Table 3.
Open in new tab

Direction of Effects Assessed in the Included Studies

Exposure and study referenceOutcomes of interesta
Risk of biasb
GrowthInfectionBowel functionObesity, overweight, body compositionGlucose metabolism and homeostasisLipidsMicrobiota
Digestible carbohydrates
Glycemic carbohydrates
Chaidez et al (2014)27 (WIC)

  • Added sugars at 12-24 mo:

  • < > WAZ after 6 mo

——

  • Added sugars at 12-24 mo:

  • < > WHZ after 6 mo

  • < > BMZ after 6 mo

———Some
Cowin et al (2001)28 (ALSPAC)

  • Total carbohydrates at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Starch at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Sugars at 18 mo:

  • < > Height at 31 mo

——

  • Total carbohydrates, starch, sugars at 18 mo:

  • < > BMI at 31 mo

—

  • Total carbohydrates at 18 mo:

  • ▼TC (boys)

  • ▼TC:HDL-C (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (girls) at 31 mo

  • Starch at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C at 31 mo

  • Sugar at 18 mo:

  • ▲TC (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (at 31 mo; univariate)

  • Sugar at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C (boys), graphic TC:HDL-C (girls) (at 31 mo; multivariate)

  • Starch, total carbohydrates intake at 18 mo:

  • < > Lipids (at 31 mo; multivariate)

—Low
DONALD study:
Buyken et al (2008)24———

  • Added sugars at 2 y:

  • < > %BF, BMIZ (at 2 y; 2-7 y change)

———Some
Herbst et al (2011)32———

  • Added sugars:

  • < > %BF at 7 y (higher intake at 1 y)

  • ▲BMIZ at 7 y (higher intake at 1 y)

  • graphic BMIZ at 7 y (higher intake between 1 and 2 y)

———
Garden et al (2011)31———

  • Carbohydrates intake at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Huus et al (2009)33———

  • Candy intake at 2.5 y:

  • < > Overweight/obesity at 5 y

———Some
Jardí et al (2019)34———

  • Free sugars at 12 mo:

  • ▲WHZ at 30 mo

  • < > WHZ at 12 mo

  • Natural sugars, starches at 12 mo:

  • < > WHZ at 12 mo

———Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Mono- and di- and polysaccharides at 14 mo:

  • +/– Presence of constipation at 24, 36, 48 mo

————Some
Nguyen et al (2020)41———

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > BMIZ at 10 y

  • < > FMIZ, FFMIZ at 10 y

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > Insulin at 10 y

  • Total carbohydrates at 12.9 mo:

  • ▲TG

  • < > TC, HDL-C, LDL-C at 10 y

  • Mono- and disaccharides at 12.9 mo:

  • ▲TG, HDL-C at 10 y

  • < > TC, LDL-C at 10 y

  • Polysaccharides at 12.9 mo:

  • < > TC, HDL-C, LDL-C, TG at 10 y

—Low
Scaglioni et al (2000)43———

  • Carbohydrates intake at 1 y:

  • < > Overweight at 5 y

———Some
Warner et al (2006)49———

  • Sweets consumption at 24 mo:

  • < > Obesity at 2 y

———Low
Williams and Strobino (2008)50———

  • Dietary sucrose at 3-4 y:

  • ▼BMI at 7-10 y

—

  • Dietary sucrose at 3-4 y:

  • < > TC, HDL-C, TG at 7-10 y

—Some
SSBs and fruit juice
Byrne et al (2018)25———

  • Mixed SSBs and fruit juice at 2, 3.7 y:

  • < > BMIZ at 2, 3.7 y

———Some
Cantoral et al (2016)26———

  • SSBs only at 1-5 y:

  • ▲Obesity at 8-14 y

  • ▲Abdominal obesity at 8-14 y

———Low
Dubois et al (2007)30———

  • SSBs at 2.5, 3.5, and 4.5 y:

  • ▲Obesity at 4.5 y

———Low
ECLS-B study:
DeBoer et al (2013)29———

  • SSBs at 2 y:

  • < > BMIZ at 2 y

  • < > Overweight at 2 y

  • < > Obesity at 2 y

———Low
Shefferly et al (2016)44

  • Fruit juice at 2 y:

  • ▲HAZ at 2-4 y

  • graphicWAZ at 2-4 y

——

  • Fruit juice at 2 y:

  • ▼BMIZ at 2 y, ▲ BMIZ at 2-4 y

  • < > Overweight at 2 y, ▲Overweight at 2-4 y

  • < > Obesity at 2 y, graphicObesity at 2-4 y

———Low
Garden et al (2011)31———

  • SSBs only and mixed SSBs and fruit juice at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Generation R Study:
Leermakers et al (2015a)37—————

  • Mixed SSBs and fruit juice at 13 mo:

  • graphicTG, HDL-C at 6 y

  • < > TC, LDL-C at 6 y

—Low
Leermakers et al (2015b)36

  • Mixed SSB and fruit juice at 13 mo:

  • In boys at 6 y: ▼HAZ; < > WAZ

  • In girls at 6 y:

  • graphicHAZ; graphicWAZ

——

  • Mixed SSBs and fruit juice at 13 mo:

  • < > %BF at 6 y;

