The negative impact of sugar-sweetened beverages on children’s health: an update of the literature

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

6^th to 11^th 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]

Cross-Sectional Studies

Bremer, 2009

Nationally representative sample of U.S. adolescents, NHANES, 1994-2004

6967

12-19 years

Single 24-hour dietary recall interview

Increment of a serving/day (serving = 250g)

Change in HOMA-IR

Positive

β = 0.05 [SE= 0.02]*

Bremer, 2010

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 (serving = 250g)

Change in HOMA-IR

Mixed

Non-Hispanic White:

β= 0.06 [SE=0.02]*

Non-Hispanic Black:

β=0.12 [SE=0.05]*

Mexican Americans:

β=0.04 [SE=0.04]

Kondaki, 2012

Adolescents in large multicenter European study

546

12-17 years

Mini FFQ from Health Behavior in School-Aged Children study

≥1 time/day vs. <1 time/week

5-6 times/week vs. <1 time/week

2-4 times/week vs. <1 time/week, (serving = not reported)

Change in HOMA-IR

Positive

≥1 time/day vs. ≤ 1 time/week

β = 0.19 [95%CI: 0.003, 0.38]*

5-6 times/week vs. ≤1 time/week

β = 0.28 [95%CI: 0.07, 0.49]*

2-4 times/week vs. ≤ 1 time/week

β =0.080 [95%CI:

-0.084, 0.245]

Santiago-Torres, 2016

Hispanic children attending inner-city school in Milwaukee

187

10-14 years

Block for Kid’s FFQ with Hispanic foods

SSB consumption, (serving = not reported)

Change in HOMA-IR

Positive

β =0.104*

No measure of variation reported

Wang, 2012

Caucasian children recruited from primary schools in Canada

632

8-10 years

Three 24-hour dietary recalls

Increment of a serving/day (serving = 100ml)

Change in HOMA-IR

Mixed

Null overall

Positive in one sub-group

Null in one sub-group

Among all children:

β =0.024

> 85^th BMI percentile

β = 0.097*

<85^th BMI percentile

β =-0.027

No measure of variation reported

Longitudinal Studies

Wang, 2014

Caucasian Canadian children with at least one obese parent

564

8-10 years

Three 24-hour dietary recalls

Increment of 10g/day of added sugar from liquid sources

HOMA-IR

Positive

Among all children:

0.091 [95%CI: 0.034, 0.149] *

Overweight/ obese:

0.121 [95%CI: 0.013, 0.247] *

Normal weight:

0.046 [95%CI:

-0.003, 0.096]

Cross-Sectional Studies

Armfield, 2013

Australian children enrolled in school dental services

16,508

5-16 years

Questionnaire given to parents asked about SSB consumption

≥3/day, 1-2/day vs. 0/day, (1 serving = “1 medium glass”)

Decayed, missing and filled deciduous teeth (for ages 5-10)

Decayed, missing and filled permanent teeth (for ages 11-16)

Positive

5-10 years old

≥3 vs. 0 servings/day

β = 0.46 [95%CI: 0.29, 0.64]*

1-2 vs. 0 servings/day

β = 0.34 [95%CI: 0.23, 0.45]*

11-16 years old

≥3 vs. 0 servings/day

β = 0.27 [95%CI: 0.13, 0.41]*

1-2 vs. 0 servings/day

β = 0.16 [95%CI: 0.06, 0.26]*

Chi, 2015

Convenience sample of Alaska Native Yup’ik children

51

6-17 years

Verbally administered survey, including questions on beverage consumption adapted from Beverage and Snack Questionnaire

40 grams/day of added sugar (i.e. amount of sugar in 12-ounce soda) measured using hair biomarker and self-report.

Note: Biomarker would include all sources of added sugar, not just liquid.

Proportion of carious tooth surfaces

Mixed

Biomarker:

6.4% [95%CI: 1.2, 11.6%]*

Self-Report:

Null. No measure of association reported.

