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Pediatr Allergy Immunol. 2020 Mar 11. doi: 10.1111/pai.13243. [Epub ahead of print]

Pathways in the association between sugar sweetened beverages and child asthma traits in the 2nd year of life: findings from the BRISA Cohort.

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Department of Public Health, Postgraduate Program in Collective Health, Federal University of Maranhão (UFMA), Rua Barão de Itapary, nº 155, Centro, São Luís, Maranhão, Brazil.
Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Physiological and Health Sciences, UFMA, Avenida dos Portugueses, nº 1966, Bacanga, São Luís, Maranhão, Brazil.


Studies on the exposure of children to sugar sweetened beverages-SSB at an early age may contribute to better understand the common causes and the temporal order of the relationships between obesity and asthma in early childhood. The objective of this study was to estimate the association between SSB and Child Asthma Traits in the 2nd year of life, modelling direct and indirect pathways mediated by the highest BMI-z of the child and allergic inflammation. Data from the BRISA Cohort, São Luís-MA, Brazil (n=1,140) were obtained from the baseline and from the follow-up performed at the 2nd year of life. The main explanatory variable was the calories from added sugars in SSBs as a percentage of the total daily energy intake. The outcome Child Asthma Traits was a latent variable deduced from four indicators: medical diagnosis of asthma, wheezing, emergency visit due to intense wheezing and medical diagnosis of rhinitis. A high percentage of daily calories from sugars added to SSBs was directly associated with higher values of Child Asthma Traits (Standardized coefficient (SC = 0.073; p = 0.030). High levels of eosinophils were also directly associated with Child Asthma Traits (SC = 0.118; p = 0.049). No mediation pathways were observed via greater BMI-z or eosinophil counts. Therefore, early exposure of children to SSB may contribute to increased risk of childhood asthma, preceding the link between sugar consumption and overweight/obesity, not yet evident in children in the first two years of life.


Sugar sweetened beverages; asthma; child; structural equation modeling


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