Supplementary information files for Unhealthy food and beverage consumption in children and risk of overweight and obesity: a systematic review and meta-analysis

Supplementary information for article  Unhealthy food and beverage consumption in children and risk of overweight and obesity: a systematic review and meta-analysis

This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.

关于儿童不健康食品和饮料消费与超重和肥胖风险的系统评价与荟萃分析补充信息
本由世界卫生组织委托进行的综述有助于补充喂养建议的更新，综合了关于儿童不健康食品和饮料消费对超重和肥胖影响的相关证据。我们检索了PubMed（Medline）、Cochrane CENTRAL和Embase数据库中的文章，无论语言或地域。纳入标准包括：1）随机对照试验（RCTs）、非随机对照试验、队列研究和前后对照研究；2）暴露时参与者年龄≤10.9岁；3）与无或低消费相比，报告不健康食品/饮料消费量更大的研究；4）评估人体测量学和/或身体成分的研究；以及5）发表日期≥1971年。不健康食品和饮料的定义采用基于营养和食品的方法。使用ROBINS-I（非随机干预研究的偏倚风险版本I）和RoB2 [Cochrane RoB（版本2）]工具分别评估非随机和随机研究的偏倚风险。在必要时，叙述性综合分析辅以荟萃分析。使用建议评估、发展和评价分级（GRADE）系统评估证据的确定性。在26,542条已识别的引用中，包括71篇文章中的60项研究。大多数研究为观察性研究（59/60），且没有纳入来自低收入国家的研究。据ROBINS-I和RoB2工具评估，证据基础质量较低。由于研究间干预措施和比较对象的不同，证据综合受到限制。证据表明，儿童时期糖分添加饮料（SSBs）和不健康食品的消费可能增加BMI/BMI z-score、体脂百分比或超重/肥胖的几率（证据确定性较低）。人工甜味饮料和100%果汁的消费对BMI、体脂百分比或超重/肥胖结果影响不大（证据确定性较低）。对部分研究进行的荟萃分析表明，SSB摄入与体脂百分比之间存在正相关，但与BMI和BMI z-score的变化无关联。需要高质量流行病学研究，旨在评估儿童时期不健康食品消费对超重/肥胖风险的影响，以贡献于更坚实的证据基础，从而为政策建议的设计提供依据。本协议已在https://www.crd.york.ac.uk/PROSPERO注册，注册号为CRD42020218109。