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  • Review
  • Open Access
  • Open Peer Review

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

BMC ObesityBMC series – open, inclusive and trusted20185:6

https://doi.org/10.1186/s40608-017-0178-9

  • Received: 30 May 2017
  • Accepted: 26 December 2017
  • Published:
Open Peer Review reports

Abstract

While sugar sweetened beverage (SSB) consumption has declined in the last 15 years, consumption of SSBs is still high among children and adolescents. This research synthesis updates a prior review on this topic and examines the evidence regarding the various health impacts of SSBs on children’s health (overweight/obesity, insulin resistance, dental caries, and caffeine-related effects). We searched PubMed, CAB Abstracts and PAIS International to identify cross-sectional, longitudinal and intervention studies examining the health impacts of SSBs in children published after January 1, 2007. We also searched reference lists of relevant articles. Overall, most studies found consistent evidence for the negative impact of SSBs on children’s health, with the strongest support for overweight/obesity risk and dental caries, and emerging evidence for insulin resistance and caffeine-related effects. The majority of evidence was cross-sectional highlighting the need for more longitudinal and intervention studies to address this research question. There is substantial evidence that SSBs increase the risk of overweight/obesity and dental caries and developing evidence for the negative impact of SSBs on insulin resistance and caffeine-related effects. The vast majority of literature supports the idea that a reduction in SSB consumption would improve children’s health.

Keywords

  • Sugar-sweetened beverages
  • Children’s health

Background

Sugar sweetened beverages (SSB) – which include drinks with added sugar such as soda, fruit drinks and energy drinks – are frequently consumed by children and adolescents in the United States (U.S.) [1]. There is evidence that consumption of SSBs has recently begun to decline in the U.S., with this decrease largely driven by fewer children consuming these beverages [2, 3]. From 2003 to 2014, the percentage of children in the U.S. consuming at least one sugar-sweetened beverage on a typical day declined significantly from 80% to 61% [3]. Much of this decline was driven by a decrease in the percentage of young children ages 2 to 5 consuming SSBs, although the decline was significant for all age groups. Over the same period, consumption from caloric beverages (SSBs, milk and 100% juice) declined from 463 to 296 daily calories, and the fraction of all beverage calories from SSBs decreased from 49% to 45% [3]. Within SSBs, the number of calories from soda and fruit drinks consumed per day declined from 116 kcal to 49 kcal and 70 kcal to 31 kcal, respectively [3]. Despite these important declines, consumption of SSBs by children and adolescents in the U.S. still remains high. In 2013–2014, 46.5% of children aged 2–5, 63.5% of children aged 6–11 and 65.4% of adolescents aged 12–19 reported consuming at least one SSB on a given day [3]. Additionally, high levels of SSB consumption persist among low-income and racial and ethnic minorities.

In light of the frequent consumption of SSBs among children and adolescents in the U.S., there has been an interest in critically examining associated health consequences. As a result, there has been a substantial rise in the number of studies investigating the health effects of SSBs over the past decade. Evidence has emerged linking SSB consumption to a number of health consequences among adults including weight gain [4, 5], cardiovascular risk factors (e.g., dyslipidemia) [6], insulin resistance and type 2 diabetes [7, 8] and non-alcoholic fatty liver disease [9]. Studies among children are more limited and have generally focused on weight gain [4] and dental caries [10], as well as insulin resistance to a lesser extent [11, 12]. An emerging body of research has also examined the association between caffeinated SSBs (e.g., energy drinks or colas) and caffeine-related health consequences including reduced sleep quality and headaches [13]. Given the growing number of studies assessing SSB-related health consequences, concise summaries of the evidence base are needed in order to inform policy and advocacy efforts focused on reducing SSB consumption.

This review aims to synthesize the existing evidence regarding the impact of SSB consumption on children’s health. Unlike previous reviews which have been limited in scope (e.g., focusing on a single outcome such as weight gain) [14, 15], this review summarizes evidence from cross-sectional, longitudinal and intervention studies on a broad range of health outcomes relevant to children including: obesity, insulin resistance, dental caries, and caffeine-related effects. A previous review published in 2009 summarized many early studies on SSBs and children’s health [16]. Using a narrative review approach, we update the literature by reviewing more recent studies published up until 2017.

Search selection

For each of the health impacts (obesity, insulin resistance, dental caries and caffeine-related effects), separate searches were conducted of PubMed, Web of Science and PAIS International. For all searches, a search hedge was created in three parts: 1) terms relevant to SSBs including “beverage” and “sodas”, 2) terms restricting to children and adolescents including “pediatric” and “teens” and 3) terms specific to the outcome being examined such as “body mass index” and “body weight” for the search on overweight and obesity risk (see Additional file 1: Appendix for full list of search terms). These search terms were chosen to retrieve the most relevant results using an iterative process in consultation with a medical librarian. For searches of PubMed, MeSH subject headings were used. In addition to database searches, reference lists of SSB reviews and articles were searched. Following the removal of duplicate studies, one author (K.V.) screened titles, abstracts and full-texts and another author (S.B.) confirmed the inclusion of these studies. Included studies had to be peer-reviewed articles examining the effects of SSBs on a specific health outcome, be limited to children and adolescents, and be published after January 1, 2007. We selected 2007 as the start date because the most recent relevant review [16] included studies published prior to this. Studies were excluded if they were not published in English, were not conducted in high-income countries (defined as membership in Organisation for Economic Co-operation and Development) or were grey literature. We limited our scope to high-income countries to promote generalizability of results.

Effects of SSBs on health outcomes in children

Overweight and obesity risk

A large number of studies have reported on the association between SSB consumption and overweight/obesity risk, with the majority of a cross-sectional [1735] or longitudinal design [3654] and only a few intervention studies (Table 1).
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

Cross sectional studies

Most cross-sectional studies found significant positive associations between SSB intake and obesity risk among children and adolescents [1719, 2125, 27, 2932, 34, 35, 55]. For example, among 12 to 19 year olds in the 1999–2004 National Health and Nutritional Examination Survey (NHANES), each additional SSB serving (250 g) consumed per day was associated with a 0.93-percentile increase in Body Mass Index (BMI) z-score [34]. These positive findings were well-replicated across a range of OECD countries, including Canada, Spain, Greece and in Australia where those who consumed more than one SSB servings (≥250 g) per day were 26% more likely to be overweight or obese compared to those who consumed less than one serving per day [27]. They are also consistent with results focused on specific sub-groups such as among Mexican-American children aged 8–10 years where each additional SSB serving (240 mL) per week was associated with a 1.29 greater odds of obesity [17] and among toddlers living in low-income families where no SSB intake was associated with a 31% lower obesity prevalence compared to households where toddlers consumed two or more SSB servings (serving = 12 fluid ounces) per day [23].

