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Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis
Open accessAbstract
Background The relation between sugar-sweetened beverages (SSBs) and body weight remains controversial.Objective We conducted a systematic review and meta-analysis to summarize the evidence in children and adults.Design We searched PubMed, EMBASE, and Cochrane databases through March 2013 for prospective cohort studies and randomized controlled trials (RCTs) that evaluated the SSB-weight relation. Separate meta-analyses were conducted in children and adults and for cohorts and RCTs by using random- and fixed-effects models.Results Thirty-two original articles were included in our meta-analyses: 20 in children (15 cohort studies, n = 25,745; 5 trials, n = 2772) and 12 in adults (7 cohort studies, n = 174,252; 5 trials, n = 292). In cohort studies, one daily serving increment of SSBs was associated with a 0.06 (95% CI: 0.02, 0.10) and 0.05 (95% CI: 0.03, 0.07)-unit increase in BMI in children and 0.22 kg (95% CI: 0.09, 0.34 kg) and 0.12 kg (95% CI: 0.10, 0.14 kg) weight gain in adults over 1 y in random- and fixed-effects models, respectively. RCTs in children showed reductions in BMI gain when SSBs were reduced [random and fixed effects: -0.17 (95% CI: -0.39, 0.05) and -0.12 (95% CI: -0.22, -0.2)], whereas RCTs in adults showed increases in body weight when SSBs were added (random and fixed effects: 0.85 kg; 95% CI: 0.50, 1.20 kg). Sensitivity analyses of RCTs in children showed more pronounced benefits in preventing weight gain in SSB substitution trials (compared with school-based educational programs) and among overweight children (compared with normal-weight children).Conclusion Our systematic review and meta-analysis of prospective cohort studies and RCTs provides evidence that SSB consumption promotes weight gain in children and adults.
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“Studies among children are more limited and have generally focused on weight gain [4] and dental caries [10], as well as insulin resistance to a lesser extent [11, 12].”
From The negative impact of sugar-sweetened beverages on children’s health: an update of the literature (2018) · cites this paper as [4]
In the citing paper
“Evidence has emerged linking SSB consumption to a number of health consequences among adults including weight gain [4, 5], cardiovascular risk factors (e.g., dyslipidemia) [6], insulin resistance and type 2 diabetes [7, 8] and non-alcoholic fatty liver disease [9].”
From The negative impact of sugar-sweetened beverages on children’s health: an update of the literature (2018) · cites this paper as [4]
In the citing paper
“Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence)”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [53]
In the citing paper
“Dose-response analysis based on seven cohort studies showed that a one serving/day increment of sugar sweetened beverages was associated with a 0.22 kg weight gain in one year (weighted mean difference 0.22, 0.09 to 0.34).”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [53]
In the citing paper
“The authors conducted a dose-response analysis and showed that body mass index in children increased by 0.07 units for every one serving/day increment of sugar sweetened beverages (weighted mean difference 0.07, 0.01 to 0.12) (low; IV).”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [53]
In the citing paper
“Dietary sugar consumption had harmful associations with endocrine and metabolic outcomes, including changes in body mass index in children,53 changes in body weight,53 changes in body weight (one year),53 gout,11 13 58 high density lipoprotein cholesterol,60 hyperuricaemia,11 59 latent autoimmune diabetes in adults,30 low density lipoprotein cholesterol,60 metabolic syndrome,61 obesity in children”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [53]
In the citing paper
“dietary sugar consumption, especially sugar sweetened beverage consumption, is convincingly associated with the risk of obesity weight gain,1 3 53”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [53]
In the citing paper
“A meta-analysis of seven cohort studies and five randomized controlled trials (RCTs) found SSB’s increased weight by 0.12 kg/serving/year (95% confidence interval [CI]: 0.10–0.14) in adults (124).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [124]
In the citing paper
“This may be an important consideration given the emerging evidence of sugar-sweetened beverages (SSB) in the aetiology of obesity( 102 , 103 ) and cardiometabolic risk( 104 , 105 ).”
From Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality (2015) · cites this paper as [103]
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“Meanwhile, there is no doubt that added sugars and sugar-containing soft drinks are important determinants of blood pressure, serum lipids and bodyweightwithin the free-living population consuming an ad libitum diet [207,208].”
BackgroundShould We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence
Allcott, H., Lockwood, B., & Taubinsky, D. (2019) · The Journal of Economic Perspectives · doi:10.1257/jep.33.3.202 · Cited by 254
“For reviews of cohort studies, see Vartanian, Schwartz, and Brownell (2007) and Malik et al. (2013).”