Derlerck, 2008

Preschool children in four distinct geographical areas of Belgium

2533

3 and 5 year olds

Questionnaire given to parents with structured open-ended questions about dietary habits

Daily or more consumption of SSBs at night vs. none

Daily consumption of SSBs between meals vs. none

Odds of caries experience (using criteria from British Association for the Study of Community Dentistry)

Positive

SSB consumption at night

3 year-olds

OR= 7.96 [95%CI: 1.57, 40.51] *

5 year-olds

OR = 1.64 [95%CI: 0.18, 14.63]

SSB consumption between meals

3 year-olds

OR=1.47 [95%CI: 0.36, 6.04]

5-year olds

OR= 2.60 [95%CI: 1.16, 5.84] *

Evans, 2013

Low-income children recruited from pediatric dental clinics in D.C. and Ohio

883

2-6 years

Parent-completed 24-hour recall and interviewer-administered FFQ

Using 24-hour recall

1.7 to 14 servings SSB/day vs. 0 servings/day

Using FFQ

0.63 to 7 servings SSB/day vs. <0.16 servings/day (1 serving = 8 ounces)

Odds of severe early childhood caries

Positive

Using 24-hour recall

OR = 2.02 [95%CI: 1.33, 3.06]*

Using FFQ

OR = 4.63 [95%CI: 2.86, 7.49]*

Guido, 2011

Children from small rural villages in Mexico

162

2-13 years

Questionnaire with questions about beverage consumption specific to ones sold in local stores

Drinking soda at least onece/day

Decayed, missing and filled deciduous teeth

Decayed, missing and filled permanent teeth

Positive

No measures of association reported

p=0.71

p=0.04*

Hoffmeister, 2015

Random sample of children in southern Chile from a daycare center register

2987

2 and 4 years

Survey filled out by parents with questions about sugary drink frequency

>3 servings of sugary drinks/week at bedtime vs. ≤ 3 servings of sugar drinks/week at bedtime (1 serving = not reported)

Prevalence ratio of decayed, missing and filled deciduous teeth

Positive

2 year olds

PR = 1.43 [95%CI: 0.97, 2.10] *

4 year olds

PR = 1.30 [95%CI: 1.06, 1.59] *

Jerkovic, 2009

Children recruited from primary schools in northern region of the Netherlands, including low and high SES schools

301

6 and 10 years

Questionnaire filled out by parents including information on nutritional care

≥5 glasses of fruit juice/soft drinks vs. ≤4 glasses of fruit juice/soft drinks

Prevalence of caries

Positive

Measures of association not reported.

p<0.001 *

Jurzak, 2015

Pediatric patients from university dental clinic in Poland

686

1-6 years

Questionnaire including questions about SSB consumption

Frequent consumption of fruit juices and carbonated drinks vs. Infrequent consumption (1 serving = not reported)

Odds of decayed, missing and filled teeth

Mixed, depending on age

1-2 years old

2.60 [95%CI: 0.77, 8.74]

3-4 years old

2.23 [95%CI: 1.25, 3.96] *

5 years old

OR=2.134 [95%CI: 0.84, 5.44]

6 years old

OR= 2.25 [95%CI: 1.03, 4.92]*

Kolker, 2007

African American children with household incomes below 250% of the 2000 federal poverty level

436

3-5 years

Block Kids FFQ

Consumption of soda (1 serving = not reported)

Odds of higher score of decayed, missing and filled deciduous teeth

Null

OR = 1.00 [95%CI: 1.0, 1.1]

Note: this result is for soda. See full paper for powdered drinks, sports drinks, fruit drinks, etc.

Lee, 2010

Convenience sample of healthy primary school children in Australia

266

4-12 years

Prat Questionnaire asked about consumption of sweet drinks

Sweet drinks consumed in the evening/night vs. no sweet drinks consumed

Caries experience in past 12 months

Positive

18% vs. 29%

p=0.004*

Measure of association not reported.

Majorana, 2014

Italian toddlers born to mothers attending two obstetric wards

2395

24-30 months

Self-administered questionnaire for mothers with questions about SSB consumption

≥2 servings day vs. ≤1 servings of SSBs, (1 serving = 250mL)

Odds of higher International Caries Detection and Assessment System score

Positive

OR = 1.18 [95%CI: 0.99-1.40]*

Mello, 2008

Sample of schoolchildren in Portugal

700

13 years

Semi-quantitative FFQ

≥2 servings/week vs. ≤2 servings/week of soft drinks derived from cola, other soft drinks and any soft drinks (1 serving = not reported)

Odds of ≥4 decayed, missing and filled teeth

Positive

Soft drinks from cola

OR = 2.23 [95%CI: 1.50, 3.31]*

Other soft drinks

OR = 1.54 [95%CI: 1.05, 2.26]*

Any soft drinks

OR = 1.88 [95%CI: 1.07, 3.29]*

Nakayama, 2015

Japanese infants

1675

18-23 months

Questionnaire for parents or guardian with questions about SSB consumption

Drinking soda ≥4 times/week vs. <4 times/week, (1 serving = not reported)

Odds of early childhood caries

Positive

OR = 3.70 [95%CI: 1.07, 12.81] *

Pacey, 2010

Inuit preschool-aged children in Nunavut, Canada

388

3-5 years

Past-month qualitative FFQ, 24-hour dietary recall (with repeat 24-hour recalls on 20% of sub-sample)

Mean SSB consumption compared between groups of Reported Caries Experience

Reported Caries Experience (RCE)

Positive

Mean SSB consumption /day among those with RCE

0.8 [SE=0.1]

Mean SSB consumption /day among those without RCE

0.5 [SE=0.1]

*Significant difference between groups.

