PURPOSE: To assess country-level trends in the prevalence of daily consumption of sugary (2002-2018) and diet (2006-2018) soft drinks among European adolescents, overall and by family material affluence. METHODS: We used 2002, 2006, 2010, 2014 and 2018 data from the 'Health Behaviour in School-aged Children' survey. Nationally representative samples of adolescents completed a standardised questionnaire at school, including a short food frequency questionnaire (n = 530,976 and 21 countries for sugary soft drinks; n = 61,487 and 4 countries for diet soft drinks). We classified adolescents into three socioeconomic categories for each country and survey year, using the Family Affluence Scale. Multilevel logistic models estimated time trends, by country. RESULTS: Sugary soft drinks: the prevalence of daily consumption (≥ 1×/day) declined in 21/21 countries (Plinear trends ≤ 0.002). Absolute [range - 31.7 to - 3.4% points] and relative [range - 84.8 to - 22.3%] reductions varied considerably across countries, with the largest declines in Ireland, England and Norway. In 3/21 countries, the prevalence of daily consumption decreased more strongly in the most affluent adolescents than in the least affluent ones (P ≤ 0.002). Daily consumption was more prevalent among the least affluent adolescents in 11/21 countries in 2018 (P ≤ 0.002). Diet soft drinks: overall, daily consumption decreased over time in 4/4 countries (Plinear trends ≤ 0.002), more largely among the most affluent adolescents in 1/4 country (P ≤ 0.002). CONCLUSIONS: Daily consumption of sugary and diet soft drinks in European adolescents decreased between 2002 (2006 for diet drinks) and 2018. Public health interventions should continue discouraging daily soft drink consumption, particularly among adolescents from lower socioeconomic groups.

Department of Child and Adolescent Health Institute of Mother and Child Warsaw Poland

Department of Health Promotion and Centre for Evaluation of Public Health Measures Norwegian Institute of Public Health Bergen Norway

Department of Recreation and Leisure Studies Faculty of Physical Culture Palacky University Olomouc Olomouc Czechia

Health Promotion Research Centre School of Health Sciences NUI Galway Galway Ireland

School of Public Health Université libre de Bruxelles Ecole de Santé Publique CP 598 Route de Lennik 808 1070 Brussels Belgium

Zobrazit více v PubMed

Bleich SN, Vercammen KA, Koma JW, Li Z (2018) Trends in beverage consumption among children and adults, 2003–2014. Obesity (Silver Spring) 26(2):432–441. https://doi.org/10.1002/oby.22056 DOI

Sousa A, Sych J, Rohrmann S, Faeh D (2020) The importance of sweet beverage definitions when targeting health policies-the case of Switzerland. Nutrients. https://doi.org/10.3390/nu12071976 PubMed DOI PMC

Luger M, Lafontan M, Bes-Rastrollo M, Winzer E, Yumuk V, Farpour-Lambert N (2017) Sugar-sweetened beverages and weight gain in children and adults: a systematic review from 2013 to 2015 and a comparison with previous studies. Obes Facts 10(6):674–693. https://doi.org/10.1159/000484566 PubMed DOI PMC

Malik VS, Pan A, Willett WC, Hu FB (2013) Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 98(4):1084–1102. https://doi.org/10.3945/ajcn.113.058362 PubMed DOI PMC

Moynihan PJ, Kelly SA (2014) Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 93(1):8–18. https://doi.org/10.1177/0022034513508954 PubMed DOI PMC

Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews KG, Engell RE, Ezzati M, Mozaffarian D, Global Burden of Diseases N, Chronic Diseases Expert G (2015) Global, regional, and national consumption of sugar-sweetened beverages, fruit juices, and milk: a systematic assessment of beverage intake in 187 countries. PLoS One 10(8):e0124845. https://doi.org/10.1371/journal.pone.0124845 PubMed DOI PMC

Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL (2013) Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr 98(1):180–188. https://doi.org/10.3945/ajcn.112.057943 PubMed DOI

Azais-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA (2017) A review of total & added sugar intakes and dietary sources in Europe. Nutr J 16(1):6. https://doi.org/10.1186/s12937-016-0225-2 PubMed DOI PMC

Heuer T, Krems C, Moon K, Brombach C, Hoffmann I (2015) Food consumption of adults in Germany: results of the German National Nutrition Survey II based on diet history interviews. Br J Nutr 113(10):1603–1614. https://doi.org/10.1017/S0007114515000744 PubMed DOI PMC

Marriott BP, Hunt KJ, Malek AM, Newman JC (2019) Trends in intake of energy and total sugar from sugar-sweetened beverages in the United States among children and adults, NHANES 2003–2016. Nutrients. https://doi.org/10.3390/nu11092004 PubMed DOI PMC

Han E, Powell LM (2013) Consumption patterns of sugar-sweetened beverages in the United States. J Acad Nutr Diet 113(1):43–53. https://doi.org/10.1016/j.jand.2012.09.016 PubMed DOI PMC

Inchley J, Currie D, Budisavljevic S, Torsheim T, Jåstad A, Cosma A, Kelly C, Arnarsson AM, Samda O (eds) (2020) Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data. WHO Regional Office for Europe, Copenhagen, Denmark

Duffey KJ, Huybrechts I, Mouratidou T, Libuda L, Kersting M, De Vriendt T, Gottrand F, Widhalm K, Dallongeville J, Hallstrom L, Gonzalez-Gross M, De Henauw S, Moreno LA, Popkin BM, Group HS (2012) Beverage consumption among European adolescents in the HELENA study. Eur J Clin Nutr 66(2):244–252. https://doi.org/10.1038/ejcn.2011.166 PubMed DOI

Fismen AS, Smith OR, Torsheim T, Rasmussen M, Pedersen Pagh T, Augustine L, Ojala K, Samdal O (2016) Trends in food habits and their relation to socioeconomic status among nordic adolescents 2001/2002-2009/2010. PLoS One 11(2):e0148541. https://doi.org/10.1371/journal.pone.0148541 PubMed DOI PMC

Ng SW, Ni Mhurchu C, Jebb SA, Popkin BM (2012) Patterns and trends of beverage consumption among children and adults in Great Britain, 1986–2009. Br J Nutr 108(3):536–551. https://doi.org/10.1017/S0007114511006465 PubMed DOI

Desbouys L, Mejean C, De Henauw S, Castetbon K (2020) Socio-economic and cultural disparities in diet among adolescents and young adults: a systematic review. Public Health Nutr 23(5):843–860. https://doi.org/10.1017/S1368980019002362 PubMed DOI

Vereecken CA, Inchley J, Subramanian SV, Hublet A, Maes L (2005) The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe. Eur J Public Health 15(3):224–232. https://doi.org/10.1093/eurpub/cki005 PubMed DOI

Desbouys L, De Ridder K, Rouche M, Castetbon K (2019) Food consumption in adolescents and young adults: age-specific socio-economic and cultural disparities (Belgian Food Consumption Survey 2014). Nutrients. https://doi.org/10.3390/nu11071520 PubMed DOI PMC

Mensink GBM, Schienkiewitz A, Rabenberg M, Borrmann A, Richter A, Haftenberger M (2018) Konsum zuckerhaltiger Erfrischungsgetränke bei Kindern und Jugendlichen in Deutschland-Querschnittergebnisse aus KiGGS Welle 2 und Trends. J Health Monit 3(1):32–29. https://doi.org/10.17886/RKI-GBE-2018-007 DOI

Bolt-Evensen K, Vik FN, Stea TH, Klepp KI, Bere E (2018) Consumption of sugar-sweetened beverages and artificially sweetened beverages from childhood to adulthood in relation to socioeconomic status—15 years follow-up in Norway. Int J Behav Nutr Phys Act 15(1):8. https://doi.org/10.1186/s12966-018-0646-8 PubMed DOI PMC

