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Table 1 Studies on the the overweight/obesity risk associated with SSB consumption

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

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]
  1. Note: *indicates statistical significance (p<0.05) as reported by each study