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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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“It concluded that SSB consumption promotes weight gain in children and adults.(12) The 15 RCTs in children showed reductions in body mass index gain when NNS were used to replace SSBs, and these benefits were more pronounced in overweight children compared with normal-weight children.”
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“…a number of long-term prospective cohort studies have documented increased risk for overweight and obesity, cardiovascular disease, hypertension and stroke, type 2 diabetes, and metabolic syndrome in adults who regularly consume SSB (typically one serving or more per day; see Malik et al., 2013).”
Kim, Y., & Je, Y. (2016) · Archives of cardiovascular diseases · doi:10.1016/j.acvd.2015.10.005 · Cited by 94
Stanhope, K. L., Goran, M. I., Bosy‐Westphal, A., King, J. C., Schmidt, L. A., Schwarz, J., Stice, E. M., Sylvetsky, A. C., Turnbaugh, P. J., Bray, G. A., et al. (2018) · Obesity Reviews · doi:10.1111/obr.12699 · Cited by 90
“A 2014 meta-analysis of 19 RCTs lasting 3 months to 2 years with ~3,200 participants showed no significant differences in loss of body weight between participants assigned to consume low-CHO weight loss diets compared with those assigned to consume isocaloric higher-CHO (45–65% of energy) weight loss diets (184).”
BackgroundInfluentialSelf-citationTorruella-Suárez, M. L., Vandenberg, J. R., Cogan, E. S., Tipton, G. J., Teklezghi, A. T., Dange, K., Patel, G., McHenry, J. A., Hardaway, J. A., Kantak, P. A., et al. (2019) · Journal of Neuroscience · doi:10.1523/jneurosci.1466-19.2019 · Cited by 87
“While the current obesity epidemic clearly has a variety of causes, sweetened beverages have emerged as an important target for both study and policy intervention by concerned government entities (Fowler et al., 2008; Malik et al., 2013; CDC, 2017).”
BackgroundMummah, S. A., King, A. C., Gardner, C. D., & Sutton, S. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0400-z · Cited by 77
“A review of the evidence for holistic dietary patterns suggested that the following behaviors offered significant health benefits: increased intake of fruits and vegetables [37–40]; reduced intake of sugar-sweetened beverages [41–43]; and reduced intake of animal products [44, 45].”
BackgroundSerum N 1 -Methylnicotinamide Is Associated With Obesity and Diabetes in Chinese
Liu, M. R., Li, L., Chu, J., Zhu, B., Zhang, Q., Yin, X., Jiang, W., Dai, G., Ju, W., Wang, Z., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-1732 · Cited by 87
Pries, A. M., Huffman, S. L., Adhikary, I., Upreti, S. R., Dhungel, S., Champeny, M., & Zehner, E. R. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12267 · Cited by 91
“Such high rates of sugar and sugary snack food consumption are of grave concern because of the relationship with dental caries (Moynihan 2005), and the increased risk for overweight/obesity and later development of chronic disease (Morenga et al. 2013; Malik et al. 2010; Malik et al. 2013).”
BackgroundThe role of dietary sugars in health: molecular composition or just calories?
Prinz, P. (2019) · European Journal of Clinical Nutrition · doi:10.1038/s41430-019-0407-z · Cited by 89
Al‐Jawaldeh, A., Taktouk, M., & Nasreddine, L. (2020) · Nutrients · doi:10.3390/nu12113345 · Cited by 106
Sugar sweetened beverages and cardiometabolic health
Malik, V. S. (2017) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000439 · Cited by 84
“[1] and risk of type 2 diabetes (T2D) [2,3 && ], which has become the basis of many dietary guidelines and actions already in place targeting SSBs including taxation, banning in schools, restrictions on marketing to children, public awareness campaigns, and front-of-pack labeling [4,5].”
