Although informative, the data just described represent only broad correlations.

Thus, separating studies according to type of design allowed us to examine effect magnitudes as a function of strength of research design.

Soft drink consumption also has been examined in relation to a variety of other foods, macronutrients, and micronutrients.

Note. Soft drink consumption also was associated with decreased intakes of protein (r = 0.14), fruit juice (r = 0.17), fruit (r = 0.09), and riboflavin (r = 0.12), among others.

Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS.

Five longitudinal studies reported a negative relationship between soft drink intake and intakes of milk and dairy products,26,59,7375 and 5 reported a negative relation between soft drink consumption and calcium intake.23,73,74,76,77 The average effect sizes for milk and calcium intakes were 0.21 (P < .001; Q5 = 23.09, P < .001) and 0.13 (P < .001; Q4 = 15.22, P = .004), respectively. Mazariegos-Ramos E, Guerrero-Romero F, Rodriguez-Moran M, Lazcano-Burciaga G, Paniagua R, Amato D. Consumption of soft drinks with phosphoric acid as a risk factor for the development of hypocalcemia in children: a case-control study. Beverage choices of young females: changes and impact on nutrient intakes.

In addition, higher intake of diet drinks among people with elevated BMIs could reduce or cancel out a relationship between intake of soft drinks overall and body weight.

Rogers PJ, Carlyle JA, Hill AJ, Blundell JE.

Melanson KJ, Westerterp-Plantenga MS, Campfield LA, Saris WH.

The average effect size was 0.30 (P < .001; Q4 = 2.37, P = .667).

Dietary compensation by humans for supplemental energy provided as ethanol or carbohydrate in fluids. There is a great deal of variability in the methods employed in research on the effects of soft drink consumption, and some of these methodological factors have considerable effects on study outcomes.

Savoca MR, Evans CD, Wilson ME, Harshfield GA, Ludwig DA. Novotny R, Daida YG, Acharya S, Grove JS, Vogt TM.

Another study reported a positive association between soft drink consumption and number of risk factors for metabolic syndrome.78 These effects also remained when BMI and energy intake were controlled. Shuster J, Jenkins A, Logan C, et al.

Salamoun MM, Kizirian AS, Tannous RI, et al. Smith S, Swain J, Brown EM, et al. K. D. Brownell co-originated the project and cowrote the article. Beverage use and risk for kidney stones in women. Birch LL, McPhee L, Sullivan S. Childrens food intake following drinks sweetened with sucrose or aspartame: time course effects. Bray GA, Nielsen SJ, Popkin BM.

Risk factors for overweight in five- to six-year-old Hispanic-American children: a pilot study. Almiron-Roig E, Drewnowski A.

Wyshak G, Frisch RE.


Longitudinal designs are considered stronger, but experimental designs are the strongest test of causal relationships. Hunger, thirst, and energy intakes following consumption of caloric beverages.

Personnel from the Rudd Foundation were not involved in this work in any way.

CI = confidence interval. The issues of greatest concern are elevations in blood pressure and increased risk of diabetes. In 1942 the American Medical Association mentioned soft drinks specifically in a strong recommendation to limit intake of added sugar.1 At that time, annual US production of carbonated soft drinks was 90 8-oz (240-mL) servings per person; by 2000 this number had risen to more than 600 servings.2 In the intervening years, controversy arose over several fundamental concerns: whether these beverages lead to energy overconsumption; whether they displace other foods and beverages and, hence, nutrients; whether they contribute to diseases such as obesity and diabetes; and whether soft drink marketing practices represent commercial exploitation of children.35.

Correlates of beverage intake in adolescent girls: the National Heart, Lung, and Blood Institute Growth and Health Study. A number of studies suggest links between soft drink intake and medical problems. Steinberg AD, Zimmerman SO, Bramer ML.

Carbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys.

The https:// ensures that you are connecting to the

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes.

Modifications in food-group consumption are related to long-term body-weight changes. Careers. Prospective study of beverage use and the risk of kidney stones.

Van Wymelbeke V, Beridot-Therond ME, de La Gueronniere V, Fantino M. Influence of repeated consumption of beverages containing sucrose or intense sweeteners on food intake.

De Castro JM. Moreover, some research designs are viewed as more powerful than others. The sweetening of the worlds diet.

The Lincoln Dental Caries Study: II. Bekelman JE, Li Y, Gross CP.

Mrdjenovic G, Levitsky DA.

Also, further testing of moderators revealed that effect sizes were larger among (1) women, (2) adults, (3) studies focusing on sugar-sweetened soft drinks, and (4) studies not funded by the food industry (Table 2 ).

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.3135 One study also revealed higher-than-expected energy intakes among participants given the energy they consumed from soft drinks.34 By contrast, 5 other studies reported that participants compensated at a subsequent meal for energy consumed from beverages.3640 Still others reported mixed results, depending, for example, on how long before lunch participants consumed soft drinks.41,42 The average effect size for short-term experimental studies was 0.21 (P < .001; Q18 = 37.92, P = .004).

