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Meta-Analysis
. 2022 Oct 2;13(5):1669-1696.
doi: 10.1093/advances/nmac032.

Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis

E K Rousham  1 , S Goudet  1 , O Markey  1 , P Griffiths  1 , B Boxer  1 , C Carroll  2 , E S Petherick  1   3 , R Pradeilles  1
Affiliations
Meta-Analysis

Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis

E K Rousham et al. Adv Nutr. .

Erratum in

  • Corrections.
    [No authors listed] [No authors listed] Adv Nutr. 2022 Oct 2;13(5):2065. doi: 10.1093/advances/nmac069. Adv Nutr. 2022. PMID: 36183244 Free PMC article. No abstract available.

Abstract

This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.

Keywords: GRADE approach; child; cohort; complementary food; diet; infant; infant and young child nutrition; low-and middle-income countries; sugar-sweetened beverages; ultraprocessed foods.

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Figures

FIGURE 1
FIGURE 1
Flow chart of study search and selection for the review of effects of unhealthy food or beverage consumption in children aged <10.9 y on risk of overweight/obesity.
FIGURE 2
FIGURE 2
Summary risk of bias assessment of nonrandomized studies reporting unhealthy food or beverage consumption and growth, body composition, and overweight/obesity outcomes assessed using ROBINS-I (risk of bias in nonrandomized studies of interventions version I) tool.
FIGURE 3
FIGURE 3
Forest plot of the effect of sugar-sweetened beverage consumption in children aged <10.9 y on BMI. (A) Effect of sugar-sweetened beverage consumption in children aged <10.9 y on BMI change (baseline to follow-up). (B) Effect of sugar-sweetened beverage consumption in children aged <10.9 y on BMI z-score values. REML, residual maximum likelihood.
FIGURE 4
FIGURE 4
Forest plot of the effect of sugar-sweetened beverage consumption in children aged <10.9 y on percentage body fat. REML, residual maximum likelihood.
FIGURE 5
FIGURE 5
Forest plot of the effect of 100% juice consumption in children aged <10.9 y on BMI z-score values. REML, residual maximum likelihood.
See this image and copyright information in PMC

References

    1. Huffman SL, Piwoz EG, Vosti SA, Dewey KG. Babies, soft drinks and snacks: a concern in low- and middle-income countries?. Matern Child Nutr. 2014;10(4):562–74. - PMC - PubMed
    1. Pries AM, Rehman AM, Filteau S, Sharma N, Upadhyay A, Ferguson EL. Unhealthy snack food and beverage consumption is associated with lower dietary adequacy and length-for-age z-scores among 12–23-month-olds in Kathmandu Valley. J Nutr. 2019;149(10):1843–51. - PMC - PubMed
    1. Monteiro CA, Cannon G, Levy R, Moubarac J-C, Jaime P, Martins APet al. . NOVA. The star shines bright. World Nutr. 2016;7(1–3):28–38.
    1. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013;14(S2):21–8. - PubMed
    1. Development Initiatives . 2018 Global nutrition report: shining a light to spur action on nutrition. Bristol (UK): Development Initiatives; 2018.

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