BackgroundMethodSelf-citationRahman, A. A., Jomaa, L., Kahale, L. A., Adair, P., & Pine, C. M. (2017) · Nutrition Reviews · doi:10.1093/nutrit/nux061 · Cited by 85
“Results from well-powered prospective cohort studies and randomized controlled trials (RCTs) support the association between SSB consumption and weight gain in both the short term and the long term among children and adults.(4,11,12) Furthermore, a direct dose–response relationship has been established between SSB con…”
BackgroundCost-Effectiveness Of The Sugar-Sweetened Beverage Excise Tax In Mexico
Basto-Abreu, A. C., Barrientos‐Gutiérrez, T., Vidaña‐Pérez, D., Colchero, M. A., Hernández-F, M., Hernández‐Ávila, M., Ward, Z. J., Long, M. W., & Gortmaker, S. L. (2019) · Health Affairs · doi:10.1377/hlthaff.2018.05469 · Cited by 89
Sánchez‐Romero, L. M., Canto‐Osorio, F., González-Morales, R., Colchero, M. A., Ng, S., Ramírez‐Palacios, P., Salmerón, J., & Barrientos‐Gutiérrez, T. (2020) · BMJ · doi:10.1136/bmj.m1311 · Cited by 93
Sugars and risk of mortality in the NIH-AARP Diet and Health Study
Tasevska, N., Park, Y., Jiao, L., Hollenbeck, A. R., Subar, A. F., & Potischman, N. A. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.069369 · Cited by 84
“Although all sugars are chemically indistinguishable, added sugars (ie, sugars added at the table or used as ingredients in processed or prepared foods and drinks) have been more often associated with adverse health effects (16, 19, 28, 29), given that they are sourced from foods that are energy-dense and nutrientand…”
BackgroundMorgan, E. H., Schoonees, A., Sriram, U., Faure, M. C., & Seguin‐Fowler, R. A. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012547.pub2 · Cited by 94
Dror, D. K. (2014) · Obesity Reviews · doi:10.1111/obr.12158 · Cited by 84
“Survey data demonstrate an inverse association between consumption of milk and sugar-sweetened beverages (45), which are independently associated with weight gain and obesity (46).”
BackgroundThe Origins of the Obesity Epidemic in the USA–Lessons for Today
Temple, N. (2022) · Nutrients · doi:10.3390/nu14204253 · Cited by 82
“RCTs and prospective cohort studies have generated strong evidence that consumption of SSBs leads to higher energy intake and more weight gain [22,23].”
BackgroundMéndez, M. A., Miles, D. R., Poti, J. M., Sotres‐Alvarez, D., & Popkin, B. M. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy123 · Cited by 87
Role of fruit juice in achieving the 5-a-day recommendation for fruit and vegetable intake
Benton, D., & Young, H. A. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuz031 · Cited by 90
“A meta-analysis illustrates a common problem.(21) When 20 cohort studies of children and 7 studies of”
Lakerveld, J., Woods, C. B., Hebestreit, A., Brenner, H., Flechtner‐Mors, M., Harrington, J. M., Kamphuis, C. B. M., Laxy, M., Łuszczyńska, A., Mazzocchi, M., et al. (2020) · Food Policy · doi:10.1016/j.foodpol.2020.101873 · Cited by 83
“…a backward mapping methodology (Elmore, 1979) crucial conditions for successful implementation will be identified using the Theory of change (De Silva et al., 2014) approach which allows also analyse normative and ambiguities conflicts involved in policies when they are implemented (Matland, 1995).”