Bates B, Collins D, Cox L, Nicholson S, Page P, Roberts C, Steer T, Swan G (2019) National Diet and Nutrition Survey. Years 1 to 9 of the Rolling Programme (2008/2009–2016/2017): Time trend and income analyses. Public Health England, London

Mendez MA, Miles DR, Poti JM, Sotres-Alvarez D, Popkin BM (2019) Persistent disparities over time in the distribution of sugar-sweetened beverage intake among children in the United States. Am J Clin Nutr 109(1):79–89. https://doi.org/10.1093/ajcn/nqy123 PubMed DOI

Voracova J, Sigmund E, Sigmundova D, Kalman M (2016) Family affluence and the eating habits of 11- to 15-year-old Czech adolescents: HBSC 2002 and 2014. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph13101034 PubMed DOI PMC

Devaux M, Sassi F (2013) Social inequalities in obesity and overweight in 11 OECD countries. Eur J Public Health 23(3):464–469. https://doi.org/10.1093/eurpub/ckr058 PubMed DOI

Stamatakis E, Primatesta P, Chinn S, Rona R, Falascheti E (2005) Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors? Arch Dis Child 90(10):999–1004. https://doi.org/10.1136/adc.2004.068932 PubMed DOI PMC

Singh GK, Siahpush M, Hiatt RA, Timsina LR (2011) Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976–2008. J Community Health 36(1):94–110. https://doi.org/10.1007/s10900-010-9287-9 PubMed DOI

Toews I, Lohner S, Kullenberg de Gaudry D, Sommer H, Meerpohl JJ (2019) Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 364:k4718. https://doi.org/10.1136/bmj.k4718 PubMed DOI PMC

Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, Israeli D, Zmora N, Gilad S, Weinberger A, Kuperman Y, Harmelin A, Kolodkin-Gal I, Shapiro H, Halpern Z, Segal E, Elinav E (2014) Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 514(7521):181–186. https://doi.org/10.1038/nature13793 PubMed DOI

Sylvetsky AC, Rother KI (2016) Trends in the consumption of low-calorie sweeteners. Physiol Behav 164(Pt B):446–450. https://doi.org/10.1016/j.physbeh.2016.03.030 PubMed DOI PMC

Popkin BM, Hawkes C (2016) Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes Endocrinol 4(2):174–186. https://doi.org/10.1016/S2213-8587(15)00419-2 PubMed DOI

Laverty AA, Magee L, Monteiro CA, Saxena S, Millett C (2015) Sugar and artificially sweetened beverage consumption and adiposity changes: National longitudinal study. Int J Behav Nutr Phys Act 12:137. https://doi.org/10.1186/s12966-015-0297-y PubMed DOI PMC

Paulsen MM, Myhre JB, Andersen LF (2016) Beverage consumption patterns among Norwegian adults. Nutrients. https://doi.org/10.3390/nu8090561 PubMed DOI PMC

Mullie P, Aerenhouts D, Clarys P (2012) Demographic, socioeconomic and nutritional determinants of daily versus non-daily sugar-sweetened and artificially sweetened beverage consumption. Eur J Clin Nutr 66(2):150–155. https://doi.org/10.1038/ejcn.2011.138 PubMed DOI

World Health Organization (WHO) (2016) Report of the commission on ending childhood obesity. WHO, Geneva

Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health. World Health Organization, Geneva

World Cancer Research Fund International (WCRF) (2020) NOURISHING framework. WCRF. https://www.wcrf.org/int/policy/nourishing/our-policy-framework-promote-healthy-diets-reduce-obesity . Accessed 13 Jan 2021

Inchley J, Currie C, Cosma A, Samdal O (2018) Health Behaviour in School-aged Children (HBSC) Study Protocol: Background, Methodology and Mandatory items for the 2017/18 Survey. Child and Adolescent Health Research Unit (CAHRU), St Andrews, United Kingdom