Some of the cross-sectional studies found positive associations only within subsets of the sample [18, 19, 21, 29, 32, 35, 55], including: boys [32, 35], boys aged 6 to 11 [21], children aged 9 to 11 [29], and among Mexican-American and non-Hispanic White adolescents only [18].

A small number of cross-sectional studies reported null findings [20, 26, 33], and one study conducted in Korea among 9 to 14 year olds reported an inverse association among males [28].

Longitudinal studies

Like the cross-sectional data, longitudinal studies generally demonstrated that increased SSB consumption was associated with weight-related outcomes among children and adolescents [38, 39, 4749, 51, 53, 56]. For example, among a nationally representative survey of 2 to 5 year olds in the U.S., children who consumed more than one SSB serving (serving = 8 fluid ounces) per day at 2 years old had a significantly greater increase in BMI z-score over the next 2 years compared to infrequent/non SSB drinkers [38]. Two of the positive studies examined longitudinal associations between SSB consumption and obesity risk among minority populations, with one finding that high SSB intake (defined as greater than median intake in study population) among Latino toddlers was associated with a 0.46 unit increase in weight for height z-score at 6-month follow-up [37] and the other finding that SSBs were positively associated with 2-year overweight risk among African-American preschool children [47].

Some studies found mixed results [3638, 40, 44, 45, 52], with two reporting the positive association between SSB intake and increased weight was only significant among girls [36, 45]. The first study found high SSB intake (≥15 servings/week) at 13 months old was significantly associated with an increased BMI among girls at ages 2, 3, 4, and 6 years old [45]. Another study found that girls who moved to the top tertile of SSB consumption (>335 g/day) between 14 and 17 years of age had increased BMI and nearly a five-fold greater odds of overweight or obesity risk compared to girls who remained in the lowest tertile of SSB consumption [36]. One study found a positive association when using SSB consumption at 15 years to predict change in BMI from ages 15–21 and found null results when using SSB consumption at 9 years as a predictor [52].

Some of the longitudinal studies found no association between SSBs and BMI or BMI z-scores [4144, 46, 50, 54, 57].

Intervention studies

A small number of intervention studies have examined SSB consumption and overweight and obesity risk among children [5860]. Three recent randomized controlled trials found a reduction in BMI or obesity risk in the intervention group compared to the control. De Ruyter and colleagues conducted a double-blinded placebo-controlled trial wherein 641 normal weight Dutch children were randomized to receive either a 250 mL of an SSB or a sugar-free beverage each day for 18 months [58]. At the end of the trial, the difference in BMI z-score was significantly different between the two groups, with the SSB group increasing on average by 0.15 units (compared to 0.02 units in the sugar-free group). The second study randomized 224 overweight and obese American adolescents who regularly consumed SSBs to either participate in a program to reduce SSB consumption or receive no intervention [59]. At the end of the 1-year intervention, those in the intervention group had beneficial changes in BMI and weight compared to those who did not receive the intervention, but these differences were no longer significant when participants were followed-up for an additional year after the end of the intervention. However, in a pre-planned subgroup analysis of Hispanic participants, there were significant differences in BMI between groups at both follow-up periods. The third study was a cluster randomized trial in which schools in the United Kingdom were randomized to either an intervention discouraging consumption of SSBs or no intervention for one year [61]. A significant difference in BMI z-score and overweight/obesity risk between groups was observed at the end of the first year, supporting a positive association between SSBs and obesity risk [61]. Two years after the intervention had been discontinued, the researchers completed a follow-up assessment and reported the differences between the groups were no longer significant [60].

Insulin resistance

A modest number of studies reported a positive association between SSB consumption and insulin resistance risk among children and adolescents, with the majority conducted cross-sectionally [6265], one conducted longitudinally [66] and no intervention studies conducted (Table 2).
Table 2

Studies on the insulin resistance 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

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

> 85th BMI percentile

β = 0.097*

<85th 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]

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

Cross sectional studies

A number of cross-sectional studies found a positive association in the whole or a subset of their study population [6265]. For example, among 12–19 year olds in NHANES, each additional SSB serving (250 g) consumed per day was associated with a 5% increase in HOMA-IR (a marker of insulin resistance which is calculated using fasting glucose and insulin levels) [55]. One study reported associations by race, with positive associations found among White and African Americans, but null associations among Mexican Americans [18]. Another study reported a stronger association between SSB consumption and higher HOMA-IR among overweight/obese participants compared to normal weight participants [64].

Longitudinal studies

Only one longitudinal study was conducted to examine this association, reporting that an additional 10 g/day of added sugar from liquid sources was associated with a 0.04 mmol/L higher fasting glucose, 2.3 pmol/L higher fasting insulin and a 0.01 unit increase in HOMA-IR over two year follow-up [66].

Dental caries

A growing number of studies have examined the relationship between SSB consumption and dental caries (cavities or tooth decay) among children and adolescents, with almost all evidence pointing towards a strong positive association (Table 3). While the majority of studies examining SSB intake and dental caries are cross-sectional [6782], there have been several longitudinal studies [8388] and one intervention study [89].
Table 3

Studies on the dental caries 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

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]

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

Cross sectional studies

The vast majority of cross-sectional studies found evidence for a positive association between SSB consumption and dental caries [67, 6982]. For example, one study reported that the prevalence of caries was 22% higher for each additional SSB serving consumed by children per day [81]. Several studies replicated this positive association among low-income children [70, 73, 75], with one study reporting that high SSB consumption (≥5 oz/day) was associated with a 4.6 greater odds of dental caries compared to those with lower SSB consumption [70]. Some studies examined how specific timing of SSB consumption affects dental caries, with one study [72] finding an association with dental caries and SSBs consumed at bedtime and another [69] finding an association with dental caries and SSBs consumed at nighttime among 3 year-olds and for SSBs consumed between meals among 5-year olds.

One cross-sectional study reported null results, finding no association between self-reported SSB consumption and dental caries among Alaska Natives – a result which may have been related to the small sample size (N = 51) [68].

