Avery,A., Bostock,L. and McCullough,F., (2014) J.Hum.Nutr.Diet. 10.1111/jhn.12267 [doi]
OBJECTIVE: To clarify which interventions aimed at children help to reduce consumption of sugar-sweetened beverages (SSBs) and whether these interventions lead to changes in body fatness.
DESIGN: Systematic review of intervention trials published in English language from 2000 to August 2013. Included trials tested an intervention of >/= 6 months duration to reduce consumption of SSBs in >/= 100 healthy children (including overweight and obese) aged 2-18 years, compared with control group, and reported a change in SSB consumption and body fatness. SSBs defined as carbonated and non-carbonated drinks sweetened with sugar (singular), fruit juices and milk drinks. Searches included Web of Science, Medline and EMBASE.
SETTING: Various.
PARTICIPANTS: Sample sizes of the individual studies ranged from 224 to 2950 children.
MAIN OUTCOME MEASURES: Primary outcome was reduction in consumption of SSB vs control. Secondary outcome was a change in body composition indicative of body fatness (BMI, skinfold thickness, waist circumference, risk of being overweight or percentage overweight or obese).
RESULTS: The included trials were categorised into four types of intervention programmes - school-based education programmes (5 trials), school-based education programmes with environmental change (1 trial), school-distributed drinks (1 trial) and home-delivered drinks (1 trial). Six interventions achieved significant reductions in SSB intake (P<0.05) but this was not always sustained over a longer period of time. Replacement drinks were provided in two interventions and this resulted in significant reductions in BMI (12 or 18-month follow-up) (P=0.001 and P=0.045). Of five educational programmes the risk of being overweight or obese was reduced in three of the programmes (P<0.05). However, in one of these programmes this was only the case for girls who were overweight at baseline and in another programme only for pupils perceived to be at greater risk at baseline. One study included provision of both water and education, in which the risk of being overweight was reduced by 31% (P= 0.04) in the intervention group.
CONCLUSIONS: There is a limited evidence base from which to draw conclusions. School-based education programmes that focus on reducing SSB consumption and incorporating follow-up modules may offer health professionals the best opportunities for implementing effective and sustainable interventions that are effective in both children and adolescents. Changing the school environment to support such educational programmes could improve the effectiveness of these interventions. There is a lack of relevant reported interventions carried out outside the school environment. However the school-based evidence includes certain aspects that may be reproducible and effective in other settings.
Note to Readers: Any opinions expressed in the recent research abstracts are those of the authors of the original scientific papers and may not reflect the views of Sugar Nutrition UK