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. 2020;13(4):397-417.
doi: 10.1159/000508843. Epub 2020 Aug 12.

Environmental Interventions to Reduce the Consumption of Sugar-Sweetened Beverages: Abridged Cochrane Systematic Review

Peter von Philipsborn  1   2 , Jan M Stratil  3   4 , Jacob Burns  3   4 , Laura K Busert  5 , Lisa M Pfadenhauer  3   4 , Stephanie Polus  3   4 , Christina Holzapfel  6 , Hans Hauner  6 , Eva A Rehfuess  3   4
Affiliations

Environmental Interventions to Reduce the Consumption of Sugar-Sweetened Beverages: Abridged Cochrane Systematic Review

Peter von Philipsborn et al. Obes Facts. 2020.

Abstract

Background: Regular consumption of sugar-sweetened beverages (SSB) can increase the risk for obesity, type 2 diabetes, cardiovascular disease, and dental caries. Interventions that alter the physical or social environment in which individuals make beverage choices have been proposed to reduce the consumption of SSB.

Methods: We included randomised controlled, non-randomised controlled, and interrupted time series studies on environmental interventions, with or without behavioural co-interventions, implemented in real-world settings, lasting at least 12 weeks, and including at least 40 individuals. Studies on the taxation of SSB were not included, as these are subject of a separate Cochrane review. We used standard Cochrane methods for data extraction, risk of bias assessment, and evidence grading and synthesis. Searches were updated to January 24, 2018.

Results: We identified 14,488 unique records and assessed 1,030 full texts for eligibility. We included 58 studies comprising a total of 1,180,096 participants and a median length of follow-up of 10 months. We found moderate-certainty evidence for consistent associations with decreases in SSB consumption or sales for the following interventions: traffic light labelling, price increases on SSB, in-store promotion of healthier beverages in supermarkets, government food benefit programs with incentives for purchasing fruits and vegetables and restrictions on SSB purchases, multi-component community campaigns focused on SSB, and interventions improving the availability of low-calorie beverages in the home environment. For the remaining interventions we found low- to very-low-certainty evidence for associations showing varying degrees of consistency.

Conclusions: With observed benefits outweighing observed harms, we suggest that environmental interventions to reduce the consumption of SSB be considered as part of a wider set of measures to improve population-level nutrition. Implementation should be accompanied by evaluations using appropriate methods. Future studies should examine population-level effects of interventions suitable for large-scale implementation, and interventions and settings not yet studied thoroughly.

Keywords: Cochrane; Interventions; Sugar-sweetened beverages; Systematic review.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: J.M.S., J.B., L.K.B., L.M.P., S.P., and E.A.R. have received support from LMU Munich for the submitted work; J.M.S. has received support from the Bavarian Office for Health and Food Safety for the submitted work; P.P., C.H., and H.H. have received support from Technical University Munich for the submitted work; C.H. is a member of the scientific advisory board of 4sigma GmbH, a consultancy working primarily for health insurance companies; C.H. has been involved in the preparation of a systematic review on Associations between single nucleotide polymorphisms and macronutrient intake (PROSPERO: CRD42015025738), partly funded by an institutional grant from the consumer products company Amway GmbH; H.H. has received honoraria for membership on scientific advisory boards of Weight Watchers, NovoNordisk and Boehringer Ingelheim, and honoraria for membership on scientific advisory boards of Nestle and Danone, providing advice on recommendations regarding the nutritional content of breakfast meals and dairy products; H.H.'s institution has received grants from Riemser Pharma, Amway GmbH and Certmedica, a producer of slimming products; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
PRISMA flow chart.
See this image and copyright information in PMC

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