Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Using doubly labeled water to validate associations between sugar-sweetened beverage intake and body mass among White and African-American adults



Evidence is mixed regarding sugar-sweetened beverage (SSB) intake and adiposity among adults, perhaps because of reporting bias.


The objective of this study is to determine the impact of reporting bias on any associations between increased SSB intake and overweight/obesity.


Beverage intake and overweight/obese status (body mass index 25 kg m−2) were examined among adults from a dietary assessment and doubly labeled water study (n=250). Four web-based, 24-h recalls assessed dietary intake. SSB intake was categorized as no intake, 1–99 kcals per day and >99 kcals per day. Logistic regression models adjusted for total caloric intake, age, race, education and diet quality compared SSB intake with overweight/obese status. To investigate dietary self-reporting bias, analyses were replicated in a subset of ‘true reporters’: those with self-reported total caloric intake within 25% of total energy expenditure per doubly labeled water assessments (n=108).


One-half of participants were overweight/obese; more overweight/obese participants consumed SSB than normal-weight participants (69% vs 47%; P<0.001). Intake of other beverages did not differ by adiposity. Less number of White participants (48%) consumed SSB compared with African-American participants (68%; P=0.002). Compared with no intake, SSB intake up to the median intake doubled the risk of being overweight/obese (odds ratio: 2.1, 95% confidence interval: 1.0–4.3; P=0.046) and SSB intake over the median more than doubled the risk (odds ratio: 2.6, 95% confidence interval: 1.2–6.0; P=0.018). When limited to true reporters, SSB intake significantly increased the risk of being overweight/obese by nearly fourfold.


Underreporting of SSB intake may be attenuating true associations of SSB intake and the risk of being overweight/obese.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2


  1. US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans. US Government Printing Office: Washington, DC, 2010.

  2. Basu S, McKee M, Galea G, Stuckler D . Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. Am J Public Health 2013. (Epub ahead of print).

  3. Woodward-Lopez G, Kao J, Ritchie L . To what extent have sweetened beverages contributed to the obesity epidemic? Public Health Nutr 2011; 14: 499–509.

    Article  Google Scholar 

  4. Gibson S . Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions. Nutr Res Rev 2008; 21: 134–147.

    Article  Google Scholar 

  5. Malik VS, Schulze MB, Hu FB . Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84: 274–288.

    CAS  Article  Google Scholar 

  6. Babey SH, Jones M, Yu H, Goldstein H . Bubbling over: soda consumption and its link to obesity in california. UCLA Center for Health Policy Research 2009; 1–8 Internet Accessed 22 September 2011.

  7. Olsen NJ, Heitmann BL . Intake of calorically sweetened beverages and obesity. Obes Rev 2009; 10: 68–75.

    CAS  Article  Google Scholar 

  8. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB . Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010; 33: 2477–2483.

    Article  Google Scholar 

  9. World Health Organization. Fact sheet: Obesity and overweight. No. 311. Updated March 2013. Available at: Accessed 7 May 7 2013.

  10. Vartanian LR, Schwartz MB, Brownell KD . Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 2007; 97: 667–675.

    Article  Google Scholar 

  11. Thompson FE, Subar AF . Dietary assessment methodology. In: Coulston AM, Rock CL, Monsen ER, (eds). Nutrition in the Prevention and Treatment of Disease. Academic Press: San Diego, CA, 2001; 3–39.

    Chapter  Google Scholar 

  12. Sun SZ, Empie MW . Lack of findings for the association between obesity risk and usual sugar-sweetened beverage consumption in adults - A primary analysis of databases of CSFII-1989-1991, CSFII-1994-1998, NHANES III, and combined NHANES 1999-2002. Food Chem Toxicol 2007; 45: 1523–1536.

    CAS  Article  Google Scholar 

  13. Liebman M, Pelican S, Moore SA, Holmes B, Wardlaw MK, Melcher LM et al. Dietary intake, eating behavior, and physical activity-related determinants of high body mass index in rural communities in Wyoming, Montana, and Idaho. Int J Obes 2003; 27: 684–692.

    CAS  Article  Google Scholar 

  14. O'Neil CE, Nicklas TA, Liu Y, Franklin FA . Impact of dairy and sweetened beverage consumption on diet and weight of a multiethnic population of head start mothers. J Am Diet Assoc 2009; 109: 874–882.

    CAS  Article  Google Scholar 

  15. McCarthy SN, Robson PJ, Livingstone MB, Kiely M, Flynn A, Cran GW et al. Associations between daily food intake and excess adiposity in Irish adults: towards the development of food-based dietary guidelines for reducing the prevalence of overweight and obesity. Int J Obes 2006; 30: 993–1002.

    CAS  Article  Google Scholar 

  16. Kipnis V, Midthune D, Freedman L, Bingham S, Day NE, Riboli E et al. Bias in dietary-report instruments and its implications for nutritional epidemiology. Public Health Nutr 2002; 5: 915–923.

    Article  Google Scholar 

  17. Heitmann BL, Lissner L . Dietary underreporting by obese individuals—is it specific or non-specific? BMJ 1995; 311: 986–989.

