Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis

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Abstract

Context

Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking.

Objective

This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years.

Data Sources

Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility.

Study Selection

Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies.

Data Extraction

Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software.

Results

Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups.

Conclusions

The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest.

Systematic Review Registration

PROSPERO registration number CRD42014004432.

Related collections

Most cited references 46

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Sweetened beverage consumption and risk of coronary heart disease in women.

Teresa Fung, Vasanti Malik, Kathryn Rexrode … (2009)

Previous studies have linked full-calorie sugar-sweetened beverages (SSBs) with greater weight gain and an increased risk of type 2 diabetes. We prospectively examined the association between consumption of SSBs and the risk of coronary heart disease (CHD) in women. Women (n = 88,520) from the Nurses' Health Study aged 34-59 y, without previously diagnosed coronary heart disease (CHD), stroke, or diabetes in 1980, were followed from 1980 to 2004. Consumption of SSBs was derived from 7 repeated food-frequency questionnaires administered between 1980 and 2002. Relative risks (RRs) for CHD were calculated by using Cox proportional hazards models and adjusted for known cardiovascular disease risk factors. During 24 y of follow-up, we ascertained 3105 incident cases of CHD (nonfatal myocardial infarction and fatal CHD). After standard and dietary risk factors were adjusted for, the RRs (and 95% CIs) of CHD according to categories of cumulative average of SSB consumption ( or =2 servings/d) were 1.0, 0.96 (0.87, 1.06), 1.04 (0.95, 1.14), 1.23 (1.06, 1.43), and 1.35 (1.07, 1.69) (P for trend < 0.001). Additional adjustment for body mass index, energy intake, and incident diabetes attenuated the associations, but they remained significant. Artificially sweetened beverages were not associated with CHD. Regular consumption of SSBs is associated with a higher risk of CHD in women, even after other unhealthful lifestyle or dietary factors are accounted for.

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Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004.

Y Wang, Sara Bleich, Steven L Gortmaker (2008)

We sought to document increases in caloric contributions from sugar-sweetened beverages and 100% fruit juice among US youth during 1988-2004. We analyzed 24-hour dietary recalls from children and adolescents (aged 2-19) in 2 nationally representative population surveys: National Health and Nutrition Examination Survey III (1988-1994, N = 9882) and National Health and Nutrition Examination Survey 1999-2004 (N = 10 962). We estimated trends in caloric contribution, type, and location of sugar-sweetened beverages and 100% fruit juice consumed. Per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 kcal/day (1 kcal = 4.2 kJ) in 1988-1994 to 270 kcal/day in 1999-2004; sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day. The largest increases occurred among children aged 6 to 11 years ( approximately 20% increase). There was no change in per-capita consumption among white adolescents but significant increases among black and Mexican American youths. On average, respondents aged 2 to 5, 6 to 11, and 12 to 19 years who had sugar-sweetened beverages on the surveyed day in 1999-2004 consumed 176, 229, and 356 kcal/day, respectively. Soda contributed approximately 67% of all sugar-sweetened beverage calories among the adolescents, whereas fruit drinks provided more than half of the sugar-sweetened beverage calories consumed by preschool-aged children. Fruit juice drinkers consumed, on average, 148 (ages 2-5), 136 (ages 6-11), and 184 (ages 12-19) kcal/day. On a typical weekday, 55% to 70% of all sugar-sweetened beverage calories were consumed in the home environment, and 7% to 15% occurred in schools. Children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice. Our analysis indicates increasing consumption in all ages. Schools are a limited source for sugar-sweetened beverages, suggesting that initiatives to restrict sugar-sweetened beverage sales in schools may have an only marginal impact on overall consumption. Pediatricians' awareness of these trends is critical for helping children and parents target suboptimal dietary patterns that may contribute to excess calories and obesity.

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Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

Matthias B. Schulze, Simin Liu, Eric Rimm … (2004)

Increasing evidence suggests an important role of carbohydrate quality in the development of type 2 diabetes. Our objective was to prospectively examine the association between glycemic index, glycemic load, and dietary fiber and the risk of type 2 diabetes in a large cohort of young women. In 1991, 91249 women completed a semiquantitative food-frequency questionnaire that assessed dietary intake. The women were followed for 8 y for the development of incident type 2 diabetes, and dietary information was updated in 1995. We identified 741 incident cases of confirmed type 2 diabetes during 8 y (716 300 person-years) of follow-up. After adjustment for age, body mass index, family history of diabetes, and other potential confounders, glycemic index was significantly associated with an increased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 1.15, 1.07, 1.27, and 1.59; 95% CI: 1.21, 2.10; P for trend = 0.001). Conversely, cereal fiber intake was associated with a decreased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 0.85, 0.87, 0.82, and 0.64; 95% CI: 0.48, 0.86; P for trend = 0.004). Glycemic load was not significantly associated with risk in the overall cohort (multivariate relative risks for quintiles 1-5, respectively: 1, 1.31, 1.20, 1.14, and 1.33; 95% CI: 0.92, 1.91; P for trend = 0.21). A diet high in rapidly absorbed carbohydrates and low in cereal fiber is associated with an increased risk of type 2 diabetes.

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Author and article information

Journal

Journal ID (nlm-ta): Nutr Rev

Journal ID (iso-abbrev): Nutr. Rev

Journal ID (publisher-id): nutritionreviews

Title: Nutrition Reviews

Publisher: Oxford University Press

ISSN (Print): 0029-6643

ISSN (Electronic): 1753-4887

Publication date (Print): February 2018

Publication date (Electronic): 21 December 2017

Publication date PMC-release: 21 December 2017

Volume: 76

Issue: 2

Pages: 88-107

Affiliations

[1 ]Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Balamand, Ashrafieh, Beirut, Lebanon

[2 ]Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon

[3 ]Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon

[4 ]School of Psychology, Queens University Belfast, Belfast, United Kingdom

[5 ]Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

Author notes

L. Jomaa, Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, Lebanon 1107 2020. Email: lj18@ 123456aub.edu.lb .

Article

Publisher ID: nux061

DOI: 10.1093/nutrit/nux061

PMC ID: 5939855

PubMed ID: 29281069

SO-VID: 9931a045-7576-4445-8380-47e2f0376a63

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact journals.permissions@oup.com

Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis

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Abstract

Context

Objective

Data Sources

Study Selection

Data Extraction

Results

Conclusions

Systematic Review Registration

Related collections

Chinese Journal of School Health

Most cited references 46

Sweetened beverage consumption and risk of coronary heart disease in women.

Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004.

Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

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