Background Increased intakes of sugar-sweetened beverages (SSBs) have been reported to significantly contribute to the burden of ill-health derived from obesity and its related comorbidities. As one of the greatest sources of added sugars, research and government bodies have recognised the importance of decreasing consumption of SSBs to improve public health. However, there is little evidence available on the most successful types of interventions across age groups. Consequently, a systematic review and meta-analysis was undertaken to address this gap.
Methods A search strategy was executed in Medline, Embase, Scopus, Web of Science, Cochrane’s Central Register of Controlled Trials and the Global Health Library so that randomised, non-randomised and cluster randomised-controlled trials published after 1990 in any language, with a control group available and reporting variations in daily consumption of SSBs were retrieved, screened and analysed for internal and external validity. Behaviour change techniques (BCTs) were identified and analysed in all included studies following an established taxonomy. Methodological quality was appraised through Cochrane’s risk of bias tool and a random-effects meta-analysis was used to summarise the mean difference in consumption of SSBs between groups.
Results From 5466 original records obtained, 210 papers were read in full and 29 were meta-analysed. Eighteen studies on 7780 children, four studies on 1609 adolescents and seven studies involving 1291 adults had complete data for meta-analysis on SSB intakes. Overall, interventions significantly decreased consumption of SSBs in children by 86 ml/day (95% CI: −129, −43) while reduced intakes in adolescents and adults were non-significant: 24 ml/day (95% CI: −156, 109) and 13 ml/day (95% CI: −53, 28), respectively. Heterogeneity was considerable for children (I2 = 94%) and adolescents (I2 = 91%) studies and substantial for interventions targeting adults (I2 = 55%). The inclusion of techniques that heightened motivation, enhanced planning, preparation and persistence were more likely to yield lower intakes of SSBs across all populations. Environmental support appeared to increase the likelihood of better dietary outcomes in children, but this was not identified in other age groups.
Conclusion Bringing about behavioural change in consumption of SSBs in many populations remains a challenge. While enhanced designs are warranted, a combination of strategies that motivate, prepare participants to act and persevere with this dietary behaviour can provide a useful approach to more efficacious and effective public health interventions. Additionally, a supportive environment stands as a promising feature when targeting children.
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