The associations between sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption and the risk of metabolic syndrome (MetS) remain controversial. A quantitative assessment of dose–response associations has not been reported. This study aims to assess the associations between the risk of MetS and SSB, ASB, and total sweetened beverage (TSB, the combination of SSB and ASB) consumption by reviewing population-based epidemiological studies.

Meta-analysis.

We searched PubMed, Embase and Web of Science databases prior to 4 November 2019, for relevant studies investigating the SSB–MetS and ASB–MetS associations. A random effects model was used to estimate pooled relative risks (RR) and 95 % CI. Dose–response association was assessed using a restricted cubic splines model.

We identified seventeen articles (twenty-four studies, including 93 095 participants and 20 749 MetS patients).

The pooled RR for the risk of MetS were 1·51 (95 % CI 1·34, 1·69), 1·56 (1·32, 1·83) and 1·44 (1·19, 1·75) in high consumption group of TSB, SSB and ASB, respectively; and 1·20 (1·13, 1·28), 1·19 (1·11, 1·28) and 1·31 (1·05, 1·65) per 250 ml/d increase in TSB, SSB and ASB consumption, respectively. Additionally, we found evidence of non-linear, TSB–MetS and SSB–MetS dose–response associations and a linear ASB–MetS dose–response association.

TSB, SSB and ASB consumption was associated with the risk of MetS. The present findings provide evidence that supports reducing intake of these beverages to lower the TSB-, SSB- and ASB-related risk of MetS.

To analyse trends in sweetened beverages consumption among adults in Brazil between 2007 and 2016.

A time-series analysis, with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). The prevalence of regular consumption (≥5 d/week), the average daily consumption (millilitres) and the prevalence of non-consumption of these beverages were analysed. The temporal variations of the indicators were calculated by linear regression. The analyses were performed for the complete set of the evaluated population and stratified by sociodemographic characteristics.

Brazilian capitals and Federal District.

Brazilian adults aged ≥18 years (n 519 641).

There was a reduction in both regular and average daily consumption of sugar- and artificially sweetened beverages (−1·28 percentage points (pp)/year, P=0·001 and −9·63 ml/year, P=0·001, respectively). The same result regarding regular consumption was found when only sugar-sweetened beverages were analysed (−1·11 pp/year, P=0·011). Similar trends were identified in the stratified analyses, with a greater magnitude of reduction among males, young adults, those with higher schooling and residents of more developed regions. Coincidentally, there was an increase in the prevalence of adults who did not consume sweetened beverages (1·54 pp/year, P=0·005).

The consumption of sweetened beverages decreased during the period. However, a significant portion of the population still referred a daily consumption of these beverages.

To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children.

Secondary analysis of the Young Lives cohort study in Peru.

Twenty sentinel sites from a total of 1818 districts available in Peru.

Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds.

A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28).

Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.

We examined whether drinking water per se is associated with drinking less of other beverages and whether changes in BMI are associated with the intake of water and other beverages.

Secondary analysis of a randomized trial of fourth graders followed over 1 year.

Public schools in the metropolitan area of Rio de Janeiro, Brazil.

Participants were 1134 students aged 10–11 years.

At baseline, a higher frequency of water consumption was associated with a greater daily intake of fruit juice (P = 0·02) and a higher daily frequency of milk (P = 0·005). In the intervention group, the baseline frequency of water consumption was negatively associated with weight change over 1 year but without statistical significance (coefficient = −0·08 kg/m2; 95 % CI −0·37, 0·24 kg/m2), whereas fruit juice intake frequency was positively associated with weight change: each increase in fruit juice intake of 1 glass/d was associated with a BMI increase of 0·16 (95 % CI 0·02, 0·30) kg/m2.

Our findings do not support a protective effect of water consumption on BMI, but confirm consumption of juice drinks as a risk factor for BMI gain. Students who reported high water consumption also reported high intake of other beverages; therefore, the promotion of water consumption per se would not prevent excessive weight gain.

To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.

Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.

Edmonton region, Canada.

Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.

Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.

Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

To assess the association between sugar-sweetened beverage (SSB) consumption and overweight in children from a Mediterranean country.

The children’s dietary intake was measured using a semi-quantitative FFQ completed by the parents. Overall, 2512 questionnaires were returned and 837 children were removed, leaving a final sample of 1675 children, aged between 5 and 10 years. Height and weight were measured according to international standards, and BMI was calculated. The definition of overweight and obesity was based on average centiles according to the International Obesity Task Force cut-offs. To determine the magnitude of the association between SSB consumption and overweight, OR estimates, including CI, were computed using unconditional logistic regression, adjusting for confounders.

Elementary schools throughout the city of Porto, Portugal.

We invited 5867 children, randomly selected, and their parents to participate in the study. Of those schools that agreed to take part, 3391 parents signed and returned the fully filled out consent form.

