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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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“They have been singled out as the largest driver of the obesity epidemic (7), and systematic reviews have demonstrated that consuming SSBs is linked with weight gain in children and adults (8), a higher risk of hypertension and coronary heart disease (9), and increased incidence of type 2 diabetes (10).”
BackgroundAssociation between Sugar-Sweetened Beverage Consumption and Executive Function in Children
Gui, Z., Huang, S., Chen, Y., Zhao, Y., Jiang, N., Zhang, S., & Chen, Y. (2021) · Nutrients · doi:10.3390/nu13124563 · Cited by 30
“The harmful impact of SSB on cardiometabolic health has been well documented, and it is associated with greater risks of obesity [7], hypertension [8], type 2 diabetes (independently of adiposity) [9], and cardiometabolic death [10].”
BackgroundKraak, V. I., Stanley, K. C., Harrigan, P. B., & Zhou, M. (2022) · Obesity Reviews · doi:10.1111/obr.13425 · Cited by 26
Lacerda, E. M. D. A., Bertoni, N., Alves‐Santos, N. H., Carneiro, L. B. V., Schincaglia, R. M., Boccolini, C. S., de Castro, I. R. R., dos Anjos, L. A., Berti, T. L., Kac, G., et al. (2023) · Cadernos de Saúde Pública · doi:10.1590/0102-311xen081422 · Cited by 30
“Some meta-analyses revealed that the consumption of these beverages is associated with a greater chance of weight gain 54 , symptoms of attention-deficit hyperactivity disorder 55 , increased systolic blood pressure and hypertension 56 , dyslipidemia 57 , and overweight and obesity when consumption…”
BackgroundBjelland, M., Hausken‐Sutter, S. E., Sleddens, E. F. C., Andersen, L. F., Lie, H. C., Finset, A., Maes, L., Melbye, E. L., Glavin, K., Hanssen-Bauer, M. W., et al. (2014) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-014-0130-z · Cited by 23
“These behaviours were also chosen because they are regarded as important contributors to child health and the prevention of obesity and related chronic diseases [27-29].”
BackgroundGoryakin, Y., Monsivais, P., & Suhrcke, M. (2017) · Food Policy · doi:10.1016/j.foodpol.2017.09.002 · Cited by 26
“Three systematic reviews (Malik et al., 2013, 2006; Vartanian et al., 2007), as well as another review article (Hu, 2013) concluded there was evidence of a positive association between individual-level soft drink intake and body weight or the odds of overweight and obesity.”
BackgroundZm, L., Tse, L. A., Chan, D., Wong, C. K. M., & Wong, S. Y. S. (2017) · International Journal of Obesity · doi:10.1038/ijo.2017.292 · Cited by 23
Kirkpatrick, S. I., Raffoul, A., Maynard, M. S., Lee, K. M., & Stapleton, J. E. (2018) · Nutrients · doi:10.3390/nu10081036 · Cited by 23
“…by method-related issues, including small sample sizes, short duration of follow-up, lack of repeated measures in dietary exposures and outcomes Malik et al. (2013) 2 (Brazil, U.K.; 1 year follow-up) Educational strategies to discourage SSB consumption within schools Children, aged 8–16 years -”
BackgroundMethodInfluentialIndustry use of ‘better-for-you’ features on labels of sugar-containing beverages
Brownbill, A., Miller, C. L., & Braunack‐Mayer, A. (2018) · Public Health Nutrition · doi:10.1017/s1368980018002392 · Cited by 23
“The high global consumption of sugar-containing beverages has gained international public health attention due to its contribution to obesity (1) and non-communicable diseases such as type 2 diabetes (2) , CVD risk factors (3) and tooth decay (4) .”
Hunt, K. J., Peter, J. V. S., Malek, A. M., Vrana-Diaz, C. J., Marriott, B. P., & Greenberg, D. (2020) · Nutrients · doi:10.3390/nu12092566 · Cited by 23
“The role of LCS in weight management remains controversial as randomized controlled trials typically find LCS to be of benefit in weight loss programs [24,27,32], yet some cohort studies associate LCS consumption with higher body weight [30,31,33].”
