Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health

• Published in: Cochrane database of systematic reviews 2019-06, Vol.6 (6), p.CD012292
• Main Authors: von Philipsborn, Peter, Stratil, Jan M, Burns, Jacob, Busert, Laura K, Pfadenhauer, Lisa M, Polus, Stephanie, Holzapfel, Christina, Hauner, Hans, Rehfuess, Eva
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Animals; Artificially Sweetened Beverages - supply & distribution; Child; Child health; Commerce - economics; Controlled Before-After Studies - statistics & numerical data; Drinking Behavior; Drinking Water; Environment; Fast Foods - supply & distribution; Food Supply; Fruit - supply & distribution; Humans; Interrupted Time Series Analysis - statistics & numerical data; Milk; NUTRITION, FOOD SUPPLY & ACCESS; Nutritive Value; Product Labeling; Public health; Randomized Controlled Trials as Topic - statistics & numerical data; Schools; Selection Bias; Social Environment; Sugar-Sweetened Beverages - adverse effects; Sugar-Sweetened Beverages - economics; Sugar-Sweetened Beverages - supply & distribution; Young Adult
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012292.pub2

Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The stu