Table 1.
Studies on the the overweight/obesity risk associated with SSB consumption
| Author, Year | Setting | Sample Size | Sample Age | Method of Diet Assessment | SSB Unit of Analysis | Primary Outcome | Direction of Association | Findings |
|---|---|---|---|---|---|---|---|---|
| Cross-Sectional Studies | ||||||||
| Beck, 2013 | Mexican American children recruited from enrollees of Kaiser Permanente Health Plan of Northern California | 319 | 8-10 years | Youth/ Adolescent FFQ | Increment of a serving/day of soda (1 serving = 240ml) | Odds of obesity | Positive | OR = 1.29 [95%CI: 1.13, 1.47]* |
| Bremer, 2010A | Nationally representative sample of U.S. adolescents, NHANES, 1988-1994, 1999-2004 | 1988-1994: 3234 1999-2004: 6967 |
12-19 years | Single 24-hour dietary recall interview | Increment of a serving/day of SSB (1 serving =250g) | Change in BMI percentile for age-sex | Mixed Null for one follow-up Positive for one follow-up |
1988-1994 β = 0.38 [SE: 0.45] 1999-2004 β = 0.93 [SE: 0.18]* |
| Bremer, 2010B | Nationally representative sample of U.S. adolescents, NHANES, 1999-2004 | 6967 | 12-19 years | Single 24-hour dietary recall interview | Increment of a serving/day of SSB (1 serving =250g) | Change in BMI percentile for age-sex | Mixed Positive in two sub-groups Null in one sub-group |
Non-Hispanic White: β = 1.08 [SE: 0.21]* Mexican-American: β = 0.59 [SE: 0.29]* Non-Hispanic Black: β = 0.37 [SE: 0.26] |
| Clifton, 2011 | Australian children as part of Australian National Children’s Nutrition and Physical Activity Survey | 4400 | 2-16 years | Single 24-hour dietary recall interview | Consumed any amount of SSB in last 24 hours | Proportion of overweight or obese children who consumed SSBs vs. proportion of non-overweight children Proportion of obese children who consumed SSBs compared to proportion of non-overweight children |
Mixed Null for one comparison Positive for one comparison |
Overweight and Obese vs. Normal Weight 50% vs. 47% No measure of variation reported Obese vs. Normal Weight 59% vs. 47%* No measure of variation reported |
| Coppinger, 2011 | British schoolchildren in south-west London, UK | 248 | 9-13 years | Three day diary (Friday-Sunday) | mL/day of SSB | Correlation with BMI or BMI z-score | Null | No significant correlation [r= 0.05 for soft drinks and BMI, r=0.10 for fruit beverages] |
| Danyliw, 2012 | Representative survey of Canadian children and adolescents | 10,038 | 2-18 years | Single 24-hour dietary recall interview | Soft drink beverage cluster vs. moderate beverage pattern (mean beverage consumption in each cluster differed by gender and age group) | Odds of overweight-obesity | Mixed Positive in one sub-group Null in other sub-groups |
Males, 6-11 years old OR= 2.3 [95%CI: 1.2, 4.1] * Females, 6-11 years old OR = 0.8 [95%CI: 0.4, 1.7] Males, 12-18 years old OR = 0.7 [95%CI: 0.4-1.2] Females 12-18 years old OR: 1.1 [0.6, 1.9] |
| Davis, 2012 | Low-income Hispanic toddlers from Los Angeles WIC program, 2008 data | 1483 | 2-4 years | Interview about early-life feeding practices and nutritional intake | No SSB vs. High SSB (≥2 SSBs/day) (1 serving = 12 ounces) | Odds of obesity | Positive | OR= 0.69 [95%CI: 0.47, 1.00]* |
| Davis, 2014 | Low-income Hispanic toddlers from Los Angeles WIC program, 2011 data | 2295 | 2-4 years | Interview about early-life feeding practices and nutritional intake | No SSB vs. High SSB (≥2 SSBs/day), (1 serving = 12 ounces) | Odds of obesity | Positive | AOR = 0.72 [95%CI: 0.5, 1.0]* |
