What is the question? 

• The question is: What is the relationship between beverage patterns consumed and growth, body composition, and risk of obesity? The populations of interest for this question include children and adolescents, adults and older adults, and pregnancy and postpartum. 

Why was this question asked? 

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. 

How was this question answered? 

• The Committee conducted a systematic review to answer this question with support from the USDA Nutrition Evidence Systematic Review team. 

What is the answer to the question? 

• A conclusion statement cannot be drawn about the relationship between beverage pattern consumption and growth, body composition, and risk of obesity because there is not enough evidence available.

How up-to-date is this systematic review? 

• Conclusion statements from this review are based on articles published between January 2000 and May 2023.

Background 

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted a systematic review with support from USDA’s Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between beverage patterns consumed and growth, body composition, and risk of obesity? 

Methods 

• The Committee conducted a systematic review using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention or exposure of interest was beverage pattern consumption in children, adolescents, adults, older adults, and pregnancy and postpartum. The comparators were consumption of or adherence to a different beverage pattern and different levels of consumption of or adherence to a beverage pattern. The outcomes were Growth (in children, adolescents) including: height, weight, weight-for-age, stunting, failure to thrive, wasting, BMI-for-age, body circumferences (arm, neck, thigh); Body composition (in children, adolescents, adults, older adults) including: skinfold thickness, fat mass, ectopic fat, fat-free mass or lean mass, waist circumference, waist-to-hip-ratio; Risk of obesity (in children, adolescents, adults, older adults) including: BMI, underweight, normal weight, overweight and/or obesity, weight loss and maintenance (in adults and older adults); and Pregnancy and postpartum-related weight change including: gestational weight gain and postpartum weight change. Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial, prospective or retrospective cohort, nested case-control, or Mendelian randomization study designs, b) be published in English in peer-reviewed journals, c) be from countries classified as high or very high on the Human Development Index, and d) enroll participants with a range of health statuses. The review excluded intervention studies less than 12 weeks in duration in children, adolescents, adults, and older adults. 
• NESR librarians conducted literature searches in PubMed, Embase, CINAHL, and Cochrane to identify articles published between January 2000 and May 2023. Two NESR analysts independently screened all electronic results and the reference lists of included articles based on the pre-determined criteria. 
• NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction. Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment. The Committee qualitatively synthesized the evidence according to the synthesis plan, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results. The Committee developed a conclusion statement and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability. 

Results 

Beverage patterns and growth, body composition, and risk of obesity 

Conclusion statement and grade 

• A conclusion statement cannot be drawn about the relationship between beverage pattern consumption and growth, body composition, and risk of obesity because there is not enough evidence available. (Grade: Grade Not Assignable) 

Summary of the evidence 

• Four articles met the inclusion criteria for this review. One was a randomized controlled trial (in children) and 3 were prospective cohort studies (1 each in children, adults, and pregnancy) 
• The body of evidence varied in the beverage patterns and life stages examined, with several life stages having no evidence, or just one study included. 
• Childhood was the only life stage with more than one included study. However, the two included studies in children differed substantially in how they defined beverage patterns (e.g., predefined vs. data-driven) and which beverage types were represented in each pattern.

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Suggested citation: Raynor HA, Deierlein AL, Gardner CD, Giovannucci E, Taylor CA, Hoelscher DM, Anderson CAM, Booth SL, Fung TT, Stanford FC, Talegawkar SA, Tobias DK, Kingshipp BJ, Cole NC, Webster A, Higgins M, Butera G, Terry N, Obbagy J. Beverage Patterns and Growth, Body Composition, and Risk of Obesity: A Systematic Review. November 2024. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2025.SR02