Pereira Mark A
University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN
Adv Nutr. 2014 Nov 14;5(6):797-808. doi: 10.3945/an.114.007062. Print 2014 Nov.
The goal of this review was to critically evaluate the scientific evidence in humans on the potential effect of sweetened beverages on weight gain and risk of obesity in youth and adults. Two categories of these beverages were reviewed. Sugar-sweetened beverages (SSBs) include soft drinks, colas, other sweetened carbonated beverages, and fruit drinks with added sugar. Artificially sweetened beverages (ASBs), also referred to as non-nutritive sweetened beverages, are marketed and used as a replacement for SSBs for those who want to reduce sugar and caloric intake. The totality of evidence to date demonstrates a pattern across observational and experimental studies of an increased risk of weight gain and obesity with higher intake of SSBs. However, it remains difficult to establish the strength of the association and the independence from other potentially confounding factors. The primary reason for unclear conclusions regarding the robustness of any effect of SSBs is due to the heterogeneity and methodologic limitations of both observational and experimental studies on this topic. Although some observational studies have suggested that ASBs may cause increased risk of obesity and cardiometabolic diseases, there is no clear mechanism for this pathway, and the epidemiologic studies are highly inconsistent. An important issue with the observational studies on ASBs and obesity or disease risk is reverse causality bias, with higher-quality studies demonstrating this possibility. The field needs higher-quality experimental studies in humans, with relevant direct comparisons between sweetened beverages and their sweetened solid-food alternatives.
本综述的目的是严格评估关于甜味饮料对青少年和成年人体重增加及肥胖风险潜在影响的人体科学证据。对这类饮料的两个类别进行了综述。含糖饮料（SSB）包括软饮料、可乐、其他加糖碳酸饮料以及添加糖的果汁饮料。人工甜味饮料（ASB），也称为非营养性甜味饮料，面向那些希望减少糖分和热量摄入的人群进行销售，并被用作含糖饮料的替代品。迄今为止的全部证据表明，在观察性研究和实验性研究中都呈现出一种模式，即较高的含糖饮料摄入量会增加体重增加和肥胖的风险。然而，仍然难以确定这种关联的强度以及与其他潜在混杂因素的独立性。关于含糖饮料任何影响的稳健性得出不明确结论的主要原因，是关于该主题的观察性研究和实验性研究都存在异质性和方法学局限性。尽管一些观察性研究表明人工甜味饮料可能会增加肥胖和心血管代谢疾病的风险，但这种途径尚无明确机制，而且流行病学研究结果高度不一致。关于人工甜味饮料与肥胖或疾病风险的观察性研究中的一个重要问题是反向因果关系偏差，高质量研究证明了这种可能性。该领域需要在人体中进行更高质量的实验研究，对甜味饮料及其甜味固体食物替代品进行相关的直接比较。