Longitudinal studies

All longitudinal studies included in this review found a positive or mixed association between SSB consumption and dental caries in at least part of the study population [8388]. One study reported that a high consumption of SSBs (≥3 servings per week) among infants 10 to 12 months old was associated with a 1.83 greater odds of dental caries at age 6, compared with infants who did not consume SSBs during infancy [84]. Some studies reported these positive findings among specific subgroups including: low-income [86], African American [83] and American Indian children [85]. For example, Lim et al. conducted a cluster analysis and reported that African American children who changed from being low consumers of SSBs at baseline (mean consumption = 567.4 mL/day) to high consumers of SSBs at 2-year follow-up (mean consumption = 1032.4 mL/day) had a 1.75 times higher mean number of new dental caries compared with high consumers of milk-juice at both baseline and 2-year follow-up [83].

Intervention studies

Only one intervention study has been conducted to assess SSB consumption and dental caries [89]. Maupomé et al. conducted community-wide interventions to reduce SSB consumption, improve breastfeeding practices, and promote consumption of water for thirst among American Indian toddlers. While the intervention communities demonstrated improvements in the number of dental caries, it is not possible to attribute this specifically to reduction in SSB consumption as the intervention was a multi-pronged approach.

Caffeine-related effects

A growing number of studies reported on the caffeine-related effects associated with SSB consumption with studies almost exclusively cross-sectional (Table 4).
Table 4

Studies on caffeine-related effects 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

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 7th 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

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

Cross sectional studies

A number of cross-sectional studies examined the effects of energy drink consumption among children and adolescents [9097], with each study often reporting on multiple outcomes. Some studies found evidence for an association between energy drink consumption and sleep-related issues such as sleep dissatisfaction, tiredness/fatigue and late bedtime [92, 93, 95], and others reported an association between energy drink intake and increased headaches [9193]. One study reported an association between energy drink consumption and risk-taking behaviors such as cigarette, marijuana and drug use [90], and two studies found an association between energy drink consumption and stress, depressive symptoms, and suicidal ideation, plan or attempt [90, 95]. Other outcomes examined in these cross-sectional studies reported include irritation [92], stomach ache and low appetite [93].

Some of the cross-sectional studies examined caffeine-related effects of cola drinks [93, 96, 97]. One found that both low and high consumption of cola were associated with lower stress and found null associations with anxiety and depression [96]. Another examined both cola and energy drinks and found that higher consumption of both beverages was associated with headaches, stomach-aches, sleeping problems and low appetite [93]. More specifically, among males, drinking more than one cola per day was associated with a 1.34 greater odds of sleeping problems and among females drinking more than one cola per day was associated with a 1.55 greater odds of sleeping problems.

Longitudinal studies

One longitudinal study was conducted and it found evidence that increased energy drink consumption was associated with attention deficit/hyperactivity disorder inattention and hyperactivity at 16-month follow-up, but did not find evidence for associations with depression, panic and anxiety [94].

Summary of evidence

Since the most recent relevant review was published on this topic in 2009 [16], there has been a substantial increase in research examining the health consequences of SSB consumption among children and adolescents. For example, 227 studies indexed in PubMed were published on SSBs in 2017 compared to 16 studies published in 2007.1 Many more studies are now conducted exclusively on children and adolescents, while previous evidence was based on results found among adults. While the majority of this research is still cross-sectional (limiting the ability to make inferences about causality), the past decade has seen a growing number of longitudinal studies being implemented, as well as an increasing amount of intervention trials.

The majority of this research on SSBs over the past decade has centered on the relationship with weight gain. The findings of this review confirm that there is clear and consistent evidence that the consumption of SSBs heightens obesity risk among children and adolescents. Although a formal quality assessment or strength of evidence evaluation was not conducted, the vast majority of cross-sectional, longitudinal and intervention studies find strong evidence for a positive relationship in all or part of their study population. The exact mechanism through which SSBs impact childhood obesity is not entirely understood. Generally, the research points to the low satiety of SSBs and incomplete compensation [98, 99]. In other words, drinking calories in liquid form does not decrease hunger in the same way as solid food. Additionally, people do not sufficiently reduce their total energy intake to make up for the excess calories obtained from SSBs. There is also a lively debate about whether the effect of calories from SSBs on body weight is worse than some other foods or nutrients [100, 101].

The association between SSB consumption and weight gain is paramount, given that childhood obesity affects roughly one in six (13 million) children in the U.S., disproportionately impacting children who are low-income and racial and ethnic minorities [102]. From 1976 to 2016, the prevalence of childhood obesity in the U.S. more than doubled in children ages 2 to 5 (from 5% to 13.9%), nearly tripled in children aged 6 to 11 (from 6.5% to 18.4%) and quadrupled in adolescents’ ages 12 to 19 (from 5% to 20.6%) [103105]. While there is some indication that childhood obesity rates may leveling in the U.S. [104], the overall prevalence of obesity among children in 2016–2016 was estimated at 18.5% [105], meaning it is still considerably higher than the Healthy People 2020 goal of 14.5% [4]. Given that children who are overweight and obese youth are likely to remain so as adults [106], obesity and its adverse health consequences create a serious threat to children’s current and future health [107]. Hence, reducing SSB consumption is an important intervention point to reduce the burden of childhood obesity in the U.S.

This review also finds strong and consistent evidence that consumption of SSBs is associated with dental caries among children and adolescents. The mechanism for the association between SSB consumption and dental caries is well understood: dental caries are caused by acids produced by bacteria metabolizing sugar in the mouth. Increased sugar from SSBs intensifies the acid production and causes further decay of teeth [108]. The majority of studies examining this relationship are cross-sectional, but a modest number of longitudinal studies as well as one intervention study also support the association.

While evidence has shown a positive relationship between SSB consumption and type 2 diabetes among adults [5, 12, 109], the available literature among child and adolescents is limited. The majority of studies among children and adolescents do not directly examine the link between SSB consumption and type 2 diabetes and instead measure insulin resistance, a biomarker of increased cardio-metabolic risk and type 2 diabetes. It is hypothesized that the high content of sucrose and high-fructose corn syrup present in SSBs may increase dietary glycemic load leading to insulin resistance and inflammation [7]. While not as strong and consistent as the relationships between SSB consumption and weight gain or dental caries, most studies in this review generally support an association between SSB consumption and insulin resistance among children and adolescents. However, this is limited by a small number of studies and the predominance of a cross-sectional study design.