MethodVasques‐Monteiro, I. M. L., Silva-Veiga, F. M., Miranda, C. S., Gonçalves, É. C. B. D. A., Daleprane, J. B., & Souza‐Mello, V. (2021) · Nutrition Research · doi:10.1016/j.nutres.2021.04.008 · Cited by 88
Itria, A., Borges, S. S., Rinaldi, A. E. M., Nucci, L. B., & Enes, C. C. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002901 · Cited by 86
Beverage Intake During Pregnancy and Childhood Adiposity
Gillman, M. W., Rifas‐Shiman, S. L., Fernández‐Barrés, S., Kleinman, K., Taveras, E. M., & Oken, E. (2017) · PEDIATRICS · doi:10.1542/peds.2017-0031 · Cited by 88
Billich, N., Blake, M. R., Backholer, K., Cobcroft, M., Li, V., & Peeters, A. (2018) · Appetite · doi:10.1016/j.appet.2018.05.149 · Cited by 82
Childhood Obesity, Diabetes, and Cardiovascular Disease Risk
Salama, M., Balagopal, B., Fennoy, I., & Kumar, S. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad361 · Cited by 96
Laverty, A. A., Magee, L., Monteiro, C. A., Saxena, S. K., & Millett, C. J. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-015-0297-y · Cited by 90
Mirmiran, P., Yuzbashian, E., Asghari, G., Hosseinpour‐Niazi, S., & Azizi, F. (2015) · Nutrition & Metabolism · doi:10.1186/s12986-015-0021-6 · Cited by 86
“Higher SSB intakes in adults may enhance risk of weight gain and of developing obesity and obesity-related disorders, such as MetS, type 2 diabetes, coronary heart disease, and stroke [10, 11].”
BackgroundMatheson, B. E., & Douglas, J. M. (2017) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-017-0103-7 · Cited by 81
Stępień, M., Duarte‐Salles, T., Fedirko, V., Trichopoulou, A., Λάγιου, Π., Bamia, C., Overvad, K., Tjønneland, A. M., Hansen, L., Boutron‐Ruault, M., et al. (2014) · European Journal of Nutrition · doi:10.1007/s00394-014-0818-5 · Cited by 84
“The observed link between intake of soft drinks and HCC could be mediated through some conditions associated with HCC, such as obesity [33, 34].”
BackgroundHealth Warning Labels Correct Parents’ Misperceptions About Sugary Drink Options
Moran, A. J., & Roberto, C. A. (2018) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.04.018 · Cited by 82
“drinks, fruit drinks, and sweetened tea—are healthier or less disease-promoting options for their children than soda? (2) Are SSB health warning labels more likely to influence beliefs and purchase intentions of sweetened beverages mistakenly viewed more positively than soda? (3) For sugary beverages viewed more posit…”
BackgroundMethodInfluentialWater intake and hydration state in children
Suh, H., & Kavouras, S. A. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1869-9 · Cited by 81
Potter, M. D. E., Brienesse, S. C., Walker, M. M., Boyle, A., & Talley, N. J. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.14039 · Cited by 82
Obesity and eating behavior from the perspective of twin and genetic research
Silventoinen, K., & Konttinen, H. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.12.012 · Cited by 80
“, 2019) and increased weight gain in both children and adults (Luger et al., 2017; Malik et al., 2013).”
BackgroundAn, R. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2015.08.009 · Cited by 81
Farley, T. A., Halper, H. S., Carlin, A. M., Emmerson, K. M., Foster, K. N., & Fertig, A. R. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.303750 · Cited by 80
Fooks, G., Williams, S. N., Box, G., & Sacks, G. (2019) · Globalization and Health · doi:10.1186/s12992-019-0495-5 · Cited by 82
Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?
Dyson, P. A. (2015) · Diabetes Therapy · doi:10.1007/s13300-015-0136-9 · Cited by 84
“carbohydrates, including whole grains, fruit, vegetables, and legumes, have health benefits [35], and those from refined sources, including white bread and white rice and particularly sugar and sugar-sweetened beverages (SSB), are associated with increased risk of obesity, CVD, and type 2 diabetes [36–39].”
BackgroundVizcaíno, M., Buman, M. P., DesRoches, T., & Wharton, C. M. (2020) · BMC Public Health · doi:10.1186/s12889-020-09410-0 · Cited by 78
Miracolo, A., Sophiea, M. K., Mills, M. J., & Kanavos, P. G. (2020) · Health Policy and Planning · doi:10.1093/heapol/czaa168 · Cited by 78
“Human Services, 2014), while elevated SSB consumption is generally associated with an increased risk of developing CVD, metabolic disease and obesity (Malik et al., 2013; Arsenault et al., 2017).”
Background
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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