Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews

Abstract

Background: The prevalence of overweight and obesity among children and adolescents has increased worldwide and has reached alarming proportions. Currently, sugar-sweetened beverages (SSBs) are the primary source of added sugar in the diet of children and adolescents. Contradictive findings from studies and reviews have fueled an endless debate on the role of SSBs in the development of childhood obesity.Methods: The primary aim of the present review of reviews was to assess how review-and study-level methodological factors explain conflicting results across reviews and meta-analyses by providing an up-to-date synthesis of recent evidence regarding the association between SSB consumption and weight gain, overweight, and obesity in a population of 6-month-old to 19-year-old children and adolescents. The secondary aim was to assess the quality of included reviews using the Assessment of Multiple SysTemAtic Reviews (AMSTAR) measurement tool. Systematic literature reviews and meta-analyses were included. The literature search was performed through the platforms Pubmed/Medline, Cinahl, and Web of Knowledge.Results: Thirteen reviews and meta-analyses were included. Nine reviews concluded that there was a direct association between SSBs and obesity in children and adolescents and four others did not. The quality of the included reviews was low to moderate, and the two reviews with the highest quality scores showed discrepant results.Conclusions: The majority of reviews concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents. However, recent evidence from well-conducted meta-analyses shows discrepant results regarding the association between SSB and weight gain, overweight, and obesity among children and adolescents. Improving methodological quality of studies and reviews as well as ensuring responsible conduct of research and scientific integrity is essential for the provision of objective results.

Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies

“…Adjustment for total energy intake is conducted due to controlling for confounding variables, for reducing variation, and for predicting the effect of the intervention. However, as SSBs add calories to the diet, it has also been discussed that the adjustment for total energy intake might lead to an underestimation of the effect of SSBs on body weight as total energy intake mediates the association between SSBs and body weight [15]. In our systematic review, about half of the prospective cohort studies in children and also about half in adults adjusted for energy intake, but no RCT adjusted for that.…”

“…This suggests an independent effect of SSBs, even though residual confounding by unmeasured or poorly measured factors cannot be ruled out. Total energy adjustments might influence the direction of the relationship between SSB intake and body weight measures and might change research results, which was discussed in a review in 2015 [15]. Adjustment for total energy intake is conducted due to controlling for confounding variables, for reducing variation, and for predicting the effect of the intervention.…”

“…However, two systematic reviews have shown that in studies funded by the sugar and beverages industries the link between caloric sweeteners and weight gain was weak [13,14]. A more recent systematic literature review concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents [15]. Another systematic analysis showed that inconsistent findings might be due to methodological bias in original studies and in reviews [16].…”

The Importance of the World Health Organization Sugar Guidelines for Dental Health and Obesity Prevention

“…The review concluded that intake of free sugars or sugar sweetened beverages was a determinant of body weight, with increased sugar intake leading to weight gain and inversely [Te Morenga et al, 2012]. Evidence from other systematic reviews and meta-analyses also suggest a direct association between intake of sugarsweetened beverages and weight gain, overweight and obesity [Keller, and Bucher Della Torre, 2015;Malik et al, 2013].…”

Effectiveness of Obesity Prevention and Control

“…In 2015, Keller and Bucher Della Torre (2015) examined 13 systematic reviews on the relationship between SSBs and obesity in children. The quality of the included studies was low to moderate, and 9 indicated a positive association between SSBs and obesity.…”