Re: Sugar-Sweetened Beverage Intake in a Rural Family Medicine Clinic

To the Editor: Drs. Pinon, Khandalavala, and Geske recently addressed sugar sweetened beverage (SSB) intake in a rural medicine clinic and showed that their rural population on average only drinks 7 kcals more than the national average per day.¹ The authors' methods may not have fully captured true intake, as they only sampled during normal business hours over 6 weeks.

The patients who participated during normal business hours were likely only a subset of this community's population. For example, the working class may only seek primary care during evening and weekend hours. Blue collar workers have been found to eat less fruits and vegetables as well as have less physical activity.^3,4 SSB intake is likely tied to these other unhealthy lifestyle choices. Rural communities have higher rates of age-adjusted related deaths, which SSB intake could be tied to.² SSB consumption has been associated with elevated cardiovascular risk.⁵ Heart disease and strokes are 2 of the leading causes of death, both in rural and urban communities. However, rural communities continue to lag behind advancements in health care when compared with their urban cohorts.² By better quantifying SSB intake, we can design meaningful interventions to reverse this lag.

In terms of coming up with solutions to help these patients, we need to fully understand their dietary choices. A random sample in a clinic during normal business hours may not capture the entire community. Future research needs to target broader sampling so there can be more insights into this population.