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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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“Recent reviews indicated that only some studies reported significant relations between 312 these parameters and BMI (Malik et al., 2013; Must, Barish, & Bandini, 2009).”
Prenatal and Early Life Fructose, Fructose-Containing Beverages, and Midchildhood Asthma
Wright, L. S., Rifas‐Shiman, S. L., Oken, E., Litonjua, A. A., & Gold, D. R. (2017) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201707-530oc · Cited by 68
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“For example, consumption of SSB may result in an incomplete compensatory reduction in energy intake at subsequent meals after intake of liquid energy, and/or unregulated hepatic uptake and metabolism of fructose, which in turn leads to liver lipid accumulation, dyslipidaemia, decreased insulin sensitivity and increase…”
Huang, Y., Kypridemos, C., Liu, J., Lee, Y., Pearson‐Stuttard, J., Collins, B., Bandosz, P., Capewell, S., Whitsel, L. P., Wilde, P., et al. (2019) · Circulation · doi:10.1161/circulationaha.118.036751 · Cited by 61
“4 The final model incorporated (1) associations of added sugars from SSBs and from other foods with BMI; (2) subsequent BMI-mediated effects on CHD, stroke, and diabetes mellitus; and (3) separate BMIindependent associations of added sugars from SSBs (but not from other foods) with CHD and diabetes mellitus (Table III…”
BackgroundSugar-sweetened beverage consumption and bone health: a systematic review and meta-analysis
Ahn, H., & Park, Y. K. (2021) · Nutrition Journal · doi:10.1186/s12937-021-00698-1 · Cited by 56
“This increase in sugar intake through beverages and its potential adverse effects on public health are of major concern [4].”
BackgroundScheelbeek, P., Cornelsen, L., Marteau, T. M., Jebb, S. A., & Smith, R. (2019) · BMJ · doi:10.1136/bmj.l4786 · Cited by 56
Alvarado, M., Kostova, D., Suhrcke, M., Hambleton, I. R., Hassell, T., Samuels, T. A., Adams, J. M., & Unwin, N. C. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.07.013 · Cited by 56
van Opstal, A. M., Kaal, I., van den Berg‐Huysmans, A. A., Hoeksma, M. R., Blonk, C., Pijl, H., Rombouts, S. A. R. B., & van der Grond, J. (2018) · Nutrition · doi:10.1016/j.nut.2018.09.004 · Cited by 57
Notario-Barandiarán, L., Valera‐Gran, D., González‐Palacios, S., de la Hera, M. G., Fernández‐Barrés, S., Pereda, E. P., Fernández‐Somoano, A., Guxens, M., Íñiguez, C., Romaguera, D., et al. (2020) · International Journal of Obesity · doi:10.1038/s41366-020-0557-z · Cited by 57
Bel‐Serrat, S., Ojeda‐Rodríguez, A., Heinen, M. M., Buoncristiano, M., Abdrakhmanova, S., Duleva, V. L., Sant’Angelo, V. F., Fijałkowska, A., Hejgaard, T., Petrescu, C. H., et al. (2019) · Nutrients · doi:10.3390/nu11030511 · Cited by 56
“Low fruit and vegetable (F&V) intake [4,5], consumption of high energy-dense/nutrient-poor foods [6,7], low physical activity (PA) levels and high sedentary time [8,9] have individually been associated with childhood overweight and obesity in a large number of studies; however, their effects on children’s lifestyles a…”
BackgroundLane, M. M., Travica, N., Gamage, E., Marshall, S., Trakman, G., Young, C., Teasdale, S. B., Dissanayaka, T. D., Dawson, S. L., Orr, R., et al. (2024) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-062322-020650 · Cited by 56
Regional Differences in Sugar-Sweetened Beverage Intake among US Adults
Park, S., McGuire, L. C., & Galuska, D. A. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2015.06.010 · Cited by 55
Impact of sugars and sugar taxation on body weight control: A comprehensive literature review
Bes‐Rastrollo, M., Sayón-Orea, C., Ruiz‐Canela, M., & Martínez‐González, M. Á. (2016) · Obesity · doi:10.1002/oby.21535 · Cited by 59
“The statement by the 2015 US DGAC highlighting the strong evidence for the association between added-sugar intake and obesity comes from three of the most recent and comprehensive metaanalyses included in Table 1 (11,21,22).”