| Denova-Gutiérrez, 2009 | Adolescent children of workers at two institutes and one university in Mexico | 1055 | 10-19 years | Semi-quantitative FFQ | Increment of a serving/day of sweetened beverage (1 serving = 240mL) | Change in BMI Odds of obesity |
Positive | β =0.33 95%CI: 0.2, 0.5]* OR=1.55 [95%CI: 1.32, 1.80]* |
| Gibson, 2007 | Children in the UK part of the UK National Dietary and Nutritional Survey of Young People | 1294 | 7-18 years | Seven day weighed food records | Top tertile of caloric soft drink intake (>396kJ/day)) vs. bottom tertile (<163kj/day) | Odds of overweight | Weakly Positive | OR=1.39 [95%CI: 0.96, 2.0] |
| Grimes, 2013 | Nationally representative sample of Australian children | 4283 | 2-16 years | Two 24-hour dietary recalls | More than one serving/day vs. less than one serving/day (1 serving = 250g) | Odds of overweight-obese | Positive | OR=1.26 [95%CI: 1.03, 1.53]* |
| Gómez-Martinez, 2009 | Representative sample of urban Spanish adolescents | 1523 | 13-18 years | Single 24-hour dietary recall | Non-consumers vs. moderate consumption (<336g/day) vs. high consumption (>336g/day) of sweetened soft drinks | Mean BMI | Null | No significant differences in BMI across SSB consumption groups |
| Ha, 2016 | Combination of 5 studies conducted on Korean children between 2002 and 2011 | 2599 | 9-14 years | Three day dietary records | More than one serving/day vs. no SSB (1 serving = 200mL) | Odds of obesity | Mixed Negative in one sub-group Null in one sub-group |
Males OR: 0.52 [95%CI: 0.26, 1.05]* Females OR: 1.36 [95%CI: 0.62, 2.97] |
| Jiménez-Aguilar, 2009 | Representative sample of Mexican adolescents who participated in Mexican National Health and Nutrition Survey | 10,689 | 10-19 years | Semi-quantitative FFQ | Increment of a serving/day of soda (1 serving = 240ml) | Change in BMI | Mixed Positive in one sub-group Null in one sub-group |
Males β =0.17 [95%CI: 0.02, 0.32]* Females β =-0.07 [95%CI: -0.23, 0.10] Note: these results are for soda. See full paper for fruit drinks, sugar beverages and SSBs. |
| Kosova, 2013 | Nationally representative sample of U.S. children from NHANES, 1994-2004 | 4880 | 3-11 years | Single 24-hour dietary recall interview | Increment of a serving/day of SSB (1serving = 250g) | Change in BMI percentile | Mixed Null overall and in some sub-groups Positive in one sub-group |
Overall β =0.71 [SE=0.38] 3-5 year olds β =-0.46 [SE=0.68] 6-8 year olds β =0.19 [SE=0.65] 9-11 year olds β =1.42 [SE=0.46]* |
| Linardakis, 2008 | Children in public kindergartens in a single county in Greece | 856 | 4-7 years | Three day weighed dietary records | High consumers (>250g/day) vs. non/low consumers of sugar-added beverage | Odds of obesity | Positive | OR= 2.35* No measure of variation reported |
| Papandreou, 2013 | Greek children in Thessaloniki | 607 | 7-15 years | Three 24-hour dietary recalls | High consumers (>360mL/day) vs. low (<180mL/day) of SSBs | Odds of obesity | Positive | OR = 2.57 [95%CI: 1.06, 3.38]* |
| Schröder, 2014 | Representative sample of Spanish adolescents | 1149 | 10-18 years | Single 24-hour dietary recall | Soft drink beverage cluster (mean= 553g) vs. whole milk cluster | One-unit increase in BMI z-score | Positive | Males OR = 1.29 [95%CI: 1.01, 1.65]* Note: No soft drink cluster was identified for females |
| Valente, 2010 | Elementary school children in Portugal | 1675 | 5-10 years | Semi-quantitative FFQ | >2 servings/day (330mL) vs. less than 1 serving/day | Odds of overweight | Null | Males OR: 0.64 [95%CI: 0.33, 1.52] Females OR: 0.63 [95%CI: 0.33, 1.22] |
| Longitudinal Studies | ||||||||