The findings of this review also point to an association between caffeinated SSBs and a wide range of health issues including poor quality or reduced sleep, headaches, risk-seeking behavior and depressive symptoms. The presence of caffeine in energy drinks and other caffeinated SSBs (e.g., cola), in conjunction with the large volumes consumed, can lead to neurological and psychological effects associated with high caffeine consumption. The majority of studies examining the caffeine-related effects of SSBs focus on energy drinks, with very few analyzing the effects of other caffeinated SSBs such as colas. One reason for this may be the considerably higher level of caffeine content in energy drinks: a 250 mL energy drink has an average of 80 mg of caffeine (range: 27-87 mg), compared to 40 g of caffeine (range: 30-60 mg) in a 330 mL cola drink [110]. Additionally, studies examining caffeine-related effects have almost exclusively been cross-sectional, limiting the strength of inferences that can be made and bringing forth issues of reverse causation.

While there is a large and growing body of research examining the impact of SSBs on children’s health, important gaps remain. First, researchers should utilize more rigorous study designs (intervention trials and longitudinal studies) and move away from a reliance on cross-sectional studies. This will strengthen the evidence base and allow firmer conclusions to be made regarding the causal relationships between SSB consumption and negative health consequences. Second, more consistency is needed in the definition of SSBs (e.g., specifying which beverages are included and what is a typical serving size) and measurement strategy (e.g., FFQ vs. 24-h recall). Similarly, more uniformity is needed in assessing outcomes, particularly in the risk of overweight/obesity where studies vary considerably in the outcomes measured (e.g., BMI, BMI z-score, BMI percentile, overweight/obese status). Third, researchers should more rigorously examine differences in health risks by subpopulations (e.g., race/ethnicity, socioeconomic status, age and gender) to determine if the intake of SSBs in particularly harmful in certain population subsets. While it is established that low-income and racial and ethnic minorities consume more SSBs, it is unclear the extent to which health consequences are magnified among these groups. This is important particularly for targeting interventions and policy approaches to reduce children’s SSB consumption. Better insights in these areas have the potential to inform real-world policies and recommendations that may greatly benefit children’s health. Finally, additional research is needed about caffeinated SSBs and their impact on children’s health. Energy and sport drink consumption is rising rapidly in the U.S. [13] and so studies examining the negative health effects of caffeinated SSBs are needed to inform future efforts to reduce consumption.

This review has several limitations. First, it only focuses on four main health effects associated with SSB consumption and does not address other potential consequences which have been documented among consumers of SSBs (e.g., hyperlipidemia, non-alcoholic fatty liver disease). Second, our conclusions for a particular health consequence did not include a quality assessment and was limited to an informal evaluation of consistency and lack of conflicting studies. Third, article screening was not done in duplicate, although all included articles were confirmed by a second reviewer.

Conclusion

This review provides clear and consistent evidence that consumption of SSBs increases obesity risk and dental caries among children and adolescents, with emerging evidence supporting an association with insulin resistance and caffeine-related effects. In general, the strength of evidence for all four health consequences could be improved through the implementation of more longitudinal and intervention studies. Additionally, more consistency is needed from studies in the measurement of exposures (e.g., standardized measurement and definition of SSBs) and outcomes (e.g., assessment of weight-related outcomes) to create a stronger evidence base. Future research should compare low-income and racial/ethnic minority subgroups in order to determine if differences in health risks associated with SSBs exist. Although SSB consumption has declined in the last 15 years, consumption still remains high (61% of children consume at least one SSB per day). The vast majority of the available literature suggests that reducing SSB consumption would improve children’s health.

Footnotes
1

Author calculations, based on PubMed results by year.

 

Abbreviations

BMI: 

Body mass index

NHANES: 

National Health and Nutritional Examination Survey

OECD: 

Organisation for Economic Co-operation and Development

SSB: 

Sugar-sweetened beverage

Declarations

Acknowledgements

Not applicable

Funding

This work was funded by the Robert Wood Johnson Foundation Healthy Eating Research Program.

Availability of data and materials

Please contact author for data requests.

Authors’ contributions

SNB designed the research. KAV conducted the review. SNB and KAV drafted and revised the paper for intellectual content. SNB had primary responsibility for final content. Both authors read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
(2)
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA

References

  1. US Department of Health and Human Services USDoA. 2015–2020 Dietary guidelines for Americans. 8th ed.. Washington (DC): USDA. 2015.Google Scholar
  2. Bleich SN, Wolfson JA. Trends in SSBs and snack consumption among children by age, body weight, and race/ethnicity. Obesity. 2015;23(5):1039–46.View ArticlePubMedPubMed CentralGoogle Scholar
  3. Bleich SN, Vercammen KA, Kom JW, Zhonghe L. Trends in beverage consumption among children and adults, 2003-2014. Obesity. 2017;Google Scholar
  4. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084–102.View ArticlePubMedPubMed CentralGoogle Scholar
  5. Resolved HFB. There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2013;14(8):606–19. https://doi.org/10.1111/obr.12040. View ArticleGoogle Scholar
  6. Malik VS, Popkin BM, Bray GA, Després J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356–64.View ArticlePubMedPubMed CentralGoogle Scholar
  7. Malik VS, Popkin BM, Bray GA, Després J-P, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. Diabetes Care. 2010;33(11):2477–83.View ArticlePubMedPubMed CentralGoogle Scholar
  8. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292(8):927–34.View ArticlePubMedGoogle Scholar
  9. Nseir W, Nassar F, Assy N. Soft drinks consumption and nonalcoholic fatty liver disease. World J Gastroenterol: WJG. 2010;16(21):2579.View ArticlePubMedPubMed CentralGoogle Scholar
  10. Tahmassebi J, Duggal M, Malik-Kotru G, Curzon M. Soft drinks and dental health: a review of the current literature. J Dent. 2006;34(1):2–11.View ArticlePubMedGoogle Scholar
  11. Davis JN, Ventura EE, Weigensberg MJ, Ball GD, Cruz ML, Shaibi GQ, et al. The relation of sugar intake to β cell function in overweight Latino children. Am J Clin Nutr. 2005;82(5):1004–10.PubMedPubMed CentralGoogle Scholar
  12. Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. 2010;100(1):47–54. https://doi.org/10.1016/j.physbeh.2010.01.036.View ArticlePubMedPubMed CentralGoogle Scholar
  13. Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health effects and public health concerns of energy drink consumption in the United States: a mini-review. Front Public Health. 2017;5:225.View ArticlePubMedPubMed CentralGoogle Scholar
  14. Forshee RA, Anderson PA, Storey ML. Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr. 2008;87(6):1662–71.PubMedGoogle Scholar
  15. Harrington S. The role of sugar-sweetened beverage consumption in adolescent obesity: a review of the literature. J Sch Nurs. 2008;24(1):3–12.View ArticlePubMedGoogle Scholar
  16. Gortmaker S, Long M, Wang YC. The negative impact of sugar-sweetened beverages on Children's health: a research synthesis. Robert Wood Johnson Foundation; 2009.Google Scholar
  17. Beck AL, Tschann J, Butte NF, Penilla C, Greenspan LC. Association of beverage consumption with obesity in Mexican American children. Public Health Nutr. 2014;17(2):338–44. https://doi.org/10.1017/s1368980012005514.View ArticlePubMedGoogle Scholar
  18. Bremer AA, Byrd RS, Auinger P. Differences in male and female adolescents from various racial groups in the relationship between insulin resistance-associated parameters with sugar-sweetened beverage intake and physical activity levels. Clin Pediatr. 2010;49(12):1134–42. https://doi.org/10.1177/0009922810379043.View ArticleGoogle Scholar
  19. Clifton PM, Chan L, Moss CL, Miller MD, Cobiac L. Beverage intake and obesity in Australian children. Nutrition & metabolism. 2011;8:87. https://doi.org/10.1186/1743-7075-8-87.View ArticleGoogle Scholar
  20. Coppinger T, Jeanes Y, Mitchell M, Reeves S. Beverage consumption and BMI of British schoolchildren aged 9-13 years. Public Health Nutr. 2013;16(7):1244–9. https://doi.org/10.1017/s1368980011002795.View ArticlePubMedGoogle Scholar
  21. Danyliw AD, Vatanparast H, Nikpartow N, Whiting SJ. Beverage patterns among Canadian children and relationship to overweight and obesity. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2012;37(5):900–6. https://doi.org/10.1139/h2012-074. View ArticlePubMedGoogle Scholar
  22. Davis JN, Koleilat M, Shearrer GE, Whaley SE. Association of infant feeding and dietary intake on obesity prevalence in low-income toddlers. Obesity (Silver Spring, Md). 2014;22(4):1103–11. https://doi.org/10.1002/oby.20644. View ArticleGoogle Scholar
  23. Davis JN, Whaley SE, Goran MI. Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers. Am J Clin Nutr. 2012;95(1):3–8. https://doi.org/10.3945/ajcn.111.019372.View ArticlePubMedGoogle Scholar
  24. Denova-Gutierrez E, Jimenez-Aguilar A, Halley-Castillo E, Huitron-Bravo G, Talavera JO, Pineda-Perez D, et al. Association between sweetened beverage consumption and body mass index, proportion of body fat and body fat distribution in Mexican adolescents. Annals of nutrition & metabolism. 2008;53(3–4):245–51. https://doi.org/10.1159/000189127.View ArticleGoogle Scholar
  25. Gibson S, Neate D. Sugar intake, soft drink consumption and body weight among British children: further analysis of National Diet and nutrition survey data with adjustment for under-reporting and physical activity. Int J Food Sci Nutr. 2007;58(6):445–60. https://doi.org/10.1080/09637480701288363.View ArticlePubMedGoogle Scholar
  26. Gómez-Martínez S, Martín A, Romeo Marín J, Castillo Garzón MJ, Mesena M, Baraza J et al. Is soft drink consumption associated with body composition? A cross-sectional study in Spanish adolescents. 2009.Google Scholar
  27. Grimes CA, Riddell LJ, Campbell KJ, Nowson CA. Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics. 2013;131(1):14–21. https://doi.org/10.1542/peds.2012-1628.View ArticlePubMedGoogle Scholar
  28. Ha K, Chung S, Lee H, Kim C, Joung H, Paik H, et al. Association of dietary sugars and sugar-sweetened beverage intake with obesity in Korean children and adolescents. Nutrients. 2016;8(1):31.View ArticlePubMed CentralGoogle Scholar
  29. Kosova EC, Auinger P, Bremer AA. The relationships between sugar-sweetened beverage intake and cardiometabolic markers in young children. J Acad Nutr Diet. 2013;113(2):219–27. https://doi.org/10.1016/j.jand.2012.10.020.View ArticlePubMedPubMed CentralGoogle Scholar