The overall effect size for calcium intake was 0.04 (P < .001; Q28 = 368.65, P < .001, fail-safe N = 418). The stability of soft drinks intake from adolescence to adult age and the association between long-term consumption of soft drinks and lifestyle factors and body weight.

Bowman SA. Soft drink consumption and urinary stone recurrence: a randomized prevention trial. Average Energy Intake Effect Sizes, by Type of Research Design.

Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.

Effects of consumption of caloric vs noncaloric sweet drinks on indices of hunger and food consumption in normal adults. will also be available for a limited time. PMC legacy view Rolls BJ, Kim S, Fedoroff IC. Food away from home, sugar-sweetened drink consumption and juvenile obesity. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. This discrepancy was particularly striking in studies examining the effects of soft drink consumption on energy intake; effect sizes were moderate (r = 0.23) for nonfunded studies and essentially nil (r = 0.05) for funded studies. Further testing of moderators revealed significantly larger effect sizes among (1) women, (2) adults, (3) studies focusing on sugar-sweetened soft drinks, and (4) studies not funded by the food industry (Table 1 ). American Medical Association Council on Foods and Nutrition. Yoo S, Nicklas T, Baranowski T, et al. 8600 Rockville Pike

The issue of industry funding has been the focus of considerable scrutiny in several areas of medical research, particularly pharmaceutical studies.103 Our analyses revealed that the overall pattern of results differed significantly when studies funded and not funded by the food industry were compared.

The site is secure. The effect of acidulated carbonated beverages on the incidence of dental caries.

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. In certain cases, it was necessary to manually calculate effect sizes. Shuster J, Finlayson B, Scheaffer RL, Sierakowski R, Zoltek J, Dzegede S. Primary liquid intake and urinary stone disease. Effect sizes for soft drink consumption and milk and calcium intake are shown in Tables 3 and 4 , respectively. Rajeshwari R, Yang SJ, Nicklas TA, Berenson GS.

A preliminary report of the short-term effect of carbonated beverage consumption on calcium metabolism in normal women.

Whiting SJ, Healey A, Psiuk S, Mirwald R, Kowalski K, Bailey DA.

The 5 longitudinal studies that we identified all reported positive associations between soft drink consumption and overall energy intake.17,2326 The average effect size for these studies was 0.24 (P < .001; Q6 = 109.11, P < .001).

In addition, studies funded by the food industry exhibited slight positive effects, whereas studies not funded by the food industry exhibited small negative effects (Table 4 ). Storey ML, Forshee RA, Anderson PA.

The issue is not new.

These authors proposed that fructose is digested, absorbed, and metabolized differently than glucose in ways that favor de novo lipogenesis and do not stimulate insulin secretion or enhance the production of leptin, both afferent signals in the regulation of food intake and body weight. official website and that any information you provide is encrypted

Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls.

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. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity.

Ma D, Jones G. Soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children: a population-based case-control study.

Stanton MF, Ahrens RA, Douglass LW.

Bethesda, MD 20894, Web Policies Phillips SM, Bandini LG, Naumova EN, et al.

One would expect a weaker relationship of soft drink consumption with body weight than with energy intake because soft drinks are not the only source of energy in the diet. The overall effect size (r) across all studies for the relation between soft drink consumption and energy intake was 0.16 (P < .001, Q46 = 715.46, fail-safe N = 9726). 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.g., diabetes). 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.

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. Holt SH, Sandona N, Brand-Miller JC. Hirvonen T, Pietinen P, Virtanen M, Albanes D, Virtamo J. Nutrient intake and use of beverages and the risk of kidney stones among male smokers. Yearly US per capita consumption of nondiet soft drinks rose 86% between 1970 and 1997 alone (22 gal [83.6 L] vs 41 gal).99 The prevalence of obesity increased 112% during that approximate time.100 US per capita energy consumption from added sugar rose from 984 kJ (235 kcal) per day in 1977 through 1978 to 1331 kJ (318 kcal) in 1994 through 1996, with soft drinks contributing far more to the total (440 kJ [105 kcal]) than foods such as fruit drinks (130 kJ [31 kcal]) and desserts (251 kJ [60 kcal]).101. FOIA DiMeglio DP, Mattes RD. The effect sizes for these studies, respectively, were 0.13, 0.24, and 0.30. Marshall TA, Levy SM, Broffitt B, et al.

Frary CD, Johnson RK, Wang MQ.

In the case of many of these outcomes, there were only a small number of studies (and sometimes only a single study). Carbonated beverage consumption and bone mineral density among older women: the Rancho Bernardo Study.