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“[77] Meta-analysis of 5 trials 2 of 5 trials resulted in significant weight loss from reducing sugar calories in one model but not another”
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Chazelas, E., Srour, B., Desmetz, E., Kesse-Guyot, E., Julia, C., Deschamps, V., Druesne-Pecollo, N., Galan, P., Hercberg, S., Latino-Martel, P., et al. (2019) · BMJ · doi:10.1136/bmj.l2408 · Cited by 225
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Functionality of sugars in foods and health
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Determinants of sugar‐sweetened beverage consumption in young children: a systematic review
Paes, V. M., Hesketh, K. R., O’Malley, C. L., Moore, H. J., Summerbell, C., Griffin, S. J., van Sluijs, E. M. F., Ong, K. K., & Lakshman, R. (2015) · Obesity Reviews · doi:10.1111/obr.12310 · Cited by 237
“Moreover, recent systematic reviews on experimental evidence show that reducing SSB consumption in young children is successful in reducing obesity (15,16).”
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“The disappearance or marked attenuation of the effect of SSBs on weight gain after adjustment for total energy in one meta-analysis [55] and on diabetes risk after adjustment of adiposity [56], a proxy of high caloric intake, in another meta-analysis suggests that the effect of SSBs on cardiometabolic diseases appears…”
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“In particular, a decrease in the consumption of sugar-sweetened beverages leads to a reduced prevalence of obesity and related diseases [198,199].”
BackgroundGene-Diet Interaction and Precision Nutrition in Obesity
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“Intake of free sugars or sugar sweetened beverages is a determinant of body weight [48,49].”
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“Previous reviews in this topic have focused on establishing associations between higher intakes of SSB and detrimental health outcomes (3,5,6) or have been focused on identifying effective components in interventions aimed exclusively at children (28,29) or adolescents within specific settings (such as the school) (30…”
BackgroundEffect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis
Valenzuela, M. J., Waterhouse, B., Aggarwal, V. R., Bloor, K., & Doran, T. (2021) · European Journal of Public Health · doi:10.1093/eurpub/ckaa147 · Cited by 194
Uric Acid as a Cause of the Metabolic Syndrome
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“Given that almost all SSB are high in calories and not dense in nutrients, their consumption has been associated with excess body weight [27,28], type 2 diabetes [29–31] and CVD [32,33].”
BackgroundBehavioral factors influencing childhood obesity: a systematic review and meta-analysis
Poorolajal, J., Sahraei, F., Mohamdadi, Y., Doosti‐Irani, A., & Moradi, L. (2020) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2020.03.002 · Cited by 189
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A genome-wide association study of bitter and sweet beverage consumption
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“Furthermore, prospective and cross-sectional studies, performed in different countries, indicate a strong association between the elevated consumption of soft drinks and weight gain and obesity (12,33 – 35) .”
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An overview of the nutrition transition in West Africa: implications for non-communicable diseases
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McGlynn, N. D., Khan, T. A., Wang, L., Zhang, R., Chiavaroli, L., Au‐Yeung, F., Lee, J. J., Noronha, J. C., Comelli, E. M., Mejía, S. B., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.2092 · Cited by 169
Self-citationUltraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms
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Adjustment for energy intake in nutritional research: a causal inference perspective
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Red and Processed Meats and Health Risks: How Strong Is the Evidence?
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“and that limits energy-dense nutrient-poor (EDNP) foods and beverages [1].”
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Nonnutritive sweeteners in weight management and chronic disease: a review
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“Given the wellestablished associations among added sugars, obesity (2), type 2 diabetes (3), cardiovascular disease (4), nonalcoholic fatty liver disease (5), and cancer (6), the 2015 Dietary Guidelines for Americans recommend limiting added sugar to less than 10% of total energy intake (7), and similar guidance has b…”
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“Intake of SSB has been consistently associated with weight gain and risk of diabetes [83].”
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Metadata
- Authors
- Malik, V. S., Pan, A., Willett, W. C., & Hu, F. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 98
- Issue
- 4
- Pages
- 1084-1102
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC3778861
- OpenAlex
- W2163234420
- Cited by
- 1,668
- References
- 85
- Citations by year
- 2026: 59 · 2025: 95 · 2024: 82 · 2023: 119 · 2022: 143 · 2021: 164 · 2020: 181 · 2019: 174 · 2018: 165 · 2017: 156 · 2016: 118 · 2015: 128 · 2014: 75 · 2013: 4
- FWCI
- 15.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL60712, R01HL060712)
- National Cancer Institute (U54CA155626)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, P30DK046200, P30 DK-46200, DK58845, T32DK007703)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- sugar-sweetened beverages, weight gain, body mass index, children, adults, overweight children, school-based education programs, randomized controlled trials, prospective cohort
- MeSH terms
- Adolescent, Adult, Beverages, Child, Child, Preschool, Female, Humans, Male, Prospective Studies, Cohort Studies, Weight Gain, Bias, Body Mass Index, Randomized Controlled Trials as Topic, Dietary Sucrose
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