Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis

Abstract

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.

FIGURE 1.

Flowchart of study search and selection. PubMed, http://www.ncbi.nlm.nih.gov/pubmed; EMBASE, http://www.embase.com; Cochrane, http://www.thecochranelibrary.com/. SSB, sugar-sweetened beverage.

FIGURE 2.

Changes in BMI (95% CI) per 1-serving/d increase in sugar-sweetened beverages during the time period specified in each study from prospective cohort studies in children. Horizontal lines denote 95% CIs; solid diamonds represent the point estimate of each study. Open diamonds represent pooled estimates, and the dashed line denotes the point estimate of the pooled results from the random-effects model (D+L). Study weights are from the random-effects analysis (D+L). Pooled estimates from the random-effects analysis (D + L) and the fixed-effects analysis (I-V) are shown based on 15 cohort studies (n = 25,745). The I² and P values for heterogeneity are shown. D+L, DerSimonian and Laird; I-V, inverse variance.

FIGURE 3.

One-year changes in BMI (95% CI) per 1-serving/d increase in sugar-sweetened beverages from prospective cohort studies in children using a change versus change analysis strategy. Horizontal lines denote 95% CIs; solid diamonds represent the point estimate of each study. Open diamonds represent pooled estimates, and the dashed line denotes the point estimate of the pooled result from the random-effects model (D+L). Weights are from the random-effects analysis (D+L). Pooled estimates from the random-effects analysis (D+L) and the fixed-effects analysis (I-V) are shown based on 7 cohort studies (n = 16,004). The I² and P values for heterogeneity are shown. D+L, DerSimonian and Laird; I-V, inverse variance.

FIGURE 4.

Weighted mean differences in BMI change (95% CI) between the intervention and control regimens from randomized controlled trials in children. Interventions evaluated the effect of reducing sugar-sweetened beverages. Horizontal lines denote 95% CIs; solid diamonds represent the point estimate of each study. Open diamonds represent pooled estimates of the intervention effect, and the dashed line denotes the point estimate of the pooled result from the random-effects model (D+L). Weights are from the random-effects analysis (D+L). Pooled estimates from the random-effects analysis (D+L) and the fixed-effects analysis (I-V) are shown based on 5 randomized controlled trials (n = 2772). The I² and P values for heterogeneity are shown. D+L, DerSimonian and Laird; I-V, inverse variance.

FIGURE 5.

One-year changes (95% CI) in weight (kg) per 1-serving/d increase in sugar-sweetened beverages from prospective cohort studies in adults using a change versus change analysis strategy. Horizontal lines denote 95% CIs; solid diamonds represent the point estimate of each study. Open diamonds represent pooled estimates, and the dashed line denotes the point estimate of the pooled result from the random-effects model (D+L). Weights are from the random-effects analysis (D+L). Pooled estimates from the random-effects analysis (D+L) and the fixed-effects analysis (I-V) are shown based on 7 cohort studies (n = 174,252). The I² and P values for heterogeneity are shown. D+L, DerSimonian and Laird; I-V, inverse variance.

FIGURE 6.

Weighted mean differences (95% CI) in weight change (kg) between the intervention and control regimens from randomized controlled trials in adults. Interventions evaluated the effect of adding sugar-sweetened beverages. Horizontal lines denote 95% CIs; solid diamonds represent the point estimate of each study. Open diamonds represent pooled estimates of the intervention effect, and the dashed line denotes the point estimate of the pooled result from the random-effects model (D+L). Weights are from the random-effects analysis (D+L). Pooled estimates from the random-effects analysis (D+L) and the fixed-effects analysis (I-V) are shown based on 5 randomized controlled trials (n = 292). The I² and P values for heterogeneity are shown. D+L, DerSimonian and Laird; I-V, inverse variance.