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Try out PMC Labs and tell us what you think. Learn More. In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems e. Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods longitudinal and experimental vs cross-sectional studies.

Several other factors also moderated effect sizes e. Finally, studies funded by the food industry reported significantly smaller effects than did non—industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.

Soft drink consumption has become a highly visible and controversial public health and public policy issue. Soft drinks are viewed by many as a major contributor to obesity and related health problems and have consequently been targeted as a means to help curtail the rising prevalence of obesity, particularly among children.

Soft drinks have been banned from schools in Britain and France, and in the United States, school systems as large as those in Los Angeles, Philadelphia, and Miami have banned or severely limited soft drink sales. Many US states have considered statewide bans or limits on soft drink sales in schools, with California passing such legislation in A key question is whether actions taken to decrease soft drink consumption are warranted given the available science and whether decreasing population consumption of soft drinks would benefit public health.

The issue is not new. In the American Medical Association mentioned soft drinks specifically in a strong recommendation to limit intake of added sugar. Similar positions have been taken by other trade associations such as the British Soft Drinks Association and the Australian Beverages Council. Legislative and legal discussions focusing on soft drink sales often take place on political and philosophical grounds with scant attention to existing science.

Our objectives were to review the available science, examine studies that involved the use of a variety of methods, and address whether soft drink consumption is associated with increased energy intake, increased body weight, displacement of nutrients, and increased risk of chronic diseases. We focused on research investigating the effects of sugar-sweetened beverages; diet and artificially sweetened beverages are noted only in certain cases for comparison purposes.

Finally, we contacted the authors of each included article with a request for unpublished or in-press work, and we asked each author to forward our request to other researchers who might have relevant work. Our searches yielded a total of 88 articles that were included in the present analysis. There is a great deal of variability in research methods in this literature.

Studies vary in their design i. Because such heterogeneity of research methods is likely to produce heterogeneity of effect sizes across studies an effect size represents the magnitude of the relationship between 2 variables , we took 2 steps to assess the impact of research method on outcome. Initially, for each primary outcome energy intake, body weight, milk intake, and calcium intake , we assessed the degree of heterogeneity of effect sizes by testing the significance of the Q statistic, which is the sum of the squared deviations of each effect size from the overall weighted mean effect size.

We did not assess the degree of heterogeneity for secondary outcomes nutrition and health because there were relatively few studies in these domains. Our analysis of primary outcomes revealed a significant degree of heterogeneity of effect sizes in each case, and thus we separated the studies according to research design. This procedure reduces the likelihood of aggregating effect-size estimates across heterogeneous studies. Moreover, some research designs are viewed as more powerful than others.

Cross-sectional studies represent the weakest design, because such studies cannot determine causality. Longitudinal designs are considered stronger, but experimental designs are the strongest test of causal relationships.

Thus, separating studies according to type of design allowed us to examine effect magnitudes as a function of strength of research design. We further explored variability in effect sizes by examining a number of potential moderator variables, including 1 population studied children and adolescents vs adults , 2 gender of participants only male, only female, or male and female combined , 3 type of beverage sugar-sweetened carbonated soft drinks vs a mix of sugar-sweetened and diet beverages , 4 whether the reported results were adjusted for covariates e.

Articles that did not report a funding source or cited support from other sources e. In most cases, we entered data in the form in which they appeared in each individual study, including group means and standard deviations, correlation coefficients, t values, P values, and odds ratios and confidence intervals.

In certain cases, it was necessary to manually calculate effect sizes. For example, when means for more than 2 groups were presented e. When data from different subgroups were presented separately e. In the case of studies that reported multiple measures of a particular construct e. When there was extraordinary variability in sample sizes across studies, we employed the conservative approach of limiting the sample size of the largest study in a particular domain e.

This approach ensured that the calculated average effect size would not be dominated by a single study. We considered an effect size of 0. The overall effect size r across all studies for the relation between soft drink consumption and energy intake was 0. Because there was a significant degree of heterogeneity among the effect sizes, we separated studies according to type of research design.

Because some studies reported both cross-sectional and longitudinal data, and because long-term experimental studies are not displayed, the numbers for the Overall column do not necessarily equal the sum of the numbers for the other columns. Of the 12 cross-sectional studies examining the relation between soft drink consumption and energy intake, 10 reported a significant positive association, 10 — 19 1 reported mixed results, 20 and 1 reported no statistically significant effect.

The 5 longitudinal studies that we identified all reported positive associations between soft drink consumption and overall energy intake. Four long-term experimental studies in which participants consumed soft drinks for between 3 and 10 weeks showed that individuals failed to compensate for the extra energy consumed in the form of sugar-sweetened beverages in that they did not reduce the rest of their food energy intake, resulting in a greater total daily energy intake.

The average effect size was 0. Because the Q statistic was not statistically significant, we did not investigate moderators for long-term experimental studies. Findings from short-term experimental studies i. Of 12 studies, 5 reported that individuals who consumed soft drinks consequently took in a greater amount of total energy food energy plus beverage energy than did those who consumed water.

These results, taken together, provide clear and consistent evidence that people do not compensate for the added energy they consume in soft drinks by reducing their intake of other foods, resulting in increased total energy intakes.

