Public Health Nutrition

Hot Topic – Soft drinks

Association between commercial and traditional sugar-sweetened beverages and measures of adiposity in Costa Rica

Jinnie J Rheea1a2a3, Josiemer Matteia2 and Hannia Camposa2a4 c1

a1 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

a2 Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

a3 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

a4 Centro Centroamericano de Población, Universidad de Costa Rica, San Pedro, Costa Rica


Objective Increasing trends in the consumption of commercial sugar-sweetened beverages (SSB) have occurred in parallel with rising levels of obesity in Latin America, but data showing the relationship between these SSB and obesity are limited. The current study examined the association between commercial and traditional SSB and measures of adiposity in Costa Rica.

Design A cross-sectional analysis was conducted in which the exposure, SSB intake, was defined as frequency of daily servings of ‘fresco’ (a traditional home-made beverage), fruit drink (commercially available SSB), soda and fruit juice (made from fruits at home). Multivariate linear regression was used to estimate associations between SSB intake and BMI, waist-to-hip ratio and skinfold thickness.

Setting Central Valley, Costa Rica.

Subjects Controls (n 2045) of a case–control study on diet and heart disease in Costa Rica.

Results Fresco, fruit drink, soda and fruit juice were consumed ≥1 time/d by 47 %, 14 %, 4 % and 14 % of the population, respectively. One serving/d of soda, fruit drink and fresco was associated with 0·89, 0·49 and 0·21 kg/m2 higher BMI, respectively (all P < 0·05). Fruit drink (≥1 serving/d) was associated with higher waist-to-hip ratio (P = 0·004), while soda and fresco were associated with higher skinfold thickness (P = 0·02 and 0·01, respectively). Associations with fruit juice intake were modest and not statistically significant. Other factors associated with higher BMI were higher income and less education, smoking and physical inactivity (all P < 0·05).

Conclusions Increasing intake of commercially available SSB could be in part responsible for the high prevalence of obesity among Hispanic adults.

(Received July 08 2011)

(Revised February 02 2012)

(Accepted February 21 2012)

(Online publication April 12 2012)


c1 Corresponding author: Email