title: Substituting water for sugar-sweetened beverages reduces circulating triglycerides and the prevalence of metabolic syndrome in obese but not in overweight Mexican women in a randomized controlled trial.
abstract: BACKGROUND
  Mexico's sugar-sweetened beverage (SSB) intake is among the highest globally. Although evidence shows that increases in SSB intake are linked with increased energy intake, weight gain, and cardiometabolic risks, few randomized clinical trials have been conducted in adults.
  
  
  OBJECTIVE
  The aim of this study was to determine if replacing SSBs with water affects plasma triglycerides (TGs) (primary outcome), weight, and other cardiometabolic factors.
  
  
  METHODS
  We selected overweight/obese (BMI ≥ 25 and <39 kg/m(2)) women (18-45 y old) reporting an SSB intake of at least 250 kcal/d living in Cuernavaca, Mexico. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or the education provision (EP)-only group (n = 120). The WEP group received biweekly water deliveries, and both groups received equal monthly nutrition counseling. During nutrition counseling, the WEP group sessions included activities to encourage increased water intake, reduced SSB intake, and substitution of water for SSBs. Repeated 24-h dietary recalls, anthropometric measurements, and fasting blood samples were collected at baseline and at 3, 6, and 9 mo. The Markov-Monte Carlo method was used for multiple imputation; separate mixed-effects models tested each outcome.
  
  
  RESULTS
  An intent-to-treat (ITT) analysis indicated that the WEP group increased water intake and decreased SSB intake significantly over time, but there were no differences in plasma TG concentrations between groups at the end of the intervention (WEP at baseline: 155 ± 2.10 mg/dL; WEP at 9 mo: 149 ± 2.80 mg/dL; EP at baseline: 150 ± 1.90 mg/dL; EP at 9 mo: 161 ± 2.70 mg/dL; P for mean comparisons at 9 mo = 0.10). Secondary analyses showed significant effects on plasma TGs (change from baseline to 9 mo: WEP, -28.9 ± 7.7 mg/dL; EP, 8.5 ± 10.9 mg/dL; P = 0.03) and metabolic syndrome (MetS) prevalence at 9 mo (WEP: 18.1%; EP: 37.7%; P = 0.02) among obese participants.
  
  
  CONCLUSIONS
  Providing water and nutritional counseling was effective in increasing water intake and in partially decreasing SSB intake. We found no effect on plasma TGs, weight, and other cardiometabolic risks in the ITT analysis, although the intervention lowered plasma TGs and MetS prevalence among obese participants. Further studies are warranted. This trial was registered at http://www.clinicaltrials.gov as NCT01245010.
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Cordero
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and.
authors.forename: Simón
authors.initials: S
authors.lastname: Barquera
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez-Ramírez
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and.
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Villanueva-Borbolla
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and.
authors.forename: Teresa
authors.initials: T
authors.lastname: González de Cossio
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and.
authors.forename: Juan Rivera
authors.initials: JR
authors.lastname: Dommarco
authors.affiliation: Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC popkin@unc.edu.
authors.forename: Barry
authors.initials: B
authors.lastname: Popkin
mesh_terms: D000293:Adolescent; D000328:Adult; D001628:Beverages; D005260:Female; D006801:Humans; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D050177:Overweight / Q000178:diet therapy* / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood*; D014867:Water; D015431:Weight Loss; D055815:Young Adult
chemical_list: D014280:Triglycerides; D014867:Water