Nutrition Policy Institute (NPI)

Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to children’s added sugar consumption. This study examines whether children’s SSB and water intake are associated with diet quality and total energy intake.

Methods: Using data on children ages 2–18 years from the 2009–2014 National Health and Nutrition Examination Survey, linear regression models were used to analyze SSB and water intake in relation to Healthy Eating Index (HEI-2010) scores and total energy intake. Generalized linear models were used to analyze SSB and water intake in relation to the HEI-2010 scores. Analyses were conducted including and excluding caloric contributions from SSBs, and were conducted in 2016–2017.

Results: SSB intake was inversely associated with the HEI-2010 total scores (9.5-point lower score comparing more than two servings/day with zero servings/day, p-trend<0.0001) and positively associated with total energy intake (394 kcal higher comparing more than two servings/day with zero servings/day, p-trend<0.0001). The associations between SSB and HEI-2010 total scores were similar when SSBs were excluded from HEI-2010 calculations. Water intake was positively associated with HEI-2010 total scores, but not associated with total energy intake. SSB intake was inversely associated with several HEI-2010 component scores, notably vegetables, total fruit, whole fruit, greens and beans, whole grains, dairy, seafood and plant proteins, and empty calories. Water intake was positively associated with most of the same HEI-2010 component scores.

Conclusions: Children who consume SSBs have poorer diet quality and higher total energy intake than children who do not consume SSBs. Interventions for obesity and chronic disease should focus on replacing SSBs with water and improving other aspects of diet quality that correlate with SSB consumption.

This Nutrition Policy Institute research brief presents early evidence that California’s School Meals for All program provides meaningful financial relief to families across income levels. Drawing on a statewide survey and interviews with parents, the findings show that nearly 4 in 5 families report saving money on food costs, while more than half say their household finances would be negatively affected if the program ended. The brief highlights the broad reach of these benefits—including among families not traditionally eligible for free or reduced-price meals—and underscores the program’s role in supporting household economic stability amid rising food costs.