BackgroundHaycraft, E., Karasouli, E., & Meyer, C. (2017) · Appetite · doi:10.1016/j.appet.2017.05.033 · Cited by 55
Prospective association between added sugars and frailty in older adults
Laclaustra, M., Rodríguez‐Artalejo, F., Guallar‐Castillón, P., Banegas, J. R., Graciani, A., García‐Esquinas, E., Ordovás, J. M., & López‐García, E. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy028 · Cited by 58
Effect of flavored milk vs plain milk on total milk intake and nutrient provision in children
Fayet‐Moore, F. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuv031 · Cited by 54
“Added sugar has been recently linked to cardiovascular disease mortality(14) and lower nutrient density of children’s diets(11); moreover, added sugar from beverages has been associated with weight gain among children in a study whose definition of beverages did not include flavored milk.(15) Although other beverages…”
BackgroundInfant feeding practices in a South African birth cohort—A longitudinal study
Budree, S., Goddard, E., Brittain, K., Cader, S., Myer, L., & Zar, H. J. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12371 · Cited by 54
Löfvenborg, J. E., Andersson, T., Carlsson, P., Dorkhan, M., Groop, L., Martinell, M., Tuomilehto, J., Wolk, A., & Carlsson, S. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0376 · Cited by 56
Perrar, I., Schadow, A. M., Schmitting, S., Buyken, A. E., & Alexy, U. (2019) · Nutrients · doi:10.3390/nu12010020 · Cited by 53
“In particular, a high intake of sugars from liquid sources may be detrimental for health: Due to a lack of satiety [17] and incomplete compensation of liquid calories [10], a high sugar intake from SSB promotes weight gain and the development of overweight [3,12,13,18] or diabetes [11,15].”
BackgroundWeston, L. J., Kim, H., Talegawkar, S. A., Tucker, K. L., Correa, A., & Rebholz, C. M. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1003863 · Cited by 56
“The added sugar and calories from added sugar in SSBs can result in weight gain [41].”
BackgroundGlobal Coverage and Design of Sugar-Sweetened Beverage Taxes
Hattersley, L. A., & Mandeville, K. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.1412 · Cited by 59
Sørensen, L. B., Vasilaras, T. H., Astrup, A. V., & Raben, A. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.081554 · Cited by 54
Atay, Z., & Bereket, A. (2016) · Obesity Medicine · doi:10.1016/j.obmed.2016.05.005 · Cited by 55
Tasevska, N., DeLia, D., Lorts, C., Yedidia, M. J., & Ohri‐Vachaspati, P. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.03.013 · Cited by 53
Yu, Z., Ley, S. H., Sun, Q., Hu, F. B., & Malik, V. (2018) · British Journal Of Nutrition · doi:10.1017/s0007114517003841 · Cited by 56
“SSB are composed of energy-containing sweeteners such as sucrose (50 % glucose, 50% fructose), high-fructose maize syrup (HFCS; 45 % glucose and 55% fructose or 58 % glucose and 42 % fructose), or fruit juice concentrates (46) .”
Self-citationPowell, L. M., Leider, J., & Léger, P. T. (2020) · Annals of Internal Medicine · doi:10.7326/m19-2961 · Cited by 53
Gibson, S., Horgan, G., Francis, L., Gibson, A., & Stephen, A. (2016) · Nutrients · doi:10.3390/nu8010009 · Cited by 52
“The majority of randomised controlled trials (RCTs) among adults suggest that using LCB instead of caloric beverages over several weeks or months results in modest weight loss [10–13], although results vary by age, sex, ethnicity, or weight status groups [14].”
BackgroundTakeuchi, M. (2016) · Diagnostics · doi:10.3390/diagnostics6020023 · Cited by 52
“The increased consumption of SSB has been observed not only in Western, but also in Asian countries [122], and has been extensively associated with an increased risk of DM and also with weight gain, obesity, MetS, hypertriglyceridemia, coronary heart disease, and hypertension [123–129].”
BackgroundFluid intake in urban China: results of the 2016 Liq.In 7 national cross-sectional surveys
Zhang, N., Morin, C., Guelinckx, I., Moreno, L. A., Kavouras, S. A., Gandy, J., Martínez, H., Salas‐Salvadó, J., & Ma, G. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1755-5 · Cited by 55
“Excessive SSB consumption increases risk of dental caries [12], weight gain [13], obesity [14], risk of developing the metabolic syndrome [15], type 2 diabetes [16], and dyslipidaemia [17].”
BackgroundSilver nanoparticles-based plasmonic assay for the determination of sugar content in food matrices
Pelle, F. D., Scroccarello, A., Scarano, S., & Compagnone, D. (2018) · Analytica Chimica Acta · doi:10.1016/j.aca.2018.11.015 · Cited by 51
Kuhnle, G., Tasevska, N., Lentjes, M. A. H., Griffin, J. L., Sims, M., Richardson, L., Aspinall, S. M., Mulligan, A. A., Luben, R., & Khaw, K. (2015) · Public Health Nutrition · doi:10.1017/s1368980015000300 · Cited by 52
“While public perception suggests that the intake of sugar is associated with an increased risk of obesity and thus overweight people consume more sugar((3)), data from observational studies are inconsistent and weight increase or markers of obesity are associated mainly with the intake of sugar-sweetened beverages but…”
Pulz, I. S., Martins, P., Feldman, C. H., & Veiros, M. B. (2016) · Perspectives in Public Health · doi:10.1177/1757913916636414 · Cited by 51
Parental Incarceration and Child Sleep and Eating Behaviors
Jackson, D. B., & Vaughn, M. G. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2017.03.026 · Cited by 52
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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