| Ambrosini, 2013 | Adolescent offspring from Australian Pregnancy Cohort (Raine) Study | 1433 | 14 years old, followed-up at 17 years old | FFQ, at baseline and follow-up | Movement into top tertile of SSB consumption (>1.3 servings/day) at follow-up vs. remaining in lower SSB tertile | Odds of overweight-obesity at follow-up | Mixed Null in one sub-group Positive in one sub-group |
Males: OR: 1.2 [95%CI: 0.6, 2.7] Females OR: 4.8 [95%CI: 2.1, 11.4] * |
| Chaidez, 2013 | Convenience sample of Latino mother and toddler pairs | 67 mothers | 1-2 years, followed-up for 6 months | Four 24-hour dietary recall (2 at baseline, 2 at follow-up) | High SSB consumption (higher than median) vs. low SSB consumption (lower than median) | BMI z-score, weight for height z-score, and weight for age z-score at follow-up | Mixed Positive for one measure. Null for other measures. |
Weight for height z-score
β =0.46* BMI z-score β =0.47 Weight for age z-score β =0.13 No measure of variation reported |
| DeBoer, 2013 | Nationally representative sample of toddlers in the U.S. | 9600 | 9 months, 2, 4 and 5 years (followed-up at each age) | Computer-assisted interview with questions about beverage consumption, at each follow-u | ≥1 serving/day vs. <1 serving/day of SSB (1 serving = 8 ounces) | BMI z-score at follow-up (between 2 and 4 years and between 4 and 5 years) | Mixed | Measure of association not reported. Positive for change between 2 and 4 years, null for change between 4 and 5 years. |
| Dubois, 2007 | Representative sample of children in Quebec, Canada | 1944 | 2.5, 3.5, 4.5 years (followed-up at each age) | Single 24-hour dietary recall and FFQ at each follow-up | Regular consumers (4-6 servings/week between meals) between ages 2.5 and 4.5 years vs. non-consumers of SSBs | Odds of being overweight at follow-up | Positive | OR: 2.36 [OR: 1.10, 5.05]* |
| Field, 2014 | Children of participants in the Nurses’ Health Study 2 in the U.S. | 7559 | 9-16 years, followed-up for 7 years | Youth/ Adolescent FFQ, at baseline and follow-up | Increment of baseline and change in sports drink serving/day (serving =1 can) | BMI score at follow-up | Mixed | Results differed depending on type of SSB and whether predictor was baseline intake or change in intake. Results below are for sports drink intake. Females Baseline: β =0.29 [95%CI: 0.03, 0.54]* Change: β =0.05 [95%CI: =-0.19, 0.29] Males: Baseline: β =0.33 [95%CI: 0.09, 0.58]* Change: β =0.43 [95%CI: 0.19, 0.66]* |
| Fiorito, 2009 | Non-Hispanic white girls in the U.S. | 170 | 5 years, assessed biennially until 15 years | Three 24-hour dietary recalls at each follow-up | ≥2 servings of SSB/day vs. < 1 serving of SSB/day at age 5, (1 serving = 8 ounces) | Percentage overweight in each SSB consumption group at each follow-up | Positive | 5 years old ≥2: 38.5% <1: 16.1% 7 years old ≥2: 46.2% <1: 15.1 % 9 years old ≥2: 46.2% <1: 24.2% 11 years old ≥2: 53.9% <1: 21.7% 13 years old ≥2: 46.2% <1: 22.2 15 years old ≥2: 32.0 <1: 18.5 *Significant main effect |
| Jensen, 2013A | Danish children entering school in Copenhagen participating in intervention study | 366 | 6, 9, 13 years (followed-up at each age) | 7 day dietary record at 6 and 9 years | Increment of a serving/day of SSBs at 6 or 9 years, (1 serving = 100g) | Change in BMI from 6 to 9 years, 6 to 13 years or 9 to 13 years | Null | Intake at age 6, change from 6 to 9 years β =-0.005 [95%CI: -0.059, 0.0489] Intake at age 6, change from 6 to 13 years β =-0.059 [95%CI: -0.145, 0.027] Intake at age 9, change from 9 to 13 years β =0.008 [95%CI: -0.098, 0.113] Note: these results are for SSBs. See full paper for sweet drinks and soft drinks separately. |
