• ARGH – Soda edition

    I feel like I’m being drafted over and over to defend soda. You’re all killing me. But after yesterday’s column on diet soda, I can’t ignore this. From Reuters, “Soda drinking tied to kids’ behavior problems: study“:

    After taking into account habits that may have influenced the results – such as how much TV the kids watched, how much candy they ate and their mother’s race and education – the researchers still found that drinking two or four or more servings of soda per day was tied to higher aggression scores.

    Overall, kids who drank four or more servings of soda per day were twice as likely to destroy other people’s belongings, get into fights and physically attack people, compared to children who didn’t drink soda.

    Soda drinkers also scored higher on scales measuring signs of withdrawal and attention problems, write the researchers in The Journal of Pediatrics.

    Suglia said that although the increased aggressive behavior may not be noticeable for each child, it’s moving all kids closer to the scale’s clinical threshold.

    “Furthermore, if they’re drinking this much soda, it’s probably taking away from other nutritional things the child could be eating,” she said.

    From CNN, “Does soda make kids more violent“:

    Yet another study is warning parents to limit soda consumption with children.  While previous studies have linked soda consumption with higher rates of obesity, a study published in the journal Pediatrics, says it also causes aggressive, violent behavior in children as young as 5 years old…

    The results:

    Children who consumed at least four servings of soda per day were twice as likely than those who didn’t drink any soda to display aggressive violent behaviors – such as destroying other people’s belongings, starting physical fights and verbally attacking other children. The kids were also more likely to have trouble paying attention to instructions, and were more withdrawn socially compared to 5-year-olds who didn’t consume soda.

    “There was a dose response,” said Shakira Suglia, study author and associate professor of epidemiology at Columbia University. “With every increase in soda consumption, we saw an increase in behavior problems. It was significant for kids who consumed as few as one serving of soda per day.”

    The association was present after researchers adjusted for parenting styles, and socio-demographic factors such as how much violent television the children were exposed to, their sleep schedule, and candy consumption.

    CBS has “Soda may make children more likely to destroy things, attack others“. TIME has “Soda Contributes to Behavior Problems Among Young Children“.

    The study itself:

    Objective: To examine soda consumption and aggressive behaviors, attention problems, and withdrawal behavior among 5-year-old children.

    Study design: The Fragile Families and Child Wellbeing Study is a prospective birth cohort study that follows a sample of mother-child pairs from 20 large US cities. Mothers reported children’s behaviors using the Child Behavior Checklist at age 5 years and were asked to report how many servings of soda the child drinks on a typical day.

    They took 2929 children and measured behavior scores as well as how much soda they drank. With respect to the aggression scores, which is where CNN got its'”violent” headline, they used a 100 point scale. Kids who drank no soda scored a 56 (+/- 8). Kids who drank one soda scored a 57 (+/- 8). Kids who drank two sodas scored a 58 (+/- 9). Kids who drank three sodas scored a 59 (+/- 9). Kids who drank four or more sodas scored a 62 (+/- 9). What does that mean? I have no idea. Neither do the people who wrote the manuscript:

    “It’s a little hard to interpret it. It’s not quite clinically significant,” Shakira Suglia, of Columbia University’s Mailman School of Public Health in New York, told Reuters Health.

    That’s because those scores don’t mean much in and of themselves. What’s a one point difference? No one knows. We only know, evidently, that 50 is “normal” and 65 is “a clinical marker of when children should be evaluated for a problem“. Moreover, once you adjust for everything (as they did in Table III), then there is no longer any significant difference between kids who drank 1 or zero sodas. There’s also no significant difference between kids who drank 3 and zero sodas. There’s a 3-point significant difference between those who drank 4 or more versus zero sodas, with the 95% CI going from 1 to 5.

    The other finding that’s being touted is that kids who drink 4 or more sodas are “more than twice as likely to destroy things belonging to others (OR, 2.54; 95% CI 1.7-3.8).” But twice as likely is a relative thing. Did it go from 25% of kids to 50% of kids? Or did it go from 0.01% of kids to 0.02% of kids. I can’t tell you, because the “data [were] not shown in tables”.

