Understanding the determinants of sugar-sweetened beverage consumption in children to design effective interventions

It has been known for decades that most dietary habits are formed during early childhood and the consumption of high-calorie sugar-sweetened beverages (SSBs) is no exception to that. SSB consumption around the world has reached unprecedented proportions and the rise in the prevalence of cardiometabolic risk factors in children such as abdominal obesity and insulin resistance has increased in parallel. Health authorities such as the World Health Organization (WHO) recommend that children keep the consumption of SSBs (or any other food items that contain added sugars) to a minimum. Public health policies and regulatory strategies aiming at reducing SSB consumption in children have been set in place in many countries and several others are currently being envisioned. In order to be effective, such strategies need to be backed by the highest levels of scientific evidence. In this regard, a recent scientific article on the determinants of SSB consumption in children may very well be of help to guide informed policies on SSB consumption.

In the latest issue of the journal Obesity Reviews, a team of researchers from the Institute of Public Health at the Cambridge University, United Kingdom, presents results of a systematic review of the literature published between 1999 and 2014 that aimed at identifying and better understanding the determinants of SSB consumption in children under 7 years of age. As many as 46,876 scientific articles were screened for eligibility and 44 articles that met prespecified criteria were included in the systematic review. These articles presented reports from intervention, prospective and cross-sectional studies. The authors identified 12 factors that were associated with elevated SSB consumption in children:

  • Child’s preference for SSBs
  • Child television viewing/screen time
  • Child snack consumption
  • Parents’ lower socioeconomic status
  • Parents’ lower age
  • Parents’ SSB consumption
  • Formula milk feeding
  • Early introduction of solids
  • Using food as rewards
  • Parental-perceived barriers
  • Attending out-of-home care
  • Living near a fast-food/convenience store

Five additional factors were associated with lower SSB consumption in children:

  • Parental positive modelling
  • Parents’ married/cohabiting
  • School nutrition policy
  • Staff skills
  • Living near a supermarket

Although this systematic review of the literature does not bring new evidence with regards to SSB consumption in children and that (as the authors acknowledge) most of the cited reports emerged from economically developed countries, several key messages can be derived from this very thorough analysis of the scientific literature. For instance, this work highlights that a large number of factors, from children’s crave for SSBs to the way they get their education from their parents and schools as well as their built environment may drive children to drink SSBs. It also suggests that there are strong inter-relationships among these determinants and that targeting only one of them in isolation without the others might not be effective in reducing SSB consumption in children, although this stills needs to be demonstrated. This report also questions whether SSBs alone are a driver of poor cardiometabolic health in children or a marker of an overall poor socioeconomic status. Given what we know so far on the biological consequences of SSB consumption and lower socioeconomic status in children, the answer is probably both. This manuscript is nevertheless encouraging as it shows that the vast majority of the determinants of SSB consumption in children are modifiable. However, in order to modify them, unprecedented interventions targeting children directly, their parents as well as their school and built environment will likely be required if we want to be serious in our efforts to reduce SSB consumption in children.