Posted Feb 19 , 2018 02:02 AM

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

Lugar M, et al. Obesity Facts 2017;10:674–693

What were the findings (excerpted from the Abstract)?

Due to partly inconsistent findings from previous reviews which have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development the authors aimed to systematically review the recent evidence in children and adults. Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted. Thirty (30) publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. Sixty three percent (63%) of the RCT studies were of good, 30% of medium quality, and none was funded by industry. In support of previous studies and analyses, recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the more recent studies cited in this review article, the authors concluded that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water.

Why is this important?

Aside from the obvious association of SSBs with obesity, there is evidence that they are associated not only with diabetes, but with non-alcoholic fatty liver disease (NAFLD). These are all important issues with SSBs that deserve airing. Many of the ‘sugar’ sweetened beverages are actually sweetened by addition of high fructose corn syrup produced as starch in corn is digested with heat and enzymes to make corn syrup. The sweet syrup still contains some undigested oligosaccharides as well as 5-hydroxymethyl-2-furfural (HMF) which is a known toxin. This arouses concern about food safety of these products. In addition, analysis of carbonated soft drinks (CSD) has shown significant degradation products of sugar components, namely α-dicarbonyl compounds (Gensberger S, et al J. Agri. Food Chem. 2013;61:10238-10245) which most of us associate with diabetes. There is clear evidence that dicarbonyl stress is a contributing mediator of obesity and vascular complications of diabetes. A recent article (Kearns CE, et al. JAMA Intern Med. 2016;176(11):1680-1685) suggested that in the past the Sugar Research Foundation sponsored a research program that successfully cast doubt about the health hazards of a high-sugar diet and rather promoted fat "as the dietary culprit" in health concerns such as heart disease. The drumbeat to ‘do something’ about the issue(s) associated with SSB’s has led some groups to tax SSBs. An interesting example is the city of Seattle. (  Do you believe that SSBs should be taxed?  Do you counsel your patients to avoid SSBs?

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