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Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis

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.g., diabetes).

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.g., gender, age, beverage type). 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 2005. 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 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

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. 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.

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