What is the question?

• The question is: What is the relationship between sugar-sweetened beverage consumption and growth, body composition, and risk of obesity? The populations of interest for this question include infants and young children up to age 24 months, children, adolescents, adults, older adults, and pregnancy and postpartum.

Why was this question asked?

• This systematic review with meta-analysis 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 with meta-analysis to answer this question with support from the USDA Nutrition Evidence Systematic Review team. This review updated an existing review that was conducted by the 2020 Dietary Guidelines Advisory Committee.

What is the answer to the question?

• Sugar-sweetened beverage consumption by infants, children, and adolescents is associated with unfavorable growth patterns and body composition, and higher risk of obesity in childhood up to early adulthood. This conclusion statement is based on evidence graded as moderate.
• Sugar-sweetened beverage consumption by adults and older adults is associated with unfavorable body composition. This conclusion statement is based on evidence graded as moderate.
• Sugar-sweetened beverage consumption by adults and older adults is associated with higher risk of obesity. This conclusion statement is based on evidence graded as moderate.
• A conclusion statement cannot be drawn about the relationship between sugar-sweetened beverage consumption during pregnancy and adequacy of gestational weight gain because there is not enough evidence available, and there are substantial concerns with consistency, precision, risk of bias, directness, and generalizability in the available body of evidence.
• A conclusion statement cannot be drawn about the relationship between sugar-sweetened beverage consumption during postpartum and postpartum weight change because there is not enough evidence available.

How up-to-date is this systematic review?

• This review searched for studies published between January 2000 and May 2023.

Background

• This systematic review with meta-analysis 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 meta-analysis with support from USDA’s Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between sugar-sweetened beverage consumption and growth, body composition, and risk of obesity? This review is an update to an existing review that was conducted by the 2020 Dietary Guidelines Advisory Committee.

Methods

• The Committee conducted a systematic review with meta-analysis using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention/exposure was sugar-sweetened beverage (SSB) consumption in infants and young children up to age 24 months, children, adolescents, adults, older adults, and pregnancy and postpartum. The comparators were consumption of a different amount of SSB (including no consumption and versions diluted with water), water, and low- and no-calorie sweetened beverages, and the outcomes were measures of Growth (in infants and young children up to age 24 months, children, and adolescents) including: height, length/stature-for-age, weight, weight-for-age, stunting, failure to thrive, wasting, BMI-for-age, weight-for-length/stature, body circumferences (arm, neck, thigh), head circumference; Body composition (in infants and young children up to age 24 months, 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); 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 a literature search 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. The results of this search were combined with included articles from the existing review.
• 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. Additionally, for studies conducted in infants, children, and adolescents and in adults and older adults, NESR analysts and biostatisticians converted eligible results to a common effect size and completed meta-analyses, assessments of heterogeneity, and assessments of non-reporting bias, according to the synthesis plan. The Committee qualitatively synthesized the evidence, from all included articles identified in the updated literature search and from the existing review and also considered results from meta-analyses, 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 conclusion statements and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability.

Results

Infants, children, and adolescents

Conclusion statement and grade

• Sugar-sweetened beverage consumption by infants, children, and adolescents is associated with unfavorable growth patterns and body composition, and higher risk of obesity in childhood up to early adulthood. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• One hundred eleven articles examined SSB consumption in in infants, children, and adolescents. Five articles included data from randomized controlled trials (RCT, all articles included in meta-analysis), 106 articles included data from prospective cohort studies (PCS, 72 articles included in meta-analysis), and 1 article was a retrospective cohort study (not included in meta-analysis).
• The direction of results and size of effects were similar across studies, though there was some heterogeneity. Meta-analysis results showed similar consistency in the direction and magnitude of findings across analyses, with mostly low heterogeneity.
• The size of study groups was large, and effect estimates were narrow across studies.
• Some studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review.
• The evidence applies to the U.S. population, though the RCT samples were less diverse, and there was limited data included in meta-analyses for infants and young children.

Adults and older adults

Conclusion statement and grade

• Sugar-sweetened beverage consumption by adults and older adults is associated with unfavorable body composition. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Sixty-six articles examined SSB consumption in adults and older adults. Eight were RCT and 58 were PCS.
• Twenty-nine of those articles examined body composition outcomes in adults and older adults, specifically. Eight were RCTs (7 included in meta-analysis), and 21 were PCS (9 included in meta-analysis)
• The direction of results and size of effects were similar across studies, though there was some heterogeneity in both the systematic review and meta-analysis findings.
• The size of study groups was small in some studies. Variation around the effect estimates ranged from narrow to wide across studies.
• Some studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review.
• The evidence applies to the U.S. population, but some studies had limited diversity in race and/or ethnicity and socioeconomic position.

Conclusion statement and grade

• Sugar-sweetened beverage consumption by adults and older adults is associated with higher risk of obesity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Sixty-six articles examined SSB consumption in adults and older adults. Eight were RCT and 58 were PCS.
• Fifty-three of those articles examined body composition outcomes in adults and older adults, specifically. Seven were RCTs (7 included in meta-analysis), and 47 were PCS (23 included in meta-analysis).
• The direction of results and size of effects were similar across studies, though there was some heterogeneity in both the systematic review and meta-analysis findings.
• The size of study groups was small in some studies. Variation around the effect estimates ranged from narrow to wide across studies.
• Some studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review.
• The evidence applies to the U.S. population, but some studies had limited diversity in race and/or ethnicity and socioeconomic position.

Pregnancy and postpartum

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between sugar-sweetened beverage consumption during pregnancy and adequacy of gestational weight gain because there is not enough evidence available, and there are substantial concerns with consistency, precision, risk of bias, directness, and generalizability in the available body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Seven articles examined SSB consumption during pregnancy. All were PCS.
• The most serious concerns were with consistency, specifically with the assessment methods and timing for both the exposure and outcome, and with the definition of gestational weight gain within studies. The articles had relatively small sample sizes and thus underpowered studies. All articles had high risk of bias in at least one domain. All studies assessed multiple dietary exposures and were not specifically designed to analyze the relationship between SSB and gestational weight gain. Concerns with these elements precluded any ability to discern relevance of findings to the U.S. population.

Conclusion statement and grade

A conclusion statement cannot be drawn about the relationship between sugar-sweetened beverage consumption during postpartum and postpartum weight change because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Four articles examined SSB consumption during postpartum. All were PCS.
• Only 4 articles were in this evidence base; they showed little consistency in exposure definition, exposure assessment timing and methods, and duration of follow-up.

Download Now*

*Data files are available upon request; contact SM.FN.NESR@USDA.gov.

Suggested citation: Deierlein AL, Raynor HA, Andres A, Byrd-Bredbenner C, Fisher JO, Fung T, Palacios C, Tobias DK, Hoelscher DM, Anderson CAM, Booth SL, Gardner CD, Giovannucci E, Stanford FC, Talegawkar SA, Taylor CA, Webster A, Kingshipp BJ, Nevins J, Cole NC, Bahnfleth CL, Becker BJ, Higgins M, Scinto-Madonich SR, Ming J, Butera G, Terry N, Obbagy J. Sugar-Sweetened Beverages and Growth, Body Composition, and Risk of Obesity: A Systematic Review with Meta-Analysis. 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.SR23