The most striking finding, in a study of 91 249 women followed for 8 years, was that those who consumed 1 or more servings of soft drinks per day (less than the US national average) were at twice the risk of developing diabetes as those who consumed less than 1 serving per month.17 This result alone warrants serious concern about soft drink intake, particularly in light of the unprecedented rise in type 2 diabetes among children. Our searches yielded a total of 88 articles that were included in the present analysis. Forshee RA, Anderson PA, Storey ML. A study was coded as industry funded if the authors acknowledged support from food companies, beverage companies, or trade associations.

Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies).

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. Newby PK, Peterson KE, Berkey CS, Leppert J, Willett WC, Colditz GA. Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota.

Children and adolescents choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. We considered an effect size of 0.10 or less as small, an effect size of 0.25 as medium, and an effect size of 0.40 or above as large.8. Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ. James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. The overall effect size for milk intake was 0.12 (P < .001, Q33 = 300.43, P < .001, fail-safe N = 4048). The

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. Future research with more uniform methodology (ideally experimental designs) would help clarify the impact of soft drink consumption on nutrition and health outcomes. The association of caffeinated beverages with blood pressure in adolescents. The largest effect sizes were observed in long-term experimental studies, followed by short-term experimental and longitudinal studies. Similar results have been reported in other food research. For example, when means for more than 2 groups were presented (e.g., low, moderate, and high soft drink consumption), we used the formulas for 1-way contrasts described by Rosenthal et al.6 In other cases, odds ratios were reported with uneven confidence intervals (as a result of rounding), and effect sizes were calculated directly from the odds ratio according to the method described by Chinn.7, When data from different subgroups were presented separately (e.g., data for male and female participants were presented independently), we calculated effect sizes separately for each subgroup. Kim SH, Morton DJ, Barrett-Connor EL. Indeed, cross-sectional and longitudinal studies showed only small positive associations between soft drink consumption and BMI (rs=0.05 and 0.09, respectively). Skinner JD, Bounds W, Carruth BR, Ziegler P. Longitudinal calcium intake is negatively related to childrens body fat indexes. Available at: Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis.

CI = confidence interval.

The effect of caffeinated, non-caffeinated, caloric and non-caloric beverages on hydration.

Carbonated soft drink consumption and bone mineral density in adolescence: the Northern Ireland Young Hearts project. Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children.

The .gov means its official. Ballew C, Kuester S, Gillespie C. Beverage choices affect adequacy of childrens nutrient intakes.

In a study of 91249 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.17 These effects were only slightly attenuated when various potential confounds, including BMI and energy intake, were controlled. 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.g., cross-sectional studies of energy intake) to the maximum sample size of the other studies in that domain.

Beverage consumption patterns in elementary school aged children across a two-year period.

Guenther PM. Jensdottir T, Arnadottir IB, Thorsdottir I, et al.

Guthrie JF.

M. B. Schwartz assisted in the coding and analyses and cowrote the article. Uncoupling sweet taste and calories: comparison of the effects of glucose and three intense sweeteners on hunger and food intake.

Larger effect sizes were observed in experimental studies than in cross-sectional or longitudinal studies. A number of studies examined links between soft drink consumption and various health outcomes. Second, effect sizes varied significantly depending on other methodological variables such as participant gender, participant age, and beverage type.

One study showed that individuals who consumed more soft drinks consumed diets with higher overall glycemic indexes,17 supporting the prediction that consumption of foods with high glycemic indexes (such as soft drinks) might stimulate intake of other such foods.22 Other studies showed that soft drink consumption is positively related to the consumption of foods such as hamburgers and pizza54 and negatively related to an overall healthy eating index.16.

Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren.

First, we found that effect magnitudes were consistently larger when studies involved more powerful designs (i.e., findings from experimental studies were consistently stronger than those from cross-sectional studies). Sugared soda consumption and dental caries in the United States. Associations of social and demographic variables with calcium intakes of high school students. Calcium intake was also negatively associated with soft drink consumption in several cross-sectional studies,14,16,19,44,64,65,6771 but the effect sizes were generally small.

Fisher JO, Mitchell DC, Smiciklas-Wright H, Mannino ML, Birch LL.

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.

In cross-sectional studies, outcomes varied depending on how body weight was operationalized.

Canty DJ, Chan MM. Bray et al.102 noted that the average American older than 2 years consumes 553 kJ (132 kcal) per day from high fructose corn syrup (the sole sweetener in US soft drinks) and that intake of this sweetener rose 1000% between 1970 and 1990. Berkey CS, Rockett HR, Field AE, Gillman MW, Colditz GA. Sugar-added beverages and adolescent weight change. We therefore aggregated effect sizes across all studies without examining the impact of research design or any other potential moderator variables.

Davy BM, Harrell K, Stewart J, King DS.

Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Several studies reported a positive association between soft drink consumption and carbohydrate intake,13,14,17,19,20,24,27,28,31,35,39 whereas 1 study reported a negative relation54 and 2 others reported no relation16,38 (average r = 0.13; 4 studies33,34,41,42 were excluded from the analysis because effect sizes could not be computed from the available data). We found 7 studies that examined the connection between soft drink intake and body weight in an experimental or intervention context. Because there was a significant degree of effect size heterogeneity, we examined effect sizes separately for each research design.

Popkin BM, Nielsen SJ.

In addition, all of the authors disclosing an affiliation with the maker of olestra have published studies supportive of the product.104. Dietary patterns and personal characteristics of women consuming recommended amounts of calcium.

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Kvaavik E, Andersen LF, Klepp KI. For example, 2 studies linked soft drink consumption with hypocalcemia (average r =0.38),79,80 and a 30-day follow-up involving a group of patients with hypocalcemia who were asked to refrain from consuming soft drinks revealed a significant increase in serum calcium.80 In addition, 2 studies reported a small but statistically significant negative association between soft drink consumption and bone mineral density,51,75 whereas 2 others did not44,68 (average r =0.03).

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. Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. This heterogeneity not only influences research outcomes but also influences the conclusions that can be drawn from a given study.

Guerrero-Romero F, Rodriguez-Moran M, Reyes E. Consumption of soft drinks with phosphoric acid as a risk factor for the development of hypocalcemia in postmenopausal women. McGartland C, Robson PJ, Murray L, et al.

The effects of sugar-free vs sugar-rich beverages on feelings of fullness and subsequent food intake.

Some nutritional aspects of sugar, candy, and sweetened carbonated beverages.

The available literature also supports the observation that people do not adequately compensate for the added energy they consume in soft drinks with their intake of other foods and consequently increase their intake of sugar and total energy. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? DellaValle DM, Roe LS, Rolls BJ.

The cariogenicity of soft drinks in the United States. One of the most consistent and powerful findings is the link between soft drink intake and increased energy consumption. Total beverage consumption and beverage choices among children and adolescents.

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.

Because there was a significant degree of heterogeneity among the effect sizes, we separated studies according to type of research design. Forshee RA, Storey ML. Bes-Rastrollo M, Sanchez-Villegas A, Gomez-Gracia E, Martinez JA, Pajares RM, Martinez-Gonzalez MA.

We did not assess the degree of heterogeneity for secondary outcomes (nutrition and health) because there were relatively few studies in these domains. Forshee RA, Storey ML.

Other studies revealed a negative association of soft drink consumption with intake of both dietary fiber (r = 0.31) and starch (r = 0.27). Ismail AI, Burt BA, Eklund SA. Similar positions have been taken by other trade associations such as the British Soft Drinks Association and the Australian Beverages Council. Effect sizes for soft drink consumption and body weight are shown in Table 2 . Legislative and legal discussions focusing on soft drink sales often take place on political and philosophical grounds with scant attention to existing science.

R. Vartanian co-originated the project, retrieved and coded the relevant articles, conducted the analyses, and cowrote the article.

Thus, these findings indicate that the increased carbohydrate intake associated with soft drink consumption primarily reflects greater consumption of added sugars. Soft drink consumption has become a highly visible and controversial public health and public policy issue. 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 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. A risk analysis model of the relationship between beverage consumption from school vending machines and risk of adolescent overweight.

Because the Q statistic was not statistically significant, we did not investigate moderators for long-term experimental studies. The new PMC design is here!

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Jacobson MF.

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. The industry trade association in the United States (the American Beverage Association, formerly the National Soft Drink Association) counters nutrition concerns with several key points: (1) the science linking soft drink consumption to negative health outcomes is flawed or insufficient, (2) soft drinks are a good source of hydration, (3) soft drink sales in schools help education by providing needed funding, (4) physical activity is more important than food intake, and (5) it is unfair to pick on soft drinks because there are many causes of obesity and there are no good or bad foods. government site.

Barr SI.

The authors are with the Department of Psychology, Yale University, New Haven, Conn.

Our review showed that increased soft drink intake is related to lower consumption of milk and calcium, but average effect sizes were small.

Studies vary in their design (i.e., cross-sectional, longitudinal, or experimental studies), sample characteristics (e.g., male vs female, adults vs children), and operational definitions of independent and dependent variables. aNumber of studies included in the analysis. The average effect size for milk intake was 0.11 (P <.001; Q27 =268.33, P <.001).

All of the authors of the present article had full access to the data. Findings from short-term experimental studies (i.e., those examining energy intake over the course of a subsequent meal or a single day) were mixed.

Body weight status, dietary habits, and physical activity levels of middle school-aged children in rural Mississippi.

Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and macronutrient intake. 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.g., age, gender, ethnicity, activity level), (5) assessment method (self-reports vs observations or measurements), and (6) presence or absence of food industry funding.