Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis1,2,3


Vasanti S Malik, An Pan, Walter C Willett, and Frank B Hu
+ Author Affiliations

1From the Departments of Nutrition (VSM, WCW, and FBH) and Epidemiology (WCW and FBH), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (WCW and FBH), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and the Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (AP).
+ Author Notes

↵2 Supported by the NIH (grants DK58845, P30 DK46200, U54CA155626, and HL60712).

↵3 Address correspondence to VS Malik, Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..">This email address is being protected from spambots. You need JavaScript enabled to view it..


Background: The relation between sugar-sweetened beverages (SSBs) and body weight remains controversial.

Objective: We conducted a systematic review and meta-analysis to summarize the evidence in children and adults.

Design: We searched PubMed, EMBASE, and Cochrane databases through March 2013 for prospective cohort studies and randomized controlled trials (RCTs) that evaluated the SSB-weight relation. Separate meta-analyses were conducted in children and adults and for cohorts and RCTs by using random- and fixed-effects models.


Results: Thirty-two original articles were included in our meta-analyses: 20 in children (15 cohort studies, n = 25,745; 5 trials, n = 2772) and 12 in adults (7 cohort studies, n = 174,252; 5 trials, n = 292). In cohort studies, one daily serving increment of SSBs was associated with a 0.06 (95% CI: 0.02, 0.10) and 0.05 (95% CI: 0.03, 0.07)-unit increase in BMI in children and 0.22 kg (95% CI: 0.09, 0.34 kg) and 0.12 kg (95% CI: 0.10, 0.14 kg) weight gain in adults over 1 y in random- and fixed-effects models, respectively. RCTs in children showed reductions in BMI gain when SSBs were reduced [random- and fixed-effects: −0.17 (95% CI: −0.39, 0.05 kg) and −0.12 (95% CI: −0.22, −0.2 kg)], whereas RCTs in adults showed increases in body weight when SSBs were added (random- and fixed-effects: 0.85 kg; 95% CI: 0.50, 1.20 kg). Sensitivity analyses of RCTs in children showed more pronounced benefits in preventing weight gain in SSB substitution trials (compared with school-based educational programs) and among overweight children (compared with normal-weight children).

Conclusion: Our systematic review and meta-analysis of prospective cohort studies and RCTs provides evidence that SSB consumption promotes weight gain in children and adults.

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