title: Fluid intake patterns: an epidemiological study among children and adolescents in Brazil.
abstract: BACKGROUND
  Energy from liquids is one of the most important factors that could impact on the high prevalence of children and adolescents obesity around the world. There are few data on the liquid consumption in Brazil. The aim of this study is to evaluate the volume and quality of liquids consumed by Brazilian children and adolescents and to determine the proportion of their daily energy intake composed of liquids.
  
  
  METHODS
  A multicenter study was conducted in five Brazilian cities; the study included 831 participants between 3 and 17 years of age. A four-day dietary record specific to fluids was completed for each individual, and the volume of and Kcal from liquid intake were evaluated. The average number of Kcal in each beverage was determined based on label information, and the daily energy intake data from liquids were compared with the recommendations of the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária- ANVISA), the Brazilian food regulation authority, according to each subject's age.
  
  
  RESULTS
  As the children aged, the volume of carbonated beverages that they consumed increased significantly, and their milk intake decreased significantly. For children between the ages of 3 and 10, milk and dairy products contributed the greatest daily number of Kcal from liquids. Sugar sweetened beverages which included carbonated beverages, nectars and artificial beverages, accounted for 37% and 45% of the total Kcal from liquid intake in the 3- to 6-year-old and 7- to 10- year-old groups, respectively. Among adolescents (participants 11- to 17- years old), most of the energy intake from liquids came from carbonated beverages, which accounted for an average of 207 kcal/day in this group (42% of their total energy intake from liquids). Health professionals should be attentive to the excessive consumption of sugar sweetened beverages in children and adolescents. The movement toward healthier dietary patterns at the individual and population levels may help to improve programs for preventing overweight and obesity in children and adolescents.
  
  
  CONCLUSIONS
  From childhood to adolescence the daily volume of liquid ingested increased reaching a total of 2.0 liters on average. Of this volume, the daily volume of milk ingested decreased while the carbonated drinks, sweetened, nectars and artificial beverages increased significantly. The proportion of water remained constant in about 1/3 of the total volume. From 3 to 17 years of age the energy intake from carbonated beverages increased by about 20%. The carbonated drinks on average corresponded to a tenth of the daily requirements of energy of adolescents.
authors.affiliation: Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, SP, Brazil. rfeferbaum@uol.com.br
authors.forename: Rubens
authors.initials: R
authors.lastname: Feferbaum
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: de Abreu
authors.forename: Claudio
authors.initials: C
authors.lastname: Leone
mesh_terms: D000293:Adolescent; D001628:Beverages / Q000032:analysis* / Q000706:statistics & numerical data*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002149:Energy Intake; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology