as part of primary prevention efforts regardless of child weight status.