  30. Linardakis M, Sarri K, Pateraki MS, Sbokos M, Kafatos A. Sugar-added beverages consumption among kindergarten children of Crete: effects on nutritional status and risk of obesity. BMC Public Health. 2008;8:279. https://doi.org/10.1186/1471-2458-8-279.View ArticlePubMedPubMed CentralGoogle Scholar
  31. Papandreou D, Andreou E, Heraclides A, Rousso II. Beverage intake related to overweight and obesity in school children? Hippokratia. 2013;17(1):42–6.PubMedPubMed CentralGoogle Scholar
  32. Schroder H, Mendez MA, Ribas L, Funtikova AN, Gomez SF, Fito M, et al. Caloric beverage drinking patterns are differentially associated with diet quality and adiposity among Spanish girls and boys. Eur J Pediatr. 2014;173(9):1169–77. https://doi.org/10.1007/s00431-014-2302-x.View ArticlePubMedGoogle Scholar
  33. Valente H, Teixeira V, Padrao P, Bessa M, Cordeiro T, Moreira A, et al. Sugar-sweetened beverage intake and overweight in children from a Mediterranean country. Public Health Nutr. 2011;14(1):127–32. https://doi.org/10.1017/s1368980010002533.View ArticlePubMedGoogle Scholar
  34. Bremer AA, Auinger P, Byrd RS. Sugar-sweetened beverage intake trends in US adolescents and their association with insulin resistance-related parameters. Journal of nutrition and metabolism. 2010;2010 https://doi.org/10.1155/2010/196476.
  35. Jiménez-Aguilar A, Flores M, Shamah-Levy T. Sugar-sweetened beverages consumption and BMI in Mexican adolescents: Mexican National Health and nutrition survey 2006. Salud Publica Mex. 2009;51:S604–S12.View ArticlePubMedGoogle Scholar
  36. Ambrosini GL, Oddy WH, Huang RC, Mori TA, Beilin LJ, Jebb SA. Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents. Am J Clin Nutr. 2013;98(2):327–34. https://doi.org/10.3945/ajcn.112.051383.View ArticlePubMedPubMed CentralGoogle Scholar
  37. Chaidez V, McNiven S, Vosti SA, Kaiser LL. Sweetened food purchases and indulgent feeding are associated with increased toddler anthropometry. J Nutr Educ Behav. 2014;46(4):293–8. https://doi.org/10.1016/j.jneb.2013.05.011.View ArticlePubMedGoogle Scholar
  38. DeBoer MD, Scharf RJ, Demmer RT. Sugar-sweetened beverages and weight gain in 2- to 5-year-old children. Pediatrics. 2013;132(3):413–20. https://doi.org/10.1542/peds.2013-0570.View ArticlePubMedPubMed CentralGoogle Scholar
  39. Dubois L, Farmer A, Girard M, Peterson K. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc. 2007;107(6):924–934; discussion 34-5. https://doi.org/10.1016/j.jada.2007.03.004.View ArticlePubMedGoogle Scholar
  40. Field AE, Sonneville KR, Falbe J, Flint A, Haines J, Rosner B, et al. Association of sports drinks with weight gain among adolescents and young adults. Obesity (Silver Spring, Md). 2014;22(10):2238–43. https://doi.org/10.1002/oby.20845. View ArticlePubMed CentralGoogle Scholar
  41. Jensen BW, Nichols M, Allender S, de Silva-Sanigorski A, Millar L, Kremer P, et al. Inconsistent associations between sweet drink intake and 2-year change in BMI among Victorian children and adolescents. Pediatric obesity. 2013;8(4):271–83. https://doi.org/10.1111/j.2047-6310.2013.00174.x.View ArticlePubMedGoogle Scholar
  42. Jensen BW, Nielsen BM, Husby I, Bugge A, El-Naaman B, Andersen LB, et al. Association between sweet drink intake and adiposity in Danish children participating in a long-term intervention study. Pediatric obesity. 2013;8(4):259–70. https://doi.org/10.1111/j.2047-6310.2013.00170.x.View ArticlePubMedGoogle Scholar
  43. Kral TVE, Stunkard AJ, Berkowitz RI, Stallings VA, Moore RH, Faith MS. Beverage consumption patterns of children born at different risk of obesity. Obesity. 2008;16(8):1802–8. https://doi.org/10.1038/oby.2008.287.View ArticlePubMedPubMed CentralGoogle Scholar
  44. Laska MN, Murray DM, Lytle LA, Harnack LJ. Longitudinal associations between key dietary behaviors and weight gain over time: transitions through the adolescent years. Obesity (Silver Spring, Md). 2012;20(1):118–25. https://doi.org/10.1038/oby.2011.179. View ArticleGoogle Scholar
  45. Leermakers ET, Felix JF, Erler NS, Cerimagic A, Wijtzes AI, Hofman A, et al. Sugar-containing beverage intake in toddlers and body composition up to age 6 years: the generation R study. Eur J Clin Nutr. 2015;69(3):314–21. https://doi.org/10.1038/ejcn.2015.2.View ArticlePubMedGoogle Scholar
  46. Libuda L, Alexy U, Sichert-Hellert W, Stehle P, Karaolis-Danckert N, Buyken AE, et al. Pattern of beverage consumption and long-term association with body-weight status in German adolescents--results from the DONALD study. Br J Nutr. 2008;99(6):1370–9. https://doi.org/10.1017/s0007114507862362. View ArticlePubMedGoogle Scholar
  47. Lim S, Zoellner JM, Lee JM, Burt BA, Sandretto AM, Sohn W, et al. Obesity and sugar-sweetened beverages in African-American preschool children: a longitudinal study. Obesity (Silver Spring, Md). 2009;17(6):1262–8. https://doi.org/10.1038/oby.2008.656. Google Scholar
  48. Millar L, Rowland B, Nichols M, Swinburn B, Bennett C, Skouteris H, et al. Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children. Obesity (Silver Spring, Md). 2014;22(5):E96–103. https://doi.org/10.1002/oby.20665. View ArticleGoogle Scholar
  49. Pan L, Li R, Park S, Galuska DA, Sherry B, Freedman DS. A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics. 2014;134(Suppl 1):S29–35. https://doi.org/10.1542/peds.2014-0646F. View ArticlePubMedPubMed CentralGoogle Scholar
  50. Vanselow MS, Pereira MA, Neumark-Sztainer D, Raatz SK. Adolescent beverage habits and changes in weight over time: findings from project EAT. Am J Clin Nutr. 2009;90(6):1489–95. https://doi.org/10.3945/ajcn.2009.27573.View ArticlePubMedGoogle Scholar
  51. Weijs PJ, Kool LM, van Baar NM, van der Zee SC. High beverage sugar as well as high animal protein intake at infancy may increase overweight risk at 8 years: a prospective longitudinal pilot study. Nutr J. 2011;10:95. https://doi.org/10.1186/1475-2891-10-95.View ArticlePubMedPubMed CentralGoogle Scholar
  52. Zheng M, Rangan A, Olsen NJ, Andersen LB, Wedderkopp N, Kristensen P, et al. Sugar-sweetened beverages consumption in relation to changes in body fatness over 6 and 12 years among 9-year-old children: the European youth heart study. Eur J Clin Nutr. 2014;68(1):77–83. https://doi.org/10.1038/ejcn.2013.243.View ArticlePubMedGoogle Scholar
