Is there a soft drink vs. alcohol seesaw? A cross-sectional analysis of dietary data in the Australian Health Survey 2011–12
Previous studies in older Australians have reported higher alcohol intake in those with low added sugar intake, yet the relationship between energy in liquid form [alcoholic beverages vs. sugar-sweetened beverages (SSB)] and measures of obesity has not been evaluated. We aimed to assess the association between the energy derived from SSB and alcoholic beverages, and to model the association between the substitution of SSB with alcoholic beverages and waist circumference.
In this cross-sectional analysis, dietary data from the Australian Health Survey 2011–12 were analyzed. Participants with implausible dietary intake were excluded by applying the Goldberg cut-off. Usual SSB intake of adults ≥ 19 years old was estimated using the Multiple Source Method and participants were classified into zero-, low- or high-SSB consumers according to their usual SSB intake. Energy from alcoholic beverages in the three SSB consumption groups was compared using multivariable general linear models. A substitution model was used to assess the association between the replacement of SSB with alcoholic beverages and waist circumference.
Zero-SSB consumers made up 33% of the included participants. In all age groups, zero-SSB consumers had significantly higher energy intakes from alcoholic beverages than low- and high-SSB consumers. Low- and high-SSB consumers had similar consumption of alcoholic beverages. Substituting SSB intake with alcoholic beverage intake was not associated with significant differences in waist circumference in most age groups.
Australian adults who avoid SSB are common but consume substantially more energy in the form of alcoholic beverages. An increase in alcoholic beverage intake could be an ‘unintended consequence’ of strictly discouraging SSB consumption.
KeywordsAustralian adults Sugar-sweetened beverage Alcoholic beverage Substitution model Energy intake
Designed research: JBM, AEB, JCYL; analyzed data or performed statistical analysis: THTW, AEB, JCYL; wrote paper: THTW, AEB, JBM, JCYL; JCYL had primary responsibility for final content.
This study was not supported by any external funding.
Compliance with ethical standards
Conflict of interest
AEB is a member of the ILSI Europe Carbohydrate Task Force and the International Carbohydrate Quality Consortium (ICQC). JBM received research grants from the Australian National Health and Medical Research Council, the European Union, and the Glycemic Index Foundation; and received royalties for books on nutrition that recommend a low glycemic index diet. She oversees a glycemic index testing service at the University of Sydney and is the president and non-executive director of the Glycemic Index Foundation. THTW and JCYL have no conflict of interest to declare.
- 2.Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG (2015) Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. https://doi.org/10.1136/bmj.h3576 Google Scholar
- 3.Huang C, Huang J, Tian Y, Yang X, Gu D (2014) Sugar sweetened beverages consumption and risk of coronary heart disease: a meta-analysis of prospective studies. Atherosclerosis 234(1):11–16. https://doi.org/10.1016/j.atherosclerosis.2014.01.037 CrossRefGoogle Scholar
- 4.World Health Organization (2015) Guideline: sugars intake for adults and children. World Health Organization, Geneva, SwitzerlandGoogle Scholar
- 5.Scientific Advisory Committee on Nutrition (2015) Carbohydrates and health. Scientific Advisory Committee on Nutrition, London, the United KingdomGoogle Scholar
- 6.National Health and Medical Research Council (Australia) (2013) Australian dietary guidelines—providing the scientific evidence for healthier Australian diets. NHMRC, DoHA, Canberra, ACT, AustraliaGoogle Scholar
- 7.Word Cancer Research Fund International (2018) Use economic tools to address food affordability and purchase incentives. The NOURSHING frameworkGoogle Scholar
- 9.Drewnowski A, Henderson SA, Shore AB, Fischler C, Preziosi P, Hercberg S (1997) The fat-sucrose seesaw in relation to age and dietary variety of French adults. Obes Res 5(6):511–518. https://doi.org/10.1002/j.1550-8528.1997.tb00571.x CrossRefGoogle Scholar
- 13.U.S. Department of Health and Human Services, U.S. Department of Agriculture (2015) 2015–2020 Dietary Guidelines for Americans. 8th ednGoogle Scholar
- 21.National Health and Medical Research Council (2009) Australian guidelines to reduce heatlh risks from drinking alcohol. NHMRC, Canberra, ACT, AustralianGoogle Scholar
- 22.Australian Institute of Health and Welfare (2019) Alcohol, tobacoo and other drugs in Australia. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/introduction. Accessed 15 Feb 2019
- 23.Australian Bureau of Statistics (2014) Australian Health Survey, 2011–13. ABS, Canberra, ACT, AustraliaGoogle Scholar
- 24.Commonwealth Government of Australia (2016) Census and Statistics Act 1905. Federal Register of Legislation, Canberra, ACT, AustraliaGoogle Scholar
- 25.Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45(12):569–581Google Scholar
- 26.Australian Bureau of Statistics (2013) Australian Health Survey: Users’ Guide, 2011–13. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/74D87E30B3539C53CA257BBB0014BB36?opendocument. Accessed 2 June 2015
- 27.U.S. Department of Agriculture (2014) AMPM–USDA Automated Multiple-Pass Method. USDA. http://www.ars.usda.gov/News/docs.htm?docid=7710. Accessed 21 May 2015
- 29.Food standards Australia New Zealand (2014) AUSNUT 2013—Australian Food Composition Tables. FSANZ, CanberraGoogle Scholar
- 31.Pan A, Malik VS, Hao T, Willett WC, Mozaffarian D, Hu FB (2013) Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies. Int J Obesity 37:1378. https://doi.org/10.1038/ijo.2012.225. https://www.nature.com/articles/ijo2012225#supplementary-information
- 34.Australian Bureau of Statistics (2011) Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), cat. no. 2033.0.55.001. Australian Bureau of Statistics, CanberraGoogle Scholar
- 35.Penczynski KJ, Herder C, Krupp D, Rienks J, Egert S, Wudy SA, Roden M, Remer T, Buyken AE (2019) Flavonoid intake from fruit and vegetables during adolescence is prospectively associated with a favourable risk factor profile for type 2 diabetes in early adulthood. Eur J Nutr 58(3):1159–1172. https://doi.org/10.1007/s00394-018-1631-3 CrossRefGoogle Scholar
- 38.Kampov-Polevoy AB, Garbutt JC, Khalitov E (2003) Family history of alcoholism and response to sweets. Alcohol Clin Exp Res 27(11):1743–1749. https://doi.org/10.1097/01.alc.0000093739.05809.dd CrossRefGoogle Scholar
- 40.NatCen Social Research, MRC Elsie Widdowson Laboratory, University College London. Medical School (2017) National Diet and Nutrition Survey—results from years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009–2011/2012). London, UKGoogle Scholar
- 42.World Health Organization (2018) Global status report on alcohol and health 2018. World Health Organization, GenevaGoogle Scholar
- 45.Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Mmath TB, Paige E, Paul DS, Sweeting M (2018) Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 391(10129):1513–1523. https://doi.org/10.1016/S0140-6736(18)30134-X CrossRefGoogle Scholar
- 46.Sui Z, Wong WK, Louie JCY, Rangan A (2016) Discretionary food and beverage consumption and its association with demographic characteristics, weight status, and fruit and vegetable intakes in Australian adults. Public Health Nutr 20(2):274–281. https://doi.org/10.1017/S1368980016002305 CrossRefGoogle Scholar