youth by making a variety of nutritious, low-energy-dense foods, such as fruits and vegetables, available in the home. Because nutrient quality should be a major consideration in selecting the family’s foods and beverages, parents should limit their purchases of items characterized by high caloric content and low nutrient density.

The mealtime setting has been shown to affect diet quality in children and youth. Several studies have shown that increased frequency of family dinners is positively associated with older children’s and adolescents’ consumption of fruits and vegetables, grains, and calcium-rich foods, and negatively associated with their consumption of fried food and soft drinks (Gillman et al., 2000; Neumark-Sztainer et al., 2003a). The influence of watching television during mealtime is another area for further research. Coon and colleagues (2001) found that watching television during mealtime was associated with consumption of fewer fruits and vegetables and increased consumption of soft drinks, salty snacks, pizza, and red meat.

One of the issues that has been raised regarding childhood obesity is the potential role of sweetened beverages, such as soft drinks and “flavored drinks” (not 100 percent juices). These beverages do not provide nutrients that are needed by growing children, but do increase the caloric intake. Nevertheless, soft drink consumption more than tripled among adolescent boys between 1977-1978 and 1994, rising from 7 to 22 ounces per day (Guthrie and Morton, 2000; French et al., 2003). By the time they are 14 years of age, 32 percent of adolescent girls and 52 percent of boys are consuming three or more eight-ounce servings of soft drinks daily (Gleason and Suitor, 2001). FITS reported that infants as young as 7 months of age are consuming soft drinks as well (Fox et al., 2004). There are concerns about the effect of increased soft drink consumption on reducing micronutrient intakes and increasing energy intake (IOM, 2002) and on displacing the intake of more nutrient-rich options such as milk (ADA, 2004). Milk consumption by adolescents declined 36 percent from 1965 to 1996 (Cavadini et al., 2000). An analysis of data from the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII) found that children and adolescents (>12 years of age) drank more soft drinks than milk, 100 percent juices, or fruit drinks (Rampersaud et al., 2003).

The link between beverage consumption and body mass index (BMI) is not definitive. In an analysis of CSFII data, Forshee and Storey (2003) reported that BMI calculated from self-reported height and weight had little or no cross-sectional association with beverage consumption. In contrast, in a prospective study of middle schoolers in which height and weight were measured directly, Ludwig and colleagues (2001) reported significant positive associations between sweetened beverage consumption and increases in BMI and obesity incidence. In a recent randomized controlled trial of a 1-year classroom-based intervention focused on carbonated beverages, dental



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