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      Impact of sugar‐sweetened beverage taxes on purchases and dietary intake: Systematic review and meta‐analysis

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          Summary

          The aim was to conduct a systematic review of real‐world sugar‐sweetened beverage (SSB) tax evaluations and examine the overall impact on beverage purchases and dietary intake by meta‐analysis. Medline, EconLit, Google Scholar, and Scopus databases were searched up to June 2018. SSB tax evaluations from any formal jurisdiction from cities to national governments were eligible if there was a comparison between pre–post tax (n = 11) or taxed and untaxed jurisdiction(s) (n = 6). The consumption outcome comprised sales, purchasing, and intake (reported by volume, energy, or frequency). Taxed and untaxed beverage consumption outcomes were examined separately by meta‐analysis with adjustment for the size of each tax. The study was registered at PROSPERO (CRD42018100620). The equivalent of a 10% SSB tax was associated with an average decline in beverage purchases and dietary intake of 10.0% (95% CI: −5.0% to −14.7%, n = 17 studies, 6 jurisdictions) with considerable heterogeneity between results ( I 2 = 97%).The equivalent of a 10% SSB tax was also associated with a nonsignificant 1.9% increase in total untaxed beverage consumption (eg, water) (95% CI: −2.1% to 6.1%, n = 6 studies, 4 jurisdictions). Based on real‐world evaluations, SSB taxes introduced in jurisdictions around the world appear to have been effective in reducing SSB purchases and dietary intake.

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          Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

          Prospective Studies Collaboration, George Davey Smith (2009)
          Summary Background The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies. Methods Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975–85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other. Findings In both sexes, mortality was lowest at about 22·5–25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% CI 1·27–1·32]): 40% for vascular mortality (HR 1·41 [1·37–1·45]); 60–120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89–2·46], 1·59 [1·27–1·99], and 1·82 [1·59–2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1·06–1·15]); and 20% for respiratory and for all other mortality (HRs 1·20 [1·07–1·34] and 1·20 [1·16–1·25], respectively). Below the range 22·5–25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI. Interpretation Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m2, median survival is reduced by 2–4 years; at 40–45 kg/m2, it is reduced by 8–10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained. Funding UK Medical Research Council, British Heart Foundation, Cancer Research UK, EU BIOMED programme, US National Institute on Aging, and Clinical Trial Service Unit (Oxford, UK).
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            Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

            Fumiaki Imamura, Laura O’Connor, Zheng Ye … (2015)
            Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.
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              Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.

              Vasanti Malik, An-Peng Pan, Walter C. Willett … (2013)
              The relation between sugar-sweetened beverages (SSBs) and body weight remains controversial. We conducted a systematic review and meta-analysis to summarize the evidence in children and adults. We searched PubMed, EMBASE, and Cochrane databases through March 2013 for prospective cohort studies and randomized controlled trials (RCTs) that evaluated the SSB-weight relation. Separate meta-analyses were conducted in children and adults and for cohorts and RCTs by using random- and fixed-effects models. Thirty-two original articles were included in our meta-analyses: 20 in children (15 cohort studies, n = 25,745; 5 trials, n = 2772) and 12 in adults (7 cohort studies, n = 174,252; 5 trials, n = 292). In cohort studies, one daily serving increment of SSBs was associated with a 0.06 (95% CI: 0.02, 0.10) and 0.05 (95% CI: 0.03, 0.07)-unit increase in BMI in children and 0.22 kg (95% CI: 0.09, 0.34 kg) and 0.12 kg (95% CI: 0.10, 0.14 kg) weight gain in adults over 1 y in random- and fixed-effects models, respectively. RCTs in children showed reductions in BMI gain when SSBs were reduced [random and fixed effects: -0.17 (95% CI: -0.39, 0.05) and -0.12 (95% CI: -0.22, -0.2)], whereas RCTs in adults showed increases in body weight when SSBs were added (random and fixed effects: 0.85 kg; 95% CI: 0.50, 1.20 kg). Sensitivity analyses of RCTs in children showed more pronounced benefits in preventing weight gain in SSB substitution trials (compared with school-based educational programs) and among overweight children (compared with normal-weight children). Our systematic review and meta-analysis of prospective cohort studies and RCTs provides evidence that SSB consumption promotes weight gain in children and adults.
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                Author and article information

                Contributors
                Andrea M. Teng:
                ORCID: https://orcid.org/0000-0002-6116-3941
                andrea.teng@otago.ac.nz
                Journal
                Journal ID (nlm-ta): Obes Rev
                Journal ID (iso-abbrev): Obes Rev
                Journal ID (doi): 10.1111/(ISSN)1467-789X
                Journal ID (publisher-id): OBR
                Title: Obesity Reviews
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1467-7881
                ISSN (Electronic): 1467-789X
                Publication date (Electronic): 19 June 2019
                Publication date (Print): September 2019
                Volume: 20
                Issue: 9 ( doiID: 10.1111/obr.v20.9 )
                Pages: 1187-1204
                Affiliations
                [ 1 ] Department of Public Health University of Otago Wellington New Zealand
                [ 2 ] Department of Economics University of Otago Dunedin New Zealand
                Author notes
                [*] [* ] Correspondence

                Andrea M. Teng, Department of Public Health, University of Otago, 23 Mein Street, PO Box 7343, Wellington, New Zealand.

                Email: andrea.teng@ 123456otago.ac.nz

                Author information
                https://orcid.org/0000-0002-6116-3941
                Article
                Publisher ID: OBR12868 Other ID: OBR-01-19-3761.R3
                DOI: 10.1111/obr.12868
                PMC ID: 9285619
                PubMed ID: 31218808
                SO-VID: ca66416e-6db0-47fb-9a1c-1ae17f94ced5
                Copyright © © 2019 The Authors Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date revision received : 27 March 2019
                Date received : 13 January 2019
                Date accepted : 29 March 2019
                Page count
                Figures: 4, Tables: 4, Pages: 18, Words: 6399
                Funding
                Funded by: Health Research Council of New Zealand , doi 10.13039/501100001505;
                Award ID: 17/007
                Award ID: 16/443
                Categories
                Subject: Public Health
                Subject: Public Health
                Custom metadata
                source-schema-version-number 2.0
                cover-date September 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:15.07.2022

                ScienceOpen disciplines: Medicine
                Keywords: evaluation,excise,meta‐analysis,natural experiment,tax,soft drinks
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: evaluation, excise, meta‐analysis, natural experiment, tax, soft drinks

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