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Acad Pediatr. 2019 Nov 8. pii: S1876-2859(19)30451-6. doi: 10.1016/j.acap.2019.11.002. [Epub ahead of print]

Use of Electronic Health Record Data to Study the Association of Sugary Drink Consumption with Child Weight Status.

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Division of Public Health Sciences, Wake Forest School of Medicine. Electronic address:
Division of Public Health Sciences, Wake Forest School of Medicine; Department of Pediatrics, Wake Forest School of Medicine.
Division of Public Health Sciences, Wake Forest School of Medicine.
Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA.



Sugar-sweetened beverages and, to some extent, fruit juice are modifiable risk factors for childhood obesity. Data on consumption have not been previously systematically collected in the electronic health record (EHR) in a way that could facilitate observational research and population health management.


In 2017-18, we used data from an EHR-based SSB and fruit juice screener to study the association between consumption and weight status among children 6 months through 17 years of age. We used linear models to examine the cross-sectional association between sugary drinks and BMIz, adjusting for sex, age, race/ethnicity, clinic site, and encounter type. We also used separate mixed effects models to examine the association of baseline consumption with ∆BMIz.


Our dataset included 22,291 children (15% <2y; 23% 2-5y; 34% 6-11y; 28% 12-17y) of diverse race/ethnicity (27% African American, 30% Hispanic). Sugary drink consumption was very common; 43% reported ≥2 per day. For children 6-17y, greater consumption was associated cross-sectionally with higher BMIz (e.g. 6-11y old children consuming ≥3/day had 0.27 (95% CI, 0.18, 0.36) higher BMIz vs. those consuming <1/week). In longitudinal models, sugary drink consumption was related to ∆BMIz for children 2-5 at the highest reported levels of consumption (∆0.35 (0.04, 0.65) BMIz/year more for children consuming ≥3/day vs. <1x/week). Larger increases in BMIz were seen for 6-17 year olds reporting consumption at or above 1x/day, vs. <1x/week. No consistent cross-sectional or longitudinal associations were observed among children under 2.


In our EHR-derived data, sugary drink consumption was most associated with high BMIz in school-aged children. Early childhood may be a critical period for intervening on sugary beverage consumption in obesity prevention efforts.


electronic health record; obesity; sugar-sweetened beverages

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