The Beverage Guidance Panel has developed guidelines for beverage classification and consumption, according to a report in the March issue of the American Journal of Clinical Nutrition.

"Over the past several decades, levels of overweight and obesity have increased across all population groups in the United States," write Barry M. Popkin, from the University of North Carolina, Chapel Hill, and colleagues. "Concurrently, an increased daily intake of 150-300 kcal (for different age-sex groups) has occurred, with approximately 50% of the increased calories coming from the consumption of calorically sweetened beverages."

To provide guidance on the relative health and nutritional benefits and risks of various beverage categories, the Beverage Guidance Panel systematically reviewed the available literature on beverages and health. The panel also hoped to develop a deeper dialogue within the scientific community on overall beverage consumption patterns in the United States, and on the great potential to improve health by changing this pattern.

On the basis of caloric and nutrient contents and related health benefits and risks, the panel ranked beverages from the lowest to the highest value. To fulfill daily water needs, drinking water was ranked as the preferred beverage, followed in decreasing value by tea and coffee, low-fat (1.5% or 1.0%) and skim (nonfat) milk and soy beverages, noncalorically sweetened beverages, beverages with some nutritional benefits (fruit and vegetable juices, whole milk, alcohol, and sports drinks), and calorically sweetened, nutrient-poor beverages.

"The Panel recommends that the consumption of beverages with no or few calories should take precedence over the consumption of beverages with more calories," the authors write. "Potable water could be used to fulfill almost all the fluid needs of healthy individuals. However, to allow for variety and individual preferences, healthful diets may include several other types of beverages."

A healthy diet does not rely on fluids to provide energy or nutrient needs, according to the panel report. Because fluids are less satiating than are solid foods, their consumption is associated with a lack of dietary compensation. In other words, fluid calories are not readily "registered" for appetite regulation.

The Panel on Water and Electrolytes of the Institute of Medicine (IOM) has recognized that fluid requirements vary widely among individuals and populations. Therefore, they defined an adequate intake (AI) for water rather than an estimated average requirement (EAR). The AI was set at 125 fl oz (3.7 L)/day for men and 91 fl oz (2.7 L)/day for women. About 80% of the AI is contributed by beverages, including water, and the rest by solid foods. Conversely, except for milk and fruit juices, the contribution of fluids to meeting the recommended dietary allowance (RDA) for essential nutrients is minimal. In a healthy diet, the balance between energy and nutrient content is a critical factor defining the role of beverages.

The proposed guidance system ranks water at the bottom (level 1), to be consumed frequently, and calorically sweetened beverages at the top (level 6), to be consumed sparingly. These recommendations are aimed at the population older than 6 years.

"Below that age, there are many additional factors, such as development of taste preferences and early imprinting of food choices, that may affect beverage choice and intake," the authors write.

For individuals older than 6 years, the Panel recommends the following ranges of intake for beverages:

• Level 1 (water), 20 to 50 fl oz/day.
• Level 2: (unsweetened tea and coffee), 0 to 40 fl oz/day (may replace water, but caffeine is a limiting factor, up to 400 mg/day, or ~32 fl oz coffee/day).
• Level 3: (low-fat and skim milk and soy beverages), 0 to 16 fl oz/day.
• Level 4: (noncalorically sweetened beverages), 0 to 32 fl oz/day (may substitute for tea and coffee with the same limitations as for caffeine).
• Level 5: (caloric beverages with some nutrients), 0 to 8 fl oz of 100% fruit juices/day, 0 to 1 alcoholic drink/day for women and 0 to 2 alcoholic drinks/day for men (one drink is ~12 fl oz of beer, 5 fl oz of wine, or 1.5 fl oz of distilled spirits), and 0 fl oz of whole milk/day.
• Level 6: (calorically sweetened beverages), 0 to 8 fl oz/day.

"The obesity epidemic provides the rationale for developing the Beverage Guidance System," the authors write. "Because some beverages provide primarily energy and can contribute significantly to a positive energy balance, reducing their consumption is an important component of a broader strategy to reduce energy intake."

Research and development issues identified for the food industry include reducing the calorie content of sweetened beverages by 75% to 80% from current levels and developing low-calorie alternatives; reversing the trend among children and adolescents to replace milk in their diet with calorically sweetened beverages; and studying potentially negative effects of fortifying noncaloric beverages, such as flavored bottled water, with essential nutrients.

"The Panel also notes the need for further research regarding the health effects of dairy products and reduced or noncalorically sweetened beverages," the authors conclude. "In our view and in agreement with the IOM, it is important that >60%, if not 100%, of fluid needs are provided by calorie-free beverages. This is important because, as we recognize, fluid needs vary widely among people, and persons with higher-than-average needs should increase their fluid intake from calorie-free beverages, preferably water."

Dr. Popkin initiated the Beverage Guidance Panel. According to the study's disclosure statement, the Unilever Health Institute in the Netherlands assisted by providing funding for the group's meeting in Boston and for the publication of its deliberations. Unilever had no power to influence or veto panel decisions and did not attempt to make changes. The manuscript was initially drafted by Dr. Popkin with major additions for all sections coming from each coauthor until full agreement was reached. All authors participated in all sections of manuscript preparation and review. One of the authors is a member of a scientific advisory board of Unilever.