Trajectories of beverage consumption during adolescence

Abstract

Beverages contribute substantially to daily energy and nutrient intakes. However, little is known about the co-development of beverage consumption throughout adolescence. This study aimed to investigate the presence of naturally occurring sub-groups of girls and boys following distinct trajectories of various types of beverage consumption (i.e. sugary beverages, tea and coffee, water, and milk) throughout adolescence. During the Monitoring Activities for Teenagers to Comprehend their Habits study, data were collected from 744 Canadian youths followed for six years (2013–2019). The participants were asked yearly (start-age 10–11 years old) to report how many times they consumed sugary beverages, tea and coffee, water, and milk in a week. Trajectories of beverage consumption were identified from age 11 to 18 using a person-centred approach, namely group-based multi-trajectory modelling. For girls, three different groups were identified: ‘Water consumers’ (62.7%), ‘High beverage consumers’ (20.9%), and ‘Water and milk consumers’ (16.4%). For boys, four different groups were identified: ‘Water consumers’ (39.1%), ‘Water and milk consumers’ (30.5%), ‘Sugary drinks, coffee and tea consumers’ (20.1%), and ‘High beverage consumers’ (10.4%). This study illustrates the complexity of beverage consumption patterns in adolescence. Various types of public health messaging and interventions may be required to promote healthier beverage consumption patterns among all adolescents.

Introduction

Beverages play a significant role in individuals’ diets since they can contribute sugar (Bailey, Fulgoni, Cowan, & Gaine, 2018), saturated fat (Troiano, Briefel, Carroll, & Bialostosky, 2000), calories (Bell, Kremer, Magarey, & Swinburn, 2005) and water (Garriguet, 2019). In Canada, public health messaging encourages Canadians to make water their beverage of choice as it ensures proper hydration without the excess calories and nutrients that other common beverages contain (Health Canada, 2019, pp. 1–62). Guidelines recommend limiting beverages that are high in sugar, sodium, and saturated fat, as these nutrients have been linked to various chronic diseases (Chazelas et al., 2019; Keller & Bucher Della Torre, 2015; Mirmiran, Yuzbashian, Asghari, Hosseinpour-Niazi, & Azizi, 2015; Pacheco et al., 2020). Further, since children and adolescents are more sensitive to the effects of caffeine than adults (Government of Canada, 2021), caffeinated drinks are also discouraged in this population (Health Canada, 2019, pp. 1–62). Health Canada recommends that the consumption of sugary beverages (e.g. fruit juice, fruit drinks, soft drinks, diet soft drinks, hot chocolate), vegetable juices, energy drinks and other high-fat, high-sugar specialty coffees and teas be limited and that unsweetened lower fat milk, unsweetened fortified plant-based beverages (e.g., almond or rice beverages) and unsweetened coffee or tea be used as alternatives to water (Health Canada, 2019, pp. 1–62).

Despite these recommendations, results from the 2015 Canadian Community Health Survey (CCHS) show that the consumption of sugary beverages among Canadian adolescents (14–18 years old) is high, with 44% of them reporting drinking three or more of these beverages per day (Vanderlee, Manske, Murnaghan, Hanning, & Hammond, 2014). Beverage consumption patterns seem to change with age, with adolescents seemingly consuming more sugary beverages than children (Jones, Kirkpatrick, & Hammond, 2019; Marshall, Curtis, Cavanaugh, Warren, & Levy, 2019). For example, data from the 2015 CCHS showed that among children (9–13 years old) and adolescents (14–18 years old) who recalled consuming sugary beverages the day before the survey, children consumed an average of 313 g (≈301 mL) of fruit juice while adolescents consumed an average of 372 g (≈357 mL) (Garriguet, 2019). Similar findings were found for diet soft drinks. Children who reported consuming diet soft drinks the previous day drank an average of 278 g (≈273 mL), whereas adolescents consumed an average of 399 g (≈391 mL) (Garriguet, 2019). In addition to sugary drinks, consumption of coffee and tea also appears to be greater in adolescence. According to the 2015 CCHS, Canadian adolescents reported drinking an average of 678 g of coffee and tea the day before the survey compared to 560 g among children (Garriguet, 2019). While it is unclear whether these coffees and teas are unsweetened, consuming large amounts of caffeinated beverages can easily lead to intakes that surpass the maximum amount of 2.5 g of caffeine per kg of bodyweight recommended by Health Canada for children over the age of 13 (Government of Canada, 2021).

While sugary beverages and caffeinated drinks seem to be consumed in greater quantities in adolescence, the opposite has been found for milk (Dror & Allen, 2014; Lioret et al., 2010). For example, a French cross-sectional study found that milk consumption was lower among adolescents aged 15–17 years (168 mL for boys and 186 mL for girls) than children aged 3–10 years (206 mL/day for boys and 186 mL/day for girls) (Lioret et al., 2010). Similar findings have also been reported in studies conducted in the United Kingdom and Belgium (Dror & Allen, 2014). In Canada, milk consumption is similar in both childhood and adolescence (364 g versus 374 g, respectively). However, adolescent boys seem to consume more milk than girls (411 g versus 336 g, respectively) (Garriguet, 2019). Some researchers have suggested that changes in beverage consumption could be due to a displacement of some beverages for others (Bowman, 2002; Hernández-Cordero & Popkin, 2015; Rajeshwari, Yang, Nicklas, & Berenson, 2005). For example, in Canada, the proportion of total daily fluid intake from plain water and sugary beverages is greater in adolescence than in childhood. In contrast, the proportion from milk appears to be greater in childhood than in adolescence (Garriguet, 2019).

Various factors can influence the types of beverages children and adolescents consume, including gender (Chen & Hsiao, 2018; Ferreira-Pêgo et al., 2015), individual preferences, past dietary experiences, and social and environmental contexts (Devine, 2005). As a result, individuals may follow different trajectories of beverage consumption over time. A better understanding of these trajectories could help improve public health messaging and health-promoting interventions or initiatives by tailoring them to specific subgroups of children and adolescents who are more likely to display unhealthy beverage consumption patterns. Group-based trajectories have recently been introduced in nutritional epidemiology (Chen & Hsiao, 2018; D.S.; Nagin, 2005) to help identify homogenous subgroups of individuals who follow distinct developmental trajectories over time. In addition, these trajectories can be used to monitor the impact of public health interventions on eating patterns at the population level.

Group-based trajectory modelling has recently been used to identify the presence of three groups of Canadian adolescent girls and five groups of adolescent boys who presented different trajectories of breakfast, vegetable and fruit, fast food and overall sugary beverage consumption from the age of 11–18 years old (Doggui, Ward, Johnson, & Bélanger, 2021). However, to date, no study has described the trajectories of the consumption of various types of beverages during adolescence. Therefore, this study aimed to investigate the presence of naturally occurring sub-groups of girls and boys following distinct trajectories of various types of beverage consumption (i.e. sugary beverages; tea and coffee; water and milk) throughout adolescence.