  53. Fiorito LM, Marini M, Francis LA, Smiciklas-Wright H, Birch LL. Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence. Am J Clin Nutr. 2009;90(4):935–42.View ArticlePubMedPubMed CentralGoogle Scholar
  54. Laurson K, Eisenmann JC, Moore S. Lack of association between television viewing, soft drinks, physical activity and body mass index in children. Acta Paediatr. 2008;97(6):795–800.View ArticlePubMedGoogle Scholar
  55. Bremer AA, Auinger P, Byrd RS. Sugar-sweetened beverage intake trends in US adolescents and their association with insulin resistance-related parameters. Journal of nutrition and metabolism. 2009;2010Google Scholar
  56. Lee A, Chowdhury R, Welsh J. Sugars and adiposity: the long-term effects of consuming added and naturally occurring sugars in foods and in beverages. Obesity science & practice. 2015;1(1):41–9.View ArticleGoogle Scholar
  57. Stoof SP, Twisk JWR, Olthof MR. Is the intake of sugar-containing beverages during adolescence related to adult weight status? Public Health Nutr. 2013;16(7):1257–62. https://doi.org/10.1017/s1368980011002783.View ArticlePubMedGoogle Scholar
  58. de Ruyter JC, Olthof MR, Seidell JC, Katan MBA. Trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012;367(15):1397–406.View ArticlePubMedGoogle Scholar
  59. Ebbeling CB, Feldman HA, Chomitz VR, Antonelli TA, Gortmaker SL, Osganian SK, et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med. 2012;367(15):1407–16.View ArticlePubMedPubMed CentralGoogle Scholar
  60. James J, Thomas P, Kerr D. Preventing childhood obesity: two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). BMJ. 2007;335(7623):762.View ArticlePubMedPubMed CentralGoogle Scholar
  61. James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ. 2004;328(7450):1237.View ArticlePubMedPubMed CentralGoogle Scholar
  62. Kondaki K, Grammatikaki E, Jiménez-Pavón D, De Henauw S, Gonzalez-Gross M, Sjöstrom M, et al. Daily sugar-sweetened beverage consumption and insulin resistance in European adolescents: the HELENA (healthy lifestyle in Europe by nutrition in adolescence) study. Public Health Nutr. 2013;16(03):479–86.View ArticlePubMedGoogle Scholar
  63. Santiago-Torres M, Cui Y, Adams AK, Allen DB, Carrel AL, Guo JY, et al. Familial and individual predictors of obesity and insulin resistance in urban Hispanic children. Pediatric obesity. 2016;11(1):54–60.View ArticlePubMedGoogle Scholar
  64. Wang J, Mark S, Henderson M, O'loughlin J, Tremblay A, Wortman J, et al. Adiposity and glucose intolerance exacerbate components of metabolic syndrome in children consuming sugar-sweetened beverages: QUALITY cohort study. Pediatric obesity. 2013;8(4):284–93.View ArticlePubMedGoogle Scholar
  65. Bremer AA, Auinger P, Byrd RS. Relationship between insulin resistance–associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999-2004 National Health and nutrition examination survey. Archives of pediatrics & adolescent medicine. 2009;163(4):328–35.View ArticleGoogle Scholar
  66. Wang J, Light K, Henderson M, O'loughlin J, Mathieu M-E, Paradis G, et al. Consumption of added sugars from liquid but not solid sources predicts impaired glucose homeostasis and insulin resistance among youth at risk of obesity. J Nutr. 2014;144(1):81–6.View ArticlePubMedGoogle Scholar
  67. Armfield JM, Spencer AJ, Roberts-Thomson KF, Plastow K. Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children. Am J Public Health. 2013;103(3):494–500.View ArticlePubMedPubMed CentralGoogle Scholar
  68. Chi DL, Hopkins S, O’Brien D, Mancl L, Orr E, Lenaker D. Association between added sugar intake and dental caries in Yup’ik children using a novel hair biomarker. BMC oral health. 2015;15(1):121.View ArticlePubMedPubMed CentralGoogle Scholar
  69. Declerck D, Leroy R, Martens L, Lesaffre E, Garcia-Zattera MJ, Broucke SV, et al. Factors associated with prevalence and severity of caries experience in preschool children. Community Dent Oral Epidemiol. 2008;36(2):168–78.View ArticlePubMedGoogle Scholar
  70. Evans EW, Hayes C, Palmer CA, Bermudez OI, Cohen SA. Must a. Dietary intake and severe early childhood caries in low-income, young children. J Acad Nutr Diet. 2013;113(8):1057–61.View ArticlePubMedPubMed CentralGoogle Scholar
  71. Guido JA, EA MM, Soto A, Eggertsson H, Sanders BJ, Jones JE, et al. Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages. Int J Paediatr Dent. 2011;21(6):432–40.View ArticlePubMedGoogle Scholar
  72. Hoffmeister L, Moya P, Vidal C, Benadof D. Factors associated with early childhood caries in Chile. Gac Sanit. 2016;30(1):59–62.View ArticlePubMedGoogle Scholar
  73. Jerkovic K, Binnekade J, Van der Kruk J, Van d, Most J, Talsma A, van der Schans C. Differences in oral health behaviour between children from high and children from low SES schools in the Netherlands. Community Dent Health. 2009;26(2):110.PubMedGoogle Scholar
  74. Jurczak A, Kościelniak D, Gregorczyk-Maga I, Kołodziej I, Ciepły J, Olczak-Kowalczyk D, et al. Influence of socioeconomic and nutritional factors on the development of early childhood caries in children aged 1-6 years. Nowa Stomatologia. 2015;Google Scholar
  75. Kolker JL, Yuan Y, Burt BA, Sandretto AM, Sohn W, Lang SW, et al. Dental caries and dietary patterns in low-income African American children. Pediatr Dent. 2007;29(6):457–64.PubMedGoogle Scholar
  76. Lee J, Messer EPL. Intake of sweet drinks and sweet treats versus reported and observed caries experience. european archives of Paediatric Dentistry. 2010;11(1):5–17.View ArticlePubMedGoogle Scholar
  77. Majorana A, Cagetti MG, Bardellini E, Amadori F, Conti G, Strohmenger L, et al. Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study. BMC Pediatr. 2014;14(1):45.View ArticlePubMedPubMed CentralGoogle Scholar
  78. Mello T, Antunes I, Waldman E, Ramos E, Relvas M, Barros H. Prevalence and severity of dental caries in schoolchildren of Porto, Portugal. Community Dent Health. 2008;25(2):119–25.PubMedGoogle Scholar
  79. Pacey A, Nancarrow T, Egeland G. Prevalence and risk factors for parental-reported oral health of Inuit preschoolers: Nunavut Inuit child health survey, 2007–2008. Rural Remote Health. 2010;10(2):1368.PubMedGoogle Scholar