BackgroundAn In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption
Miller, C. L., Ettridge, K. A., Wakefield, M. A., Pettigrew, S., Coveney, J., Roder, D. M., Durkin, S. J., Wittert, G., Martin, J. E., & Dono, J. (2020) · Nutrients · doi:10.3390/nu12092841 · Cited by 26
Sugar content and nutrient content claims of growing‐up milks in Indonesia
Pries, A. M., Mulder, A. M., Badham, J., Sweet, L., Yuen‐Esco, K., & Zehner, E. R. (2021) · Maternal and Child Nutrition · doi:10.1111/mcn.13186 · Cited by 23
Pfinder, M., Katikireddi, S. V., Pega, F., Gartlehner, G., Fenton, C., Griebler, U., Sommer, I., Heise, T. L., & Lhachimi, S. K. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012333 · Cited by 24
Yracheta, J., Alfonso, J., Lanaspa, M. A., Roncal-Jiménez, C. A., Johnson, S. B., Sánchez‐Lozada, L. G., & Johnson, R. J. (2015) · Postgraduate Medicine · doi:10.1080/00325481.2015.1021234 · Cited by 23
“In turn, multiple studies have confirmed that intake of sugarsweetened beverages is strongly associated with the development of obesity and diabetes [59-61].”
BackgroundCampbell, R., Tasevska, N., Jackson, K. G., Sági‐Kiss, V., di Paolo, N., Mindell, J. S., Lister, S. J., Khaw, K., & Kuhnle, G. (2017) · PLoS ONE · doi:10.1371/journal.pone.0179508 · Cited by 23
Can the Government Require Health Warnings on Sugar-Sweetened Beverage Advertisements?
Pomeranz, J. L., Mozaffarian, D., & Micha, R. (2018) · JAMA · doi:10.1001/jama.2017.19209 · Cited by 22
Lewis, K. H., Skelton, J. A., Hsu, F., Ezouah, P., Taveras, E. M., & Block, J. P. (2018) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2018.06.007 · Cited by 19
“Sugar-sweetened beverage (SSB) consumption is a modifiable risk factor for childhood obesity, (de Ruyter et al., 2012; Ebbeling et al., 2012; Malik et al., 2013; Dong et al., 2015; Hu, 2013; Trumbo and Rivers, 2014; Millar et al., 2014; Pan et al., 2014) and has been linked to adverse health outcomes such as cardiomet…”
BackgroundMaternal predictors of infant beverage consumption: results from the Nurture cohort study
Tovar, A., Vadiveloo, M. K., Østbye, T., & Benjamin‐Neelon, S. E. (2019) · Public Health Nutrition · doi:10.1017/s1368980019000934 · Cited by 22
Heterogeneity in Metabolic Responses to Dietary Fructose
Hou, R., Panda, C., & Voruganti, V. S. (2019) · Frontiers in Genetics · doi:10.3389/fgene.2019.00945 · Cited by 22
“However, several studies included in the meta-analysis in adults or children reported no difference in BMI based on SSB consumption (Libuda et al., 2008; Vanselow et al., 2009; Reid et al., 2010; Malik et al., 2013).”
ResultPsychometric Evaluation of the German Version of the Dietary Fat and Free Sugar-Short Questionnaire
Fromm, S. P., & Horstmann, A. (2019) · Obesity Facts · doi:10.1159/000501969 · Cited by 23
Miracle Berry as a Potential Supplement in the Control of Metabolic Risk Factors in Cancer
de Cedrón, M. G., Wagner, S., Reguero, M., Menéndez‐Rey, A., & de Molina, A. R. (2020) · Antioxidants · doi:10.3390/antiox9121282 · Cited by 26
Socio-economic inequalities in dietary intake in Chile: a systematic review
Vega‐Salas, M. J., Caro, P., Johnson, L., & Papadaki, A. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002937 · Cited by 23
Thompson, A. S., Gaggl, M., Bondonno, N. P., Jennings, A., O’Neill, J. K., Hill, C., Karavasiloglou, N., Rohrmann, S., Cassidy, A., & Kuhn, T. E. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.09.021 · Cited by 22
Changes in Obesity Between Fifth and Tenth Grades: A Longitudinal Study in Three Metropolitan Areas
Schuster, M. A., Elliott, M. N., Bogart, L. M., Klein, D. J., Feng, J. Y., Wallander, J. L., Cuccaro, P. M., & Tortolero, S. R. (2014) · PEDIATRICS · doi:10.1542/peds.2014-2195 · Cited by 22
Dietary habits among children aged 8-9 years in Italy.
Lauria, L., Spinelli, A., Cairella, G., Censi, L., Nardone, P., & Buoncristiano, M. (2015) · Annali dell Istituto Superiore di Sanità · doi:10.4415/ann_15_04_20 · Cited by 22
“The cumulative evidence from observational studies and experimental trials is sufficient to conclude that regular consumption of SSBs causes excess weight gain [47].”
BackgroundBeyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children’s Diets
Dunaway, L. F., Carton, T. W., Ma, P., Mundorf, A. R., Keel, K., & Theall, K. P. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14060662 · Cited by 23
Mendy, V. L., Vargas, R., Payton, M., & Cannon-Smith, G. (2017) · Preventing Chronic Disease · doi:10.5888/pcd14.170268 · Cited by 22
Study, O. B. O. T. F., Celis-Morales, C. A., Livingstone, K. M., Affleck, A., Navas‐Carretero, S., San-Cristóbal, R., Martínez, J. A., Marsaux, C. F. M., Saris, W. H. M., O’Donovan, C. B., et al. (2017) · European Journal of Clinical Nutrition · doi:10.1038/s41430-017-0004-y · Cited by 21
“This is in agreement with a systematic review which found that sugar sweetened carbonated drinks and sweets snacking were associated with increased obesity risk [32].”
Wang, H., Jeong, H., Kim, N.-H., Kang, Y. J., Hwang, K., Lee, H., Hong, J.-H., & Oh, K.-S. (2018) · Nutrition Research and Practice · doi:10.4162/nrp.2018.12.4.307 · Cited by 22
“Carbonated beverages include high contents of high-fructose corn syrup with high energy density thereby increasing the calorie intake leading to increased risk of obesity [45,49-51].”
BackgroundCharacteristics Associated with Household Purchases of Sugar‐Sweetened Beverages in US Restaurants
Moran, A. J., Subramanian, S. V., Rimm, E. B., & Bleich, S. N. (2019) · Obesity · doi:10.1002/oby.22380 · Cited by 22
“This list of 78 restaurants was compiled based on the following characteristics: (1) restaurant is included in MenuStat, a database with nutrient information for the top restaurants by US sales based on a list from Nation’s Restaurant News in 2012 (n = 66) or (2) restaurant is not included in MenuStat but is included…”
BackgroundGonzález-Morales, R., Canto‐Osorio, F., Stern, D., Sánchez‐Romero, L. M., Torres‐Ibarra, L., Hernández‐López, R., Rivera‐Paredez, B., Vidaña‐Pérez, D., Ramírez‐Palacios, P., Salmerón, J., et al. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-00963-2 · Cited by 23
“However, experimental studies have had short durations, ranging from 3 weeks to 6 months, providing a limited time frame for body weight change [3].”
BackgroundThe Aetiology of Olfactory Dysfunction and Its Relationship to Diet Quality
Stevenson, R. J., Mahmut, M. K., Horstmann, A., & Hummel, T. R. (2020) · Brain Sciences · doi:10.3390/brainsci10110769 · Cited by 22
“On the diet questionnaire, many of the purely sweet items are sugar-sweetened beverages, which are an interesting category of nutrient as they are strongly linked to obesity yet are not typically thought of as foods [35].”
BackgroundChildren and adults' sensory and hedonic perception of added sugar reduction in grape nectar
Lima, M., Ares, G., & Deliza, R. (2018) · Journal of Sensory Studies · doi:10.1111/joss.12317 · Cited by 22
Beun, R. J., Luiten, C., Verbeek, C., & Poelman, M. P. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2020.564529 · Cited by 22
“Reducing SSB consumption is important, because it is related to an excess of weight gain in children (8, 9).”
BackgroundNutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida
McPherson, A. C., Chen, L., O’Neil, J., & Vanderbom, K. A. (2020) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-200753 · Cited by 21
Dono, J., Ettridge, K. A., Wakefield, M., Pettigrew, S., Coveney, J., Roder, D., Durkin, S. J., Wittert, G., Martin, J., & Miller, C. L. (2021) · Public Health Nutrition · doi:10.1017/s1368980021000239 · Cited by 23
Dong, Y., Li, W., & Yin, J. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2253468 · Cited by 23
“While evidence from randomized controlled trials is limited and mainly focused on the short-term effects of SSBs on body weight, a meta-analysis across multiple trials has shown that adding SSBs to the diet significantly increased body weight (Malik et al. 2013).”
A Narrative Review of Public Health Interventions for Childhood Obesity
Heerman, W. J., Kenney, E. L., Block, J. P., Fiechtner, L. G., McMahon, E. L., Kruse, L., Sharifi, M., Edmondson, E. K., & Virudachalam, S. (2024) · Current Obesity Reports · doi:10.1007/s13679-023-00550-z · Cited by 25
“Youth consumption of added sugars from sweetened beverages, like fruit drinks and soda, is strongly associated with obesity and its downstream consequences [94–97].”
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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