The prevalence of overweight (including obesity) was 36·6 % for girls and 38·8 % for boys. With regard to SSB consumption (serving/d), no differences between with overweight and non-overweight children were found even after adjustment for confounders (1–2 servings/d: OR = 1·67, 95 % CI 0·76, 3·66, in girls; OR = 1·63, 95 % CI 0·76, 3·47, in boys; and >2 servings/d: OR = 0·63, 95 % CI 0·33, 1·22, in girls; OR = 0·64, 95 % CI 0·33, 1·52, in boys).

The intake of SSB was not associated with increased risk of overweight in Portuguese schoolchildren.

A systematic literature review was conducted to determine whether sweetened beverage intake increases the risk for obesity, and the extent to which it has contributed to recent increases in energy intake and adiposity in the USA.

The search included studies published between 1970 and 2010 that examined secular trends, mechanisms, observational associations and intervention outcomes. Observational and intervention studies were abstracted and systematically evaluated for quality.

Trends in obesity prevalence in the USA and studies from industrialized (developed) countries were included.

Studies were included for all ages, genders, ethnic and socio-economic groups for which data were available.

Obesity rates and sweetened beverage intake have increased in tandem in the USA. Studies consistently show that higher intake of sweetened beverages is associated with higher energy intake. Energy in liquid form is not well compensated for by reductions in the intake of other sources of energy. Well-designed observational studies consistently show a significant positive relationship between sweetened beverage intake and adiposity. More importantly, several well-conducted randomized controlled trials have shown statistically significant changes in adiposity as a result of corresponding changes in sweetened beverage intake.

All lines of evidence consistently support the conclusion that the consumption of sweetened beverages has contributed to the obesity epidemic. It is estimated that sweetened beverages account for at least one-fifth of the weight gained between 1977 and 2007 in the US population. Actions that are successful in reducing sweetened beverage consumption are likely to have a measurable impact on obesity.

To examine the relationship between sweetened beverage consumption and components of the metabolic syndrome in a Mexican population.

We performed a cross-sectional analysis of data from selected adults participating in the baseline assessment of the Health Workers Cohort Study. Information on participants’ sociodemographic characteristics, dietary patterns and physical activity were collected via self-administered questionnaires. Sweetened beverage consumption was evaluated through a validated semi-quantitative FFQ. Anthropometric and clinical measures were assessed with standardized procedures. The definition of metabolic syndrome was determined using criteria from the National Cholesterol Education Program Adult Treatment Panel III. The associations of interest were evaluated by means of linear and logistic regression models.

The Mexican states of Morelos and Mexico.

A total of 5240 individuals aged 20 to 70 years (mean 39·4 (sd 11·5) years) were evaluated.

Overweight/obesity prevalence was 56·6 %. The prevalence of metabolic syndrome in this sample was 26·6 %. We found that for each additional daily sweetened beverage serving consumed, participants experienced an average increase of 0·49 mmol/l in TAG and a decrease in HDL cholesterol of 0·31 mmol/l. Subjects consuming more than two servings of sweetened beverages daily were at 2·0 times greater risk of metabolic syndrome than those who did not consume sweetened beverages. We also observed that higher sweetened beverage consumption increased the risk of all components of the metabolic syndrome.

Our data support the hypothesis that sweetened beverage consumption increases the risk of metabolic syndrome in Mexican adults, possibly by providing excess energy and large amounts of rapidly absorbable sugars.

We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children’s purchase and total weekly and daily consumption of sweetened beverages.

Data were obtained from 10 719 children aged 9–13 years and 2065 elementary schools in the Early Childhood Longitudinal Study–Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages.

The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages.

A policy of availability of sweetened beverages makes an independent contribution to children’s purchase and consumption of sweetened beverages in the 5th grade year.

To determine the reliability and validity of scales measuring low-fat milk consumption self-efficacy and norms during school lunch among a cohort of 5th graders.

Two hundred and seventy-five students completed lunch food records and a psychosocial questionnaire measuring self-efficacy and norms for school lunch low-fat milk consumption during the fall and spring semesters of the 1998–1999 academic year. Test–retest reliability was assessed in participants who also completed the questionnaire in the spring semester (n = 262). Principal component analyses identified and confirmatory factor analyses confirmed latent variables. Bivariate correlations measured construct validity.

Houston-area middle school.

Fifth graders (n = 275) from one middle school in southeast Texas.

Two scales measuring psychosocial influences of low-fat milk consumption were identified and proved reliable in this population: milk self-efficacy and milk norms. Milk self-efficacy and norms were positively correlated with milk consumption and negatively correlated with consumption of sweetened beverages.

These questionnaires can be used in similar interventions to measure the impact of self-efficacy and norms for drinking low-fat milk during school lunch.