Skinner, 2015

Random sample of adolescents in Australia

1187

14 to 15 years

Questionnaire including questions about SSB consumption

0 cup of soft drinks or cordial vs. 1-2 cups per day vs. 3+ cups per day

Mean decayed, missing and filled permanent teeth

Positive

0 cups per day

Male: 1.14

Female: 0.81

1-2 cups per day

Male: 1.12

Female: 1.47

3+ cups per day

Male: 1.69

Female: 1.39

*Significant difference

between groups.

Measure of variation not reported

Note: this result is for soft drinks or cordial. See full paper for sweetened fruit juice, diet soft drinks and sports drinks.

Wilder, 2016

School-based sample of third grade students in Georgia, U.S.

2944

8 and 9 years

Supplemental survey including questions about SSB consumption

Increment of a serving/day of SSB, (1 serving = not reported)

Prevalence ratio of caries experience

Positive

PR: 1.22 [95%CI: 1.13, 1.32]*

Longitudinal Studies

Lim, 2008

Low-income African American children in Detroit

369

3-5 years, followed-up 2 years later

Block Kids FFQ

Change from low SSB consumption cluster to high SSB consumption cluster vs. low consumers at both time periods

Incident decayed, missing and filled deciduous teeth and incident filled surfaces at follow-up

Positive

New d ₂ mfs:

IRR=1.75 [95%CI: 1.16, 2.64]*

New filled surface:

IRR=2.67 [95%CI: 1.36, 5.23]*

Park, 2015

U.S. children in Infant Feeding Practices Study II and Follow-up Study

1274

10-12 months, followed-up at 6 years of age

10 postpartum surveys through infancy, which asked about intake of SSBs during past 7 days

Any SSBs vs. no SSBs during infancy

SSB introduction at or after 6 months, SSB introduction before 6 months vs. Never consumed SSBs during infancy

SSB consumption < 1 time/week, 1-3 times/week, ≥3 times/week vs. No SSBs

Dental caries in child’s lifetime at follow-up

Mixed

Any vs. No intake during infancy

OR = 1.14 [95%CI: 0.82, 1.57]

SSB intro at or after 6 months vs. no SSB

OR = 1.07 [95%CI: 0.76, 1.52]

SSB intro before 6 months vs. no SSB

OR = 1.29 [95%CI: 0.77, 2.17]

Consumed <1 time/week vs. No SSBs during infancy

OR = 1.15 [95%CI: 0.61, 2.18]

Consumed 1-3 times/week vs. No SSBs during infancy

OR = 0.85 [95%CI: 0.48, 1.49]

Consumed ≥3 times/week vs. No SSBs during infancy

OR = 1.83 [95%CI: 1.14, 2.92]*

Warren, 2009

Children in rural community in Iowa enrolled in WIC program

212

6-24 months, followed-up 9 and 18 months later

Questionnaire asking about SSB consumption at each follow-up

SSB consumption vs. no SSB consumption at baseline

Odds of caries at 18-month follow-up

Positive

OR = 3.0 [95%CI: 1.1, 8.6]*

Warren, 2016

American Indian infants from Northern Plains Tribal community

232

Infants followed-up at 4, 8, 12, 16, 22, 28 and 36 months

Validated beverage frequency questionnaire for parents adapted from Iowa Fluoride study, a 24-h dietary recall tool and food habit questionnaire

Added-sugar beverage intake as proportion of total

Odds of caries experience at follow-up

Positive

OR = 1.02 [95%CI: 1.00, 1.04]*

Watanabe, 2014

Japanese infants recruited from Kobe City Public Health Center

31,202

1.5 years, followed-up 21 months later (at ~3 years old)

Questionnaire for parents asking about SSB consumption and frequency

Daily SSB consumption vs. no SSB consumption, at baseline

Odds of dental caries at 3-years

Positive

OR = 1.56 [95%CI: 1.46, 1.65]*

Wigen, 2015

Children in the Norwegian Mother and Child Cohort Study

1095

1.5 years, followed-up at 5 years old

Questionnaire for parents asking about SSB consumption

SSBs offered at least once a week vs. less than once a week, at 1.5 years

Odds of decayed, missing and filled deciduous teeth

Positive

OR = 1.8 [95%CI: 1.1, 2.9]*

Intervention Studies

Author, Year

Setting

Sample Size

Sample Age

Intervention

Control

Primary Outcome

Direction of Association

Findings

Maupomé, 2010

American Indian toddlers in U.S.

