Impact of Restricting Sugar-Sweetened Beverages From the Supplemental Nutrition Assistance Program on Children's Health

Introduction: Children enrolled in the Supplemental Nutrition Assistance Program are at higher risk of poor diet, including higher intake of sugar-sweetened beverages than non-Supplemental Nutrition Assistance Program participants. This study aims to identify the impact of restricting sugar-sweetened beverage purchases with Supplemental Nutrition Assistance Program benefits on children's consumption and health. Methods: Using Supplemental Nutrition Assistance Program participation and dietary data of children (aged 2-19 years) in the National Health and Nutrition Examination Survey (2009-2016), a microsimulation model was constructed to assess expected changes in daily sugar-sweetened beverage consumption, total calorie intake, BMI, incidence of dental caries, and obesity prevalence of 2019 U.S. children over a 10-year period, incorporating differences in food consumption and disease risks between the Supplemental Nutrition Assistance Program and the general U.S. populations. Sensitivity analyses were conducted with various food substitution patterns and Supplemental Nutrition Assistance Program participation characteristics. Analysis was performed in 2019. Results: Sugar-sweetened beverage restriction in the Supplemental Nutrition Assistance Program was estimated to reduce daily sugar-sweetened beverage intake by 112.5 g/person (95% CI= 115.9, 109.2), which was estimated to decrease the number of decayed teeth by 0.53/person (95% CI= -0.55, -0.51), an 8.0% decline from the baseline. If sugar-sweetened beverages were substituted with fruit juice and milk, the restriction would be expected to reduce daily total calorie intake by 39.2 kcal/person (95% CI= -39.8, -38.7), resulting 2.6 kg/m(2) (95% CI= -2.9, -2.4) decrease in BMI and a 6.2 percentage point (95% CI= -6.5, -5.8) decrease in obesity prevalence among Supplemental Nutrition Assistance Program participants. Estimated changes in total calorie intake and obesity were subject to food substitution patterns. Conclusions: Restricting sugar-sweetened beverage purchases in Supplemental Nutrition Assistance Program could promote a healthier diet and significantly lower the incidence of dental caries and potentially obesity prevalence in children. (C) 2020 American Journal of Preventive Medicine. Published by Elsevier Inc.