Health Behaviour in School-aged Children (HBSC) (2020) Publications: International Reports. HBSC International Coordinating Centre. http://www.hbsc.org/publications/international/ . Accessed 13 Jan 2021

The Publications Office of the European Union (2020) EU Vocabularies. EuroVoc Thesaurus. Europe. The Publications Office of the European Union. https://op.europa.eu/en/web/eu-vocabularies/th-concept-scheme/-/resource/eurovoc/100277?uri=http://eurovoc.europa.eu/100277 . Accessed 13 Jan 2021

Vereecken CA, Maes L (2003) A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire. Public Health Nutr 6(6):581–588. https://doi.org/10.1079/phn2003466 PubMed DOI

Currie CE, Elton RA, Todd J, Platt S (1997) Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res 12(3):385–397. https://doi.org/10.1093/her/12.3.385 PubMed DOI

Torsheim T, Cavallo F, Levin KA, Schnohr C, Mazur J, Niclasen B, Currie C, Group FASDS (2016) Psychometric validation of the revised family affluence scale: a latent variable approach. Child Indic Res 9:771–784. https://doi.org/10.1007/s12187-015-9339-x PubMed DOI

Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M (2008) Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Soc Sci Med 66(6):1429–1436. https://doi.org/10.1016/j.socscimed.2007.11.024 PubMed DOI

Manor O, Matthews S, Power C (1997) Comparing measures of health inequality. Soc Sci Med 45(5):761–771. https://doi.org/10.1016/s0277-9536(96)00412-1 PubMed DOI

Power C, Hertzman C, Matthews S, Manor O (1997) Social differences in health: life-cycle effects between ages 23 and 33 in the 1958 British birth cohort. Am J Public Health 87(9):1499–1503. https://doi.org/10.2105/ajph.87.9.1499 PubMed DOI PMC

Kunst AE, Mackenbach JP (1994) International variation in the size of mortality differences associated with occupational status. Int J Epidemiol 23(4):742–750. https://doi.org/10.1093/ije/23.4.742 PubMed DOI

Bross IDJ (1958) How to use ridit analysis. Biometrics 14:18–38 DOI

Schnohr CW, Molcho M, Rasmussen M, Samdal O, de Looze M, Levin K, Roberts CJ, Ehlinger V, Krolner R, Dalmasso P, Torsheim T (2015) Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations. Eur J Public Health 25(Suppl 2):7–12. https://doi.org/10.1093/eurpub/ckv010 PubMed DOI

Williams R (2012) Using the margins command to estimate and interpret adjusted predictions and marginal effects. Stand Genom Sci 12(2):308–331. https://doi.org/10.1177/1536867X1201200209 DOI

Perrar I, Schadow AM, Schmitting S, Buyken AE, Alexy U (2019) Time and age trends in free sugar intake from food groups among children and adolescents between 1985 and 2016. Nutrients. https://doi.org/10.3390/nu12010020 PubMed DOI PMC

Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC (2011) Tracking of obesity-related behaviours from childhood to adulthood: a systematic review. Maturitas 70(3):266–284. https://doi.org/10.1016/j.maturitas.2011.08.005 PubMed DOI

Avery A, Bostock L, McCullough F (2015) A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness. J Hum Nutr Diet 28(Suppl 1):52–64. https://doi.org/10.1111/jhn.12267 PubMed DOI

von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E (2019) Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 6:CD012292. https://doi.org/10.1002/14651858.CD012292.pub2 DOI

Fernandez-Alvira JM, Mouratidou T, Bammann K, Hebestreit A, Barba G, Sieri S, Reisch L, Eiben G, Hadjigeorgiou C, Kovacs E, Huybrechts I, Moreno LA (2013) Parental education and frequency of food consumption in European children: the IDEFICS study. Public Health Nutr 16(3):487–498. https://doi.org/10.1017/S136898001200290X PubMed DOI