Four geographically separate tribal groups (3 intervention groups, 1 control group); Group A = 63 enrolled, 53 completed. Group B = 62 enrolled, 56 completed; Group C = 80 enrolled, 69 completed. Group D = NR.

18-30 months,

3-pronged approach: 1) increase breastfeeding, 2) limit SSB consumption, 3) promote consumption of water for thirst

Each intervention group measured at pre and post; also compared to control group to account for secular trends

No intervention received.

Post-pre difference in fraction of affected mouths by incident caries (d1t and d2t)

Positive

d1t

Group A:

-0.574 [SDE: 0.159]*

Group B:

-0.300 [SDE: 0.140]*

Group C:

-0.631 [0.157]*

d2t

Group A:

-0.449 [SDE: 0.180]*

Group B:

-0.430 [SDE: 0.153]*

Group C:

-0.342 [SDE: 0.181]

Cross-Sectional Studies

Azagba, 2014

Adolescents attending public schools in Atlantic Canada

8210

Grades 7, 9, 10 and 12

Self-reported survey with question asking about consumption of caffeinated energy drinks in past year

Energy drink more than once a month vs. one to two times

Odds of depression, sensation seeking, substance use

Positive

Sensation Seeking

OR = 1.17 [95%CI: 1.11, 1.22]*

Depressive symptoms, very elevated

OR = 1.95 [95%CI: 1.36, 2.79]*

Depressive symptoms, somewhat elevated

OR = 1.08 [95%CI: 0.80, 1.47]

Cigarette use

OR = 2.58 [95%CI: 1.71, 3.89]*

Marijuana use

OR = 1.87 [95%CI: 1.37, 2.56]*

Alcohol use

OR = 2.48 [95%CI: 1.83, 3.36]*

Other drug use

OR = 1.80 [95%CI: 1.26, 2.57]*

Bashir, 2016

Convenience sample of patients in waiting areas of emergency department in U.S.

612

12-18 years

Questionnaire asking about frequency of energy drink consumption

Frequent (at least once a month) vs. Infrequent (less than once a month) consumers of energy drinks

Proportion of frequent vs. infrequent consumers experience of headache, anger and increased urination

Positive

Headache

76% [95%CI: 69-81] vs. 60% [95%CI: 55-64]*

Anger

47% [95%CI: 40-54] vs. 32% [95%CI: 27-36]*

Increased urination

24 [95%CI: 18-30] vs. 13 [95%CI: 10-16]*

Study provides a number of outcomes. See paper for full results.

Koivusilta, 2016

Classroom survey of 7^th grade students in Finland

9446

13 years

Self-reported online survey asking about frequency of energy drink consumption

Several times a day vs. not at all

Odds of headache, sleeping problems, irritation, tiredness/fatigue, late bedtime

Positive

Headache

OR = 4.6 [95%CI: 2.8, 7.7]

Sleeping problems

OR = 3.6 [95%CI: 2.2, 5.8]

Irritation

OR= 4.1 [95%CI: 2.7, 6.1]

Tiredness/ fatigue

OR=3.7 [95%CI: 2.4, 5.7]

Late bedtime

OR = 7.9 [95%CI: 5.7, 10.9]

Kristjansson, 2013

School survey of children in Iceland

11,267

10-12 years

Questions on population-based survey asking about frequency of energy drink and cola consumption

≥1 cola/day vs. none

≥1 energy drink/ day vs. none

Odds of headaches, stomachaches, sleeping problems, low appetite

Positive

Colas

Headaches

Females:

OR = 1.13 [95%CI: 0.87, 1.47]

Males:

OR = 1.29 [95%CI: 1.03, 1.62]*

Stomachaches

Females:

OR = 1.40 [95%CI: 1.08, 1.80]*

Males:

OR = 1.31 [95%CI: 1.03, 1.67]*

Sleeping problems

Females:

OR = 1.55 [95%CI: 1.21, 1.98]*

Males:

OR = 1.34 [95%CI: 1.09, 1.66]*

Low appetite

Females

OR = 1.37 [95%CI: 1.03, 1.83]*

Males

OR = 1.44 [95%CI: 1.12, 1.86]*

Energy Drinks

Headaches

Females:

OR = 1.68 [95%CI: 1.17, 2.41]*

Males:

OR = 1.87 [95%CI: 1.43, 2.46]*

Stomachaches

Females:

OR = 1.76 [95%CI: 1.21, 2.54]*

Males:

OR = 2.45 [95%CI: 1.86, 3.23]*

Sleeping problems

Females:

OR = 1.56 [95%CI: 1.07, 2.25]*

Males:

OR = 1.63 [95%CI: 1.25, 2.12]*

Low appetite

Females

OR = 2.31 [95%CI: 1.58, 3.39]*

Males

OR = 1.30 [95%CI: 0.95, 1.78]

Park, 2016

Nationally representative cohort of Korean adolescents

68,043

12-18 years

Web-based survey with questions on energy drink consumption

Highly frequent energy drink consumer (≥5 times/week) vs. infrequent energy drink consumer (<1 time/week)

Moderate frequent energy drink consumer (1-4 times/week) vs. infrequent energy drink consumer

Odds of sleep dissatisfaction, perceived stress, persistent depressive mood, suicidal ideation, suicide plan, suicide attempt

Positive

Highly frequent energy drink consumer vs. infrequent energy drink consumer

Sleep dissatisfaction

OR = 1.64 [95%CI 1.61, 1.67]*

Perceived stress

OR = 2.23 [95%CI: 2.19, 2.27]*

Depressive mood

2.59 [95%CI: 2.54, 2.65]*

Suicidal ideation

3.14 [95%CI: 3.07, 3.21]*

Suicidal plan

4.65 [95%CI: 4.53, 4.78]*

Suicide attempt

6.79 [95%CI: 6.59, 7.00]*

Moderate frequent energy drink consumer vs. infrequent energy drink consumer

Sleep dissatisfaction

OR = 1.25 [95%CI: 1.25, 1.26]*

Perceived stress

OR = 1.38 [95%CI: 1.37, 1.39]*

Depressive mood

OR=1.51 [95%CI: 1.49, 1.52]*

Suicidal ideation

OR=1.43 [95%CI: 1.42, 1.45]*

Suicidal plan

OR=1.78 [95%CI: 1.75, 1.81]*

Suicide attempt

OR=1.91 [95%CI: 1.87, 1.95]*

Richards, 2015

Adolescents from three secondary schools in the South West of England

2307

11-17 years

DABS survey (assesses intake of common dietary variables), including questions on energy drink and cola consumption

High consumption (≥1 can of energy drink or cola) vs. no consumption

Low consumption (<1 can of energy drink or cola) vs. no consumption

Odds of stress, anxiety and depression

Mixed

High consumption vs. no consumption

Energy Drinks

Stress

OR = 1.10 [95%CI: 0.80, 1.50]

Anxiety

OR = 1.05 [95%CI: 0.77, 1.43]

Depression

OR = 1.11 [95%CI: 0.81, 1.52]

Cola

Stress

OR = 0.68 [95%CI: 0.52, 0.90]*

Anxiety

0.83 [95%CI: 0.64, 1.09]

Depression

1.23 [95%CI: 0.93, 1.62]

Low consumption vs. no consumption

Energy Drinks

Stress

1.38 [95%CI: 1.05, 1.80]*

Anxiety

1.26 [95%CI: 0.97, 1.64]

Depression

0.99 [95%CI: 0.76, 1.31]

Cola

Stress

0.72 [95%CI: 0.56, 0.94]*

Anxiety

0.86 [95%CI: 0.67, 1.10]

Depression

1.18 [95%CI: 0.91, 1.54]

Longitudinal Studies

Marmorstein, 2016

Cohort of middle-school students in the U.S.

144

10-14 years, followed-up 16 months later

Self-reported questionnaire with questions on energy drink consumption

Energy drink consumption at baseline

Change in ADHD inattention, ADHD hyperactive, conduct disorder, depression, panic, anxiety at follow-up (controlling for coffee)

Mixed

ADHD inattention

β = 0.20*

ADHD hyperactive

β = 0.20*

Conduct disorder

β = 0.18

Depression

β = 0.08

Panic

β = 0.17

Generalized anxiety

β = 0.09

Social Anxiety

β = -0.02