Not only do people fail to compensate for the energy consumed in soft drinks, but there is also some evidence that the increase in energy intake associated with soft drink consumption is even greater than what can be accounted for by the beverages alone, suggesting that food energy intake is also higher.

The largest effect sizes were observed in long-term experimental studies, followed by short-term experimental and longitudinal studies. The smallest effects were found in cross-sectional studies. Research evaluating the relationship between soft drink consumption and body weight is complicated by the fact that researchers operationalize body weight in a number of different ways, even within the same study. When multiple measures of weight were provided in a single study, we calculated the average effect size across those measures.

The overall effect size for studies examining the link between soft drink consumption and body weight was 0. Because there was a significant degree of effect size heterogeneity, we examined effect sizes separately for each research design.

Because some studies reported both cross-sectional and longitudinal data, the numbers for the Overall column do not necessarily equal the sum of the numbers for the other columns. In cross-sectional studies, outcomes varied depending on how body weight was operationalized.

When the focus was on the association between soft drink consumption and BMI, 2 studies reported a significant positive association, 43 , 44 whereas 9 did not. There was some evidence from the longitudinal studies examined that soft drink consumption is associated with weight gain.

Two other studies reported mixed results depending on how body weight was operationalized, 57 , 58 and 4 studies reported no association between soft drink intake and BMI or change in BMI. We found 7 studies that examined the connection between soft drink intake and body weight in an experimental or intervention context.

Five reported a positive association. Two intervention studies aimed at decreasing soft drink consumption among high school students showed that students in the intervention groups essentially maintained their weight over the treatment period, whereas those in the control groups exhibited significant weight gain.

Two studies reported no statistically significant effect of soft drink consumption on weight gain. Larger effect sizes were observed in experimental studies than in cross-sectional or longitudinal studies.

Fifteen cross-sectional studies examined the association between soft drink consumption and milk intake; 13 reported that soft drink consumption was associated with lower intakes of milk and dairy products, 10 , 14 — 16 , 19 , 20 , 51 , 54 , 63 — 67 1 reported no statistically significant association, 68 and 1 reported a small positive association between milk intake and soft drink consumption.

Calcium intake was also negatively associated with soft drink consumption in several cross-sectional studies, 14 , 16 , 19 , 44 , 64 , 65 , 67 — 71 but the effect sizes were generally small. In addition, 4 other studies reported positive associations between soft drink consumption and calcium intake, 51 , 63 , 69 , 72 and 1 reported mixed results. Results from longitudinal studies were similar to those from cross-sectional studies, but the magnitude of the effects was larger. Five longitudinal studies reported a negative relationship between soft drink intake and intakes of milk and dairy products, 26 , 59 , 73 — 75 and 5 reported a negative relation between soft drink consumption and calcium intake.

For calcium intake, larger effect sizes were observed among adults and among studies that included a variety of beverages. Soft drink consumption also has been examined in relation to a variety of other foods, macronutrients, and micronutrients. In the case of many of these outcomes, there were only a small number of studies and sometimes only a single study. We therefore aggregated effect sizes across all studies without examining the impact of research design or any other potential moderator variables.

Thus, these aggregated effects should be interpreted with caution. A complete list of the nutritional variables investigated is available from the authors. A few studies highlighted the specific sources of carbohydrate related to soft drink consumption. Thus, these findings indicate that the increased carbohydrate intake associated with soft drink consumption primarily reflects greater consumption of added sugars.

A number of studies examined links between soft drink consumption and various health outcomes. We report average effect sizes only when there was more than a single study for a particular outcome. Perhaps the most striking link between soft drink consumption and health outcomes was the prospective evidence obtained for type 2 diabetes. In a study of women followed for 8 years, those who consumed 1 or more servings of soft drink per day were twice as likely as those who consumed less than 1 serving per month to develop diabetes over the course of the study.

When diet soft drinks replaced sugar-sweetened soft drinks in the analysis, the increased risk was no longer present, suggesting that the risk was specific to sugar-sweetened soft drinks. Another study reported a positive association between soft drink consumption and number of risk factors for metabolic syndrome.

Smaller associations were found with a number of other health outcomes. The association between soft drinks and dental caries was not observed for diet soft drinks. A week experimental study showed that individuals who consumed sucrose-sweetened beverages exhibited an increase in both systolic and diastolic blood pressure over the course of the study, whereas individuals who consumed artificially sweetened beverages exhibited a decrease in blood pressure.

Intake of soft drinks and added sugars, particularly high fructose corn syrup, has increased coincident with rising body weights and energy intakes in the population of the United States. Although informative, the data just described represent only broad correlations.

A true test of links between an environmental agent such as soft drinks and various health outcomes requires a robust literature with studies involving different methods, populations, and outcomes, but most important is a critical mass of studies with strong methods and sufficient sample sizes. These conditions now exist, and several clear conclusions are apparent. One of the most consistent and powerful findings is the link between soft drink intake and increased energy consumption.

Fully 10 of 12 cross-sectional studies, 5 of 5 longitudinal studies, and all 4 of the long-term experimental studies examined showed that energy intake rises when soft drink consumption increases.



Pay & Benefits at Juice Generation: 18 Reviews

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