  80. Skinner J, Byun R, Blinkhorn A, Johnson G. Sugary drink consumption and dental caries in new South Wales teenagers. Aust Dent J. 2015;60(2):169–75.View ArticlePubMedGoogle Scholar
  81. Wilder JR, Kaste LM, Handler A, McGruder T C, Rankin KM. The association between sugar-sweetened beverages and dental caries among third-grade students in Georgia. J Public Health Dent. 2015;Google Scholar
  82. Nakayama Y, Mori M. Association between nocturnal breastfeeding and snacking habits and the risk of early childhood caries in 18-to 23-month-old Japanese children. Journal of Epidemiology. 2015;25(2):142–7.View ArticlePubMedGoogle Scholar
  83. Lim S, Sohn W, Burt BA, Sandretto AM, Kolker JL, Marshall TA, et al. Cariogenicity of soft drinks, milk and fruit juice in low-income african-american children: a longitudinal study. J Am Dent Assoc. 2008;139(7):959–67.View ArticlePubMedGoogle Scholar
  84. Park S, Lin M, Onufrak S, Li R. Association of sugar-sweetened beverage intake during infancy with dental caries in 6-year-olds. Clinical nutrition research. 2015;4(1):9–17.View ArticlePubMedGoogle Scholar
  85. Warren JJ, Blanchette D, Dawson DV, Marshall TA, Phipps KR, Starr D, et al. Factors associated with dental caries in a group of American Indian children at age 36 months. Community Dent Oral Epidemiol. 2016;44(2):154–61.View ArticlePubMedGoogle Scholar
  86. Warren JJ, Weber-Gasparoni K, Marshall TA, Drake DR, Dehkordi-Vakil F, Dawson DV, et al. A longitudinal study of dental caries risk among very young low SES children. Community Dent Oral Epidemiol. 2009;37(2):116–22.View ArticlePubMedGoogle Scholar
  87. Watanabe M, Wang D-H, Ijichi A, Shirai C, Zou Y, Kubo M, et al. The influence of lifestyle on the incidence of dental caries among 3-year-old Japanese children. Int J Environ Res Public Health. 2014;11(12):12611–22.View ArticlePubMedPubMed CentralGoogle Scholar
  88. Wigen TI, Wang NJ. Does early establishment of favorable oral health behavior influence caries experience at age 5 years? Acta Odontol Scand. 2015;73(3):182–7.View ArticlePubMedGoogle Scholar
  89. Maupomé G, Karanja N, Ritenbaugh C, Lutz T, Aickin M, Becker T. Dental caries in American Indian toddlers after a community-based beverage intervention. Ethnicity & disease. 2010;20(4):444.Google Scholar
  90. Azagba S, Langille D, Asbridge M. An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school students. Prev Med. 2014;62:54–9.View ArticlePubMedGoogle Scholar
  91. Bashir D, Reed-Schrader E, Olympia RP, Brady J, Rivera R, Serra T, et al. Clinical symptoms and adverse effects associated with energy drink consumption in adolescents. Pediatr Emerg Care. 2016;32(11):751–5.View ArticlePubMedGoogle Scholar
  92. Koivusilta L, Kuoppamäki H, Rimpelä A. Energy drink consumption, health complaints and late bedtime among young adolescents. International journal of public health. 2016;61(3):299–306.View ArticlePubMedGoogle Scholar
  93. Kristjansson AL, Sigfusdottir ID, Mann MJ, James JE. Caffeinated sugar-sweetened beverages and common physical complaints in Icelandic children aged 10–12years. Prev Med. 2014;58:40–4.View ArticlePubMedGoogle Scholar
  94. Marmorstein NR. Energy drink and coffee consumption and psychopathology symptoms among early adolescents: cross-sectional and longitudinal associations. Journal of caffeine research. 2016;6(2):64–72.View ArticlePubMedPubMed CentralGoogle Scholar
  95. Park S, Lee Y, Lee JH. Association between energy drink intake, sleep, stress, and suicidality in Korean adolescents: energy drink use in isolation or in combination with junk food consumption. Nutr J. 2016;15(1):87.View ArticlePubMedPubMed CentralGoogle Scholar
  96. Richards G, Smith A. Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. J Psychopharmacol. 2015:0269881115612404.Google Scholar
  97. Franckle RL, Falbe J, Gortmaker S, Ganter C, Taveras EM, Land T, et al. Insufficient sleep among elementary and middle school students is linked with elevated soda consumption and other unhealthy dietary behaviors. Prev Med. 2015;74:36–41.View ArticlePubMedPubMed CentralGoogle Scholar
  98. DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes. 2000;24(6):794.View ArticleGoogle Scholar
  99. Malik VS, Schulze MB, Intake HFB. Of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274–88.PubMedPubMed CentralGoogle Scholar
  100. Ludwig DS. Lifespan weighed down by diet. JAMA. 2016;315(21):2269–70.View ArticlePubMedGoogle Scholar
  101. Slavin J. Beverages and body weight: challenges in the evidence-based review process of the carbohydrate subcommittee from the 2010 dietary guidelines advisory committee. Nutr Rev. 2012;70(suppl 2):S111–S20.View ArticlePubMedGoogle Scholar
  102. Wang Y. Disparities in pediatric obesity in the United States. Advances in nutrition: an international review. Journal. 2011;2(1):23–31.Google Scholar
  103. Ogden C, Carroll M. Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Centers for Disease Control and Prevention. June 2010. 2013.Google Scholar
  104. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292–9.View ArticlePubMedGoogle Scholar
  105. Hales C, Carroll M, Fryar C, Ogden C. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief. Number 288. National Center for Health Statistics. 2017;Google Scholar
  106. Wang LY, Chyen D, Lee S, Lowry R. The association between body mass index in adolescence and obesity in adulthood. J Adolesc Health. 2008;42(5):512–8.View ArticlePubMedGoogle Scholar
  107. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998;101(Supplement 2):518–25.PubMedGoogle Scholar
  108. Touger-Decker R, Van Loveren C. Sugars and dental caries. Am J Clin Nutr. 2003;78(4):881S–92S.View ArticlePubMedGoogle Scholar
  109. Malik VS, Hu FB. Fructose and Cardiometabolic health: what the evidence from sugar-sweetened beverages tells us. J Am Coll Cardiol. 2015;66(14):1615–24. https://doi.org/10.1016/j.jacc.2015.08.025. View ArticlePubMedPubMed CentralGoogle Scholar
  110. Ruxton C. The suitability of caffeinated drinks for children: a systematic review of randomised controlled trials, observational studies and expert panel guidelines. J Hum Nutr Diet. 2014;27(4):342–57.View ArticlePubMedGoogle Scholar

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