    CAS  Article  Google Scholar 

  18. Arab L, Wesseling-Perry K, Jardack P, Henry J, Winter A . Eight self-administered 24-hour dietary recalls using the internet are feasible in African Americans and Whites: the Energetics Study. J Am Diet Assoc 2010; 110: 857–864.

    Article  Google Scholar 

  19. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sport Exer 2003; 35: 1381–1395.

    Article  Google Scholar 

  20. Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jequier E . Energy-expenditure by doubly labeled water - validation in humans and proposed calculation. Am J Physiol 1986; 250: R823–R830.

    CAS  Google Scholar 

  21. Schoeller DA, Hnilicka JM . Reliability of the doubly labeled water method for the measurement of total daily energy expenditure in free-living subjects. J Nutr 1996; 126: S348–S354.

    Google Scholar 

  22. Schoeller DA . Recent advances from application of doubly labeled water to measurement of human energy expenditure. J Nutr 1999; 129: 1765–1768.

    CAS  Article  Google Scholar 

  23. Coward WA, Ritz P, Cole TJ . Revision of calculations in the doubly labeled water method for measurement of energy-expenditure in humans. Am J Physiol 1994; 267: E805–E807.

    CAS  PubMed  Google Scholar 

  24. Neuhouser ML, Tinker L, Shaw PA, Schoeller D, Bingham SA, Horn LV et al. Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative. Am J Epidemiol 2008; 167: 1247–1259.

    Article  Google Scholar 

  25. Trabulsi J, Troiano RP, Subar AF, Sharbaugh C, Kipnis V, Schatzkin A et al. Precision of the doubly labeled water method in a large-scale application: evaluation of a streamlined-dosing protocol in the Observing Protein and Energy Nutrition (OPEN) study. Eur J Clin Nutr 2003; 57: 1370–1377.

    CAS  Article  Google Scholar 

  26. Schoeller DA . Measurement of energy expenditure in free-living humans by using doubly labeled water. J Nutr 1988; 118: 1278–1289.

    CAS  Article  Google Scholar 

  27. Arab L, Tseng CH, Ang A, Jardack P . Validity of a multipass, web-based, 24-hour self-administered recall for assessment of total energy intake in blacks and whites. Am J Epidemiol 2011; 174: 1256–1265.

    Article  Google Scholar 

  28. Arab L, Tseng C, Ang A, Jardack P . Validity of a multi-pass, web-based 24-hour self administered recall for assessment of total energy intake as strong among African Americans as Caucasians. Am J Epidemiol 174: 1256–1265.

  29. Bleich SN, Wang YC, Wang Y, Gortmaker SL . Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr 2009; 89: 372–381.

    CAS  Article  Google Scholar 

  30. R Core Team. R: A Language and Environment for Statistical Computing R Foundation for Statistical Computing: Vienna, Austria, 2012. ISBN 3-900051-07-0,

  31. Freedman D . Centers for disease control and prevention: obesity - United States, 1998-2008. MMWR Morb Mortal Wkly Rep 2010; 60 (Suppl): 73–77.

    Google Scholar 

  32. Apovian CM . Sugar-sweetened soft drinks, obesity, and type 2 diabetes. J Am Diet Assoc 2004; 292: 978–979.

    CAS  Article  Google Scholar 

  33. Bray GA . How bad is fructose? Am J Clin Nutr 2007; 86: 895–896.

    CAS  Article  Google Scholar 

  34. Bray GA, Nielsen SJ, Popkin BM . Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79: 537–543.

    CAS  Article  Google Scholar 

  35. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004; 292: 927–934.

    CAS  Article  Google Scholar 

  36. Pereira MA, Fulgoni 3rd VL . Consumption of 100% fruit juice and risk of obesity and metabolic syndrome: findings from the national health and nutrition examination survey 1999-2004. J Am Coll Nutr 2010; 29: 625–629.

    CAS  Article  Google Scholar 

  37. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L . Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med 2008; 168: 1487–1492.

    Article  Google Scholar 

  38. Morand C, Dubray C, Milenkovic D, Lioger D, Martin JF, Scalbert A et al. Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers. Am J Clin Nutr 2011; 93: 73–80.

    CAS  Article  Google Scholar 

  39. Wojcicki JM, Heyman MB . Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 2012; 102: 1630–1633.

    Article  Google Scholar 

  40. Schoeller DA . Energy expenditure from doubly labeled water: some fundamental considerations in humans. Am J Clin Nutr 1983; 38: 999–1005.

    CAS  Article  Google Scholar 

Download references


This project was funded by the National Institutes of Health grant R01CA105048 and a T32 training grant 3T3236GM084896-0251 under the National Institute of General Medical Sciences of the National Institutes of Health.

Author information

Authors and Affiliations


Corresponding author

Correspondence to J A Emond.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on International Journal of Obesity website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Emond, J., Patterson, R., Jardack, P. et al. Using doubly labeled water to validate associations between sugar-sweetened beverage intake and body mass among White and African-American adults. Int J Obes 38, 603–609 (2014).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • sugar-sweetened beverages
  • African American
  • high-fructose corn syrup


Quick links