Adams J, Mytton O, White M, Monsivais P (2016) Why are some population interventions for diet and obesity more equitable and effective than others? The role of individual agency. PLoS Med 13(4):e1001990. https://doi.org/10.1371/journal.pmed.1001990 PubMed DOI PMC

McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O’Flaherty M, Taylor-Robinson D, Guzman-Castillo M, Gillespie D, Moreira P, Allen K, Hyseni L, Calder N, Petticrew M, White M, Whitehead M, Capewell S (2015) Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 15:457. https://doi.org/10.1186/s12889-015-1781-7 PubMed DOI PMC

Lorenc T, Petticrew M, Welch V, Tugwell P (2013) What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health 67(2):190–193. https://doi.org/10.1136/jech-2012-201257 PubMed DOI

Frohlich KL, Potvin L (2008) Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health 98(2):216–221. https://doi.org/10.2105/AJPH.2007.114777 PubMed DOI PMC

Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, Martin J, Peeters A (2016) The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutr 19(17):3070–3084. https://doi.org/10.1017/S136898001600104X PubMed DOI

Sylvetsky AC, Welsh JA, Brown RJ, Vos MB (2012) Low-calorie sweetener consumption is increasing in the United States. Am J Clin Nutr 96(3):640–646. https://doi.org/10.3945/ajcn.112.034751 PubMed DOI PMC

Pereira MA (2013) Diet beverages and the risk of obesity, diabetes, and cardiovascular disease: a review of the evidence. Nutr Rev 71(7):433–440. https://doi.org/10.1111/nure.12038 PubMed DOI

Drewnowski A, Rehm CD (2015) Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008. Eur J Clin Nutr 69(9):1035–1041. https://doi.org/10.1038/ejcn.2015.38 PubMed DOI

Piernas C, Ng SW, Popkin B (2013) Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the United States. Pediatr Obes 8(4):294–306. https://doi.org/10.1111/j.2047-6310.2013.00153.x PubMed DOI PMC

Stelmach-Mardas M, Kleiser C, Uzhova I, Penalvo JL, La Torre G, Palys W, Lojko D, Nimptsch K, Suwalska A, Linseisen J, Saulle R, Colamesta V, Boeing H (2016) Seasonality of food groups and total energy intake: a systematic review and meta-analysis. Eur J Clin Nutr 70(6):700–708. https://doi.org/10.1038/ejcn.2015.224 PubMed DOI

Goiana-da-Silva F, Severo M, Cruz ESD, Gregorio MJ, Allen LN, Muc M, Morais Nunes A, Torres D, Miraldo M, Ashrafian H, Rito A, Wickramasinghe K, Breda J, Darzi A, Araujo F, Lopes C (2020) Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: a modelling study. PLoS Med 17(3):e1003036. https://doi.org/10.1371/journal.pmed.1003036 PubMed DOI PMC

Levin KA, Kirby J, Currie C, Inchley J (2012) Trends in adolescent eating behaviour: a multilevel cross-sectional study of 11–15 year olds in Scotland, 2002–2010. J Public Health (Oxf) 34(4):523–531. https://doi.org/10.1093/pubmed/fds021 DOI

Hebert JR, Clemow L, Pbert L, Ockene IS, Ockene JK (1995) Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. Int J Epidemiol 24(2):389–398. https://doi.org/10.1093/ije/24.2.389 PubMed DOI

Lissner L (2002) Measuring food intake in studies of obesity. Public Health Nutr 5(6A):889–892. https://doi.org/10.1079/phn2002388 PubMed DOI

Makransky G, Schnohr CW, Torsheim T, Currie C (2014) Equating the HBSC Family Affluence Scale across survey years: a method to account for item parameter drift using the Rasch model. Qual Life Res 23(10):2899–2907. https://doi.org/10.1007/s11136-014-0728-2 PubMed DOI