Articulo Nut

Review Article

Intake of sugar-sweetened beverages and weight gain:
a systematic review1–3
Vasanti S Malik, Matthias B Schulze, and Frank B Hu

KEY WORDS
Sugar-sweetened beverages, soft drinks, soda,
fruit drinks, weight gain, obesity, added sugar, energy compensation
INTRODUCTION

Over the past 2 decades, obesity has escalated to epidemic
proportions in the United States and manycountries around the
world. According to the World Health Organization (WHO),
Œ1 billion adults throughout the world are overweight, with a
body mass index (BMI; in kg/m2) 25. Of these, at least 300
million are considered obese (BMI 30; 1). In the United States
alone, an estimated 129.6 million persons, or 64% of the population aged 20 –74 y, are overweight, and 30% of those 129.6

274million are considered obese (2, 3). Similar trends are being seen
among children and adolescents, which could lead to serious
health complications in adulthood (4). Overweight and obesity
are associated with numerous comorbidities of great public
health concern, including hypertension, cardiovascular disease,
diabetes, depression, and breast, endometrial, colon, and prostate
cancers (5, 6).The decreases in productivity and quality of life
that result from overweight and obesity are linked to elevated
medical, psychological, and social costs (7).
Although obesity results from an imbalance of energy homeostasis, the true mechanisms underlying this process and effective strategies for prevention and treatment remain unknown.
In general, obesity reflects complex interactions ofgenetic, metabolic, cultural, environmental, socioeconomic, and behavioral
factors (2). National survey data in the United States have indicated that, over the past 20 y, concomitant with the increase in
rates of overweight and obesity, consumption of carbohydrates,
largely in the form of added sugars, has increased (8, 9). Between
1977 and 1996, the proportion of energy from the consumption
ofcaloric sweeteners rose from 13.1% to 16.0% (a 22% increase), and in 1994 –1996, Œ 30% of carbohydrates consumed
in the United States by persons aged 2 y came from caloric
sweeteners (10). As a result, the 2000 (11) and 2005 (12) Dietary
Guidelines for Americans advised the public to choose beverages and foods that will decrease their intake of added sugars, and
the WHO has suggested that addedsugars should provide no
more than 10% of dietary energy (13).
Current estimates are that the mean intake of added sugar by
Americans accounts for 15.8% of total energy and that the largest
source of these added sugars is nondiet soft drinks, which account
1

From the Department of Nutrition, Harvard School of Public Health,
Boston, MA (VSM and FBH); the Department of Epidemiology, GermanInstitute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
(MBS); and the Channing Laboratory, Department of Medicine, Brigham
and Women’s Hospital and Harvard Medical School, Boston, MA (FBH).
2
Supported by grant no. DK58845 from the National Institutes of Health and
by an American Heart Association Established Investigator Award (to FBH).
3
Reprints not available. Addresscorrespondence to FB Hu, Department of
Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston,
MA 02115. E-mail: frank.hu@channing.harvard.edu.
Received November 8, 2005.
Accepted for publication February 15, 2006.

Am J Clin Nutr 2006;84:274 – 88. Printed in USA. © 2006 American Society for Nutrition

Downloaded from ajcn.nutrition.org by guest on September 14, 2012ABSTRACT
Consumption of sugar-sweetened beverages (SSBs), particularly
carbonated soft drinks, may be a key contributor to the epidemic of
overweight and obesity, by virtue of these beverages’ high added
sugar content, low satiety, and incomplete compensation for total
energy. Whether an association exists between SSB intake and
weight gain is unclear. We searched English-language MEDLINE...