| Jensen, 2013B | Comparison groups of two quasi-experimental intervention studies in Australia (BAEW, IYM) | 1465 | 4-18 years, followed-up approximately 2 years later | Asked participants how much SSB consumed yesterday or last school day | Increment of a serving/day of sweet drink at baseline, (1 serving = 100mL) | BMI z-score at follow-up | Null | BAEW study: Β=0.005 [95%CI: -0.003, 0.012] IYM study: β =0.004 [95%CI: -0.002, 0.01] |
| Kral, 2008 | Cohort of white children in U.S. born at different risks for obesity (based on maternal pre-pregnancy BMI) | 49 | 3-6 years, followed-up at ages 3, 4, 5 and 6 years | Three day weighed food record | Change in calories from SSB from ages 3-5 | Change in BMI z-score over follow-up | Null | Measure of association not reported |
| Laska, 2012 | Adolescents enrolled in two longitudinal cohort studies in the U.S. (IDEA, ECHO) | 693 | 6th to 11th grade, followed-up 2 years later | Three telephone-administered 24-hour dietary recalls | Increment of a serving/day (1 serving = not reported) | BMI at follow-up | Mixed Positive in one sub-group Null in one sub-group |
Males β =0.25 [SE: 0.10]* Females β =-0.09 [SE: 0.16] Note: Above association was no longer significant when correcting for multiple testing |
| Laurson, 2008 | Cohort of children in three rural U.S. states | 268 | 10 years, followed-up for 18 months | Questionnaire asking about SSB consumption | SSB consumption (1 serving = not reported) | Spearman correlation with BMI at baseline or follow-up or change in BMI | Null | Males Baseline r= 0.009 Follow-up r= 0.033 Change r=0.041 Females Baseline 0.073 Follow-up 0.077 Change -0.033 |
| Lee, 2015 | Non-Hispanic Caucasian and African-American girls in the U.S. | 2021 | 9-10 years, followed-up for 1 year | Three day food records | Increment of one teaspoon of added sugar (liquid form) | Change in BMI z-score at follow-up | Positive | β = 0.002 [95%CI: 0.001, 0.003)* |
| Leermakers, 2015 | Dutch children in population-based prospective cohort study | 2371 | 13 months, followed-up at ages 2, 3, 4 and 6 | Semi-quantitative FFQ, validation against 24-hour recalls | High intake (15 servings/week) vs. low intake (3 servings/week) of sugar-containing beverages at 13 months, (1 serving = 150ml) | Change in BMI z-score at different follow-up ages | Mixed Null in some sub-groups Positive in other sub-groups |
Males 2 year olds β =-0.01 [95%CI: -0.15, 0.12] 3 year olds β = -0.01 [95%CI: -0.15, 0.12] 4 year olds β =0.01 [95%CI: -0.12, 0.09] 6 year olds β =0.05 [95%CI: -0.08, 0.18] Females 2 year olds β =0.15 [95%CI: 0.01, 0.30]* 3 year olds β =0.14 [95%CI: 0.01, 0.27]* 4 year olds β =0.13 [95%CI: 0.01, 0.25]* 6 year olds β =0.11 [0.00, 0.23]* |
| Libuda, 2008 | German adolescents participating in longitudinal study (DONALD) | 244 | 9-18 years, followed-up for 5-years | Three day weighed dietary records | Baseline and change in regular soft drink consumption | BMI z-score at follow-up | Null | Males Baseline soft drink consumption β =0.046 Change in baseline soft drink consumption β =0.009 Females Baseline soft drink consumption β =-0.291 Change in baseline soft drink consumption β =0.055 Measures of variation not reported |
| Lim, 2009 | Low-income African-American children | 365 | 3-5 years, followed-up for 2 years | Block Kids FFQ | Increment of an ounce/day of SSB at baseline | Odds of incidence of overweight at 2-year follow-up | Positive | OR=1.04 [95%CI: 1.01, 1.07]* |