    Moreover, this is NOT AN RCT. You can’t prove causality. It could be that the 4% of kids who get four or more sodas a day (which is a lot in anyone’s book) could have bad parents,* and that’s the cause of their aggression. Or, it could be the caffeine they’re ingesting is getting to them, irrelevant of its delivery mechanism. Or, it could be that they’re bad kids, and the parents give them lots of soda to shut them up. I don’t know. But what I do know is that this study does not prove that soda causes violent behavior.


    *In no way do I think kids with aggression problems have “bad” parents. I’m being provocative on purpose to illustrate that you just can’t know. Additionally, if it was caffeine, that would be good to know, but that’s a knock on caffeine, not “soda”.

    • Well obviously violent behaviour leads to soda drinking.

      It’s the new gateway drug.

      (Can I be a journalist now, please?)

    • What about the acidity of sodas (diet and otherwise)? Does that not have any negative health impacts at all? Thank you.

    • Studies like this seem down right silly. Further I would make a sizable bet that it will bet if someone tries to duplicate it that they will not get the same result.

    • If a child is consistently drinking that much soda, I do wonder about parental supervision.

    • five year old kids are drinking 5 or more servings of soda a day??? are they not getting any FOOD?!

      from the linked article: “Another possibility is that underlying organic conditions, such as low blood glucose, could lead children both to want soda and to be aggressive or withdrawn. High soda intake may affect blood glucose levels.24 Unfortunately, we did not have a direct measure
      of blood glucose.”

      coping with low blood sugar, been there done that, all my life, including sometimes weeks on end of drinking 5 or more (usually caffeinated) sodas per day. and yes, sometimes low blood sugar makes me withdrawn while other times it makes me agitated.

      resorting to drinking too many sodas, rather than carefully keeping to a healthy food intake, is sheer laziness on my part, but i see, also from the linked paper, that the data came from the Fragile Families and Child Wellbeing Study, so probably those living in poverty and near-poverty are substituting sodas for food (obtaining and keeping real food costs both time and money), in which case the kids’ problem isn’t too many sodas, it’s too little food.

      and when you’re poor or near-poor, it’s expensive to provide your family with food (and everything else): http://www.washingtonpost.com/wp-dyn/content/article/2009/05/17/AR2009051702053.html?sid=ST2009051801162

    • Effect size matters….

      We have gotten so enamored with significance that we lose sight of the fact that significance is really pretty meaningless when we have very small effect sizes…

      But I do think there are other things at work when we see kids drinking more than one or two sodas a day – as a parent – and grandparent the approach was/is that the beverage of first choice should be milk – second choice a fruit juice – third choice water. Sodas are a treat – reserved for movie nights and special occasions. That may not be the norm – but it is what we do.

      That being said a more interesting study might have been to try and understand the factors that led to parents/caregivers thinking more than a soda or two a day was a good/acceptable idea.

    • Interesting comments but the elephant is still in the room and no one has commented. That elephant is HFCS. I don’t need any studies to inform my opinion on this food additive. My opinion is based on TASTE. So if I DECIDE from my own aesthetic or taste reasons to AVOID any food items that contain even trace amounts of HFCS or of the other names that it masquerades as I need to READ ACCURATE LABELS. IF I see any “HFCS, corn sugar or other euphemism, I will not buy or eat the product. Whats wrong with having a CHOICE based on taste preference, or aesthetics…? I like the taste of cane sugar but am thwarted by agribusinesses that hide or obfuscate rather than inform.

      Currently so-called “Mexican Coke” Hecho en Mexico has no HFCS and as a result it is able to be sold at 25% higher price because of the market DEMAND. What is politically incorrect about preference?


    • The press-release-industrial complex. Unholy alliance of media and the worst parts of academia to get publicity for meaningless froth.