Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials

Background: Sugar-sweetened beverages (SSBs) have been implicated in fueling the obesity epidemic. Objectives: This study aimed to update a synthesis of the evidence on SSBs and weight gain in children and adults. Methods: MEDLINE, Embase, and Cochrane databases were searched through September 8, 2022, for prospective cohort studies and randomized controlled trials (RCTs) that evaluated intake of SSBs in relation to BMI and body weight in children and adults, respectively. Eligible interventions were compared against a noncaloric control. Study-level estimates were pooled using random-effects meta-analysis and presented as beta-coefficients with 95% CIs for cohorts and weighted mean differences (MDs) with 95% CIs for RCTs. Results: We identified 85 articles including 48 in children (40 cohorts, n = 91,713; 8 RCTs, n = 2783) and 37 in adults (21 cohorts, n = 448,661; 16 RCTs, n = 1343). Among cohort studies, each serving/day increase in SSB intake was associated with a 0.07-kg/m(2) (95% CI: 0.04 kg/m(2), 0.10 kg/m(2)) higher BMI in children and a 0.42-kg (95% CI: 0.26 kg, 0.58 kg) higher body weight in adults. RCTs in children indicated less BMI gain with SSB reduction interventions compared with control (MD: -0.21 kg/m(2); 95% CI: -0.40 kg/m(2), -0.01 kg/m2). In adults, randomization to addition of SSBs to the diet led to greater body weight gain (MD: 0.83 kg; 95% CI: 0.47 kg, 1.19 kg), and subtraction of SSBs led to weight loss (MD: -0.49 kg; 95% CI: -0.66 kg, -0.32 kg) compared with the control groups. A positive linear dose-response association between SSB consumption and weight gain was found in all outcomes assessed. Conclusions: Our updated systematic review and meta-analysis expands on prior evidence to confirm that SSB consumption promotes higher BMI and body weight in both children and adults, underscoring the importance of dietary guidance and public policy strategies to limit intake. This meta-analysis was registered at the International Prospective Register of Systematic Reviews as CRD42020209915.

Automated summary

Based on the analysis of 48 studies in children and 37 studies in adults, it was found that each additional serving of sugar-sweetened beverage (SSB) was associated with a 0.07 kg/m2 increase in BMI in children and a 0.42 kg increase in body weight in adults. Reducing SSB intake can lead to lower BMI in children, while increasing SSB intake can lead to weight gain in adults. The findings highlight the importance of limiting SSB consumption for weight control and obesity prevention.