| Millar, 2014 | Nationally representative cohort of Australian children | 4164 | 4-10 years, followed-up for 6 years | Parental interview asked about SSB consumption in past 24 hours | Increment of a serving/day (serving = not reported) | Change in BMI z-score at follow-up | Positive | β =0.015 [95%CI: 0.004, 0.025]* |
| Pan, 2014 | Children in Infant Feeding Practices Cohort Study in U.S. | 1189 | 10-12 months, followed-up at 6 years | Survey including questions about SSB consumption | Ever consumed SSBs vs. never consumed during infancy High intake of SSBs (≥3 times/week) vs. no intake of SSBs during infancy |
Odds of obesity at 6 years | Positive |
Ever Consumed vs. Never consumed:
OR: 1.71 [95%CI: 1.09, 2.68]* High vs. No SSBs OR: 2.00 [95%CI: 1.02, 3.90]* |
| Vanselow, 2009 | U.S. Adolescents from various socioeconomic and ethnic background in Minneapolis/St Paul metropolitan area | 2294 | Adolescents, followed-up for 5 years | Youth/ Adolescent FFQ | Stratified by different number of soft drinks serving/week (0, 0.5-6, ≥6) | Change in BMI over 5-year follow-up | Null | 0 servings β =1.74 [SEM= 0.18] 0.5-6 servings β =1.92 [SEM=0.10] ≥7 servings 1.80 [SEM=0.15] No significant differences across groups Note: these results are for soft drinks. See full paper for punch, low-calorie soft drinks, etc. |
| Weijs, 2011 | Dutch children | 120 | 4-13 months, followed-up 8 years later | Two day dietary record | Beverage sugar intake per one percent of energy intake | Odds of overweight | Positive | OR: 1.13 [95%CI: 1.03, 1.24]* |
| Zheng, 2014 | Danish children part of European Youth Heart Study | 283 | 9 years, followed-at ages 15 and 21 | 24-hour dietary recall, supplemented by qualitative food record from same day, conducted at baseline and first follow-up | ≥1 serving (12 ounces) vs. none at 9 years or 15 years Increase in SSB serving from 9 to 15 years vs. no change |
Change in BMI from 9 to 21 years or from 15 to 21 years | Mixed | Change in BMI from 9 to 21 years, using 9 years SSB as predictor 1.42 [SE: 0.68] Change in BMI from 15 to 21 years, using 15 years SSB as predictor 0.92 [SE: 0.54]* Change in BMI from 15 to 21 years, using change in SSB from 9 to 15 years as predictor 0.91 [SE: 0.57] |
| Intervention Studies | ||||||||
| Author, Year | Setting | Sample Size | Sample Age | Intervention | Control | Primary Outcome | Direction of Association | Findings |
| de Ruyter, 2012 | Normal weight Dutch children | 641 | 4-11 years | 250mL sugar-free, artificially sweetened beverage | Similar sugar-containing beverage (104 calories) | Difference in change of BMI z-score from baseline at 18-month follow-up | Positive | -0.13 [95%CI: -0.21, -0.05]* |
| Ebbeling, 2012 | Overweight and obese adolescents in U.S. who reported consuming at least 12oz of SSB/day | 224 | Grade 9 or 10 | 1-year intervention designed to decrease SSB consumption | No beverage (given supermarket gift cards as retention strategy) | Difference in change of BMI z-score from baseline to 1 year and from 1 year to 2 years (Change in experimental group minus change in control group) | Mixed | 1-year follow-up -0.57 [SE: 0.28]* 2-year follow-up -0.3 [SE: 0.40] |
| James, 2007 | Longitudinal follow-up of children involved in intervention in United Kingdom | 434 | 7-11 years | Discouraged children from consuming SSBs and provided one hour of additional health education during each of four school terms | No beverage | Odds of overweight at 1 year and 3-years after baseline intervention (intervention ended at 1 year) | Mixed | 1-year follow-up OR=0.58 [95%CI: 0.37, 0.89] * 3-year follow-up OR=0.79 [95%CI: 0.52, 1.21] |
Note: *indicates statistical significance (p<0.05) as reported by each study