  • graphicHigher android and gynoid ratio at 6 y in girls only

  • ▲ BMIZ at 2, 3, 4, and 6 y in girls

  • < > BMIZ at 6 y in boys

———
Lim et al (2008)38———

  • SSBs at 3-4 y:

  • ▲ BMIZ at 3-4 y

  • ▲ Overweight or obesity after 2 y of follow up

———Low
Quah et al (2019)42———

  • SSB at 18 mo:

  • < > BMIZ, SSF at 6 y

  • ▲,graphicOverweight or obesity at 6 y

———Some
Viva Project study:
Sonneville et al (2015)45———

  • Fruit juice at 1 y:

  • < > WLZ at 1 y

  • ▲ BMIZ at 3.1 y; 7.7 y

———Low
Wu et al (2021)51———

  • Fruit juice at 1 y:

  • ▲ Abdominal adiposity at 8 y, 13 y

———Low
Warner et al (2006)49———

  • SSB at 2 y:

  • ▲ Obesity at 2 y

———Low
WIC study:
Chaidez et al (2014)27

  • SSB at 12-24 mo:

  • < > WAZ after 6 mo of follow-up

——

  • SSB at 12-24 mo:

  • ▲ WHZ after 6 mo of follow-up

  • ▲ BMIZ after 6 mo of follow-up

———Some
Newby et al (2004)40

  • Fruit juice; SSBs at 2-5 y:

  • < > Weight change after 6-12 mo

——

  • Fruit juice;

  • SSBs at 2-5 y:

  • < > BMI change after 6-12 mo

———Some
Nondigestible carbohydrates
Dietary fiber
ALSPAC study:
Cowin et al (2001)28

  • Fiber intake at 18 mo:

  • < > Height at 31 mo

——

  • Fiber intake at 18 mo:

  • < > BMI at 31 mo

—

  • Fiber intake at 18 mo:

  • < > TC, HDL-C, LDL-C, TC:HDL-C at 31 mo

—Low
Tappin et al (2020)46——

  • Fiber intake at 2 y:

  • ▼Stool frequency and consistency at 2.5 y

  • ▼ Presence of constipation at 4-10 y

————Low
Taylor et al (2016)47——

  • Fiber intake at 38 mo:

  • ▼Stool hardness (constipation) at 42 mo

————Some
Beyerlein et al (2015)23————

  • Fiber intake at 12 mo:

  • < >T1DM; islet autoimmunity up to 5 y

——Low
Buyken et al (2008) (DONALD)24———

  • Fiber intake at 2 y:

  • < > %BF, BMZ at 2 y; 2-7 y change

———Some
Jardí et al (2019)34

  • Fiber at 12 mo:

  • < > Excess weight at 12 mo

  • < > Excess weight at 30 mo

——————Some
Newby et al (2003)39 (WIC)

  • Fiber intake at 2.9 y:

  • < > Weight change after 6-12 mo

——————Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Fiber intake at 14 mo:

  • < > Presence of constipation at 24, 36, 48 mo

————Some
Van Gijssel et al (2016)48———

  • Fiber intake at 12.9 mo:

  • < > %BF z score at 6 y

  • Fiber intake at 12.9 mo:

  • < > Insulin z score at 6 y

  • Fiber intake at 12.9 mo:

  • ▼HDL-C, TG at 6 y

—Low
Williams and Strobino (2008)50———

  • Fiber intake at 3-4 y:

  • < > BMI at 7-10 y

—

  • Fiber intake at 3-4 y:

  • ▼ TC

  • < > TG, HDL-C at 7-10 y

—Some
Nakamura et al (2006)52 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 6 mo)< > Weight gain, height, arm circumference during 6 mo

  • graphic Number of diarrheal episodes during 6 m

  • ▼ Duration of diarrheal episodes during 6 m

  • ▼ Duration of diarrhea during 6 mo

  • < > Stool frequency during 6 mo

————Low
Waligora-Dupriet et al (2007)53 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 21 d)—

  • ▼Diarrheal episodes during 28d

  • ▼ Number of infectious diseases requiring antibiotic

  • Treatment during 28d

< > Stool frequency, consistency, and abdominal pain during 28 d———▼Bifidobacteria and Clostridia levels at 28 dSome
Exposure and study referenceOutcomes of interesta
Risk of biasb
GrowthInfectionBowel functionObesity, overweight, body compositionGlucose metabolism and homeostasisLipidsMicrobiota
Digestible carbohydrates
Glycemic carbohydrates
Chaidez et al (2014)27 (WIC)

  • Added sugars at 12-24 mo:

  • < > WAZ after 6 mo

——

  • Added sugars at 12-24 mo:

  • < > WHZ after 6 mo

  • < > BMZ after 6 mo

———Some
Cowin et al (2001)28 (ALSPAC)

  • Total carbohydrates at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Starch at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Sugars at 18 mo:

  • < > Height at 31 mo

——

  • Total carbohydrates, starch, sugars at 18 mo:

  • < > BMI at 31 mo

—

  • Total carbohydrates at 18 mo:

  • ▼TC (boys)

  • ▼TC:HDL-C (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (girls) at 31 mo

  • Starch at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C at 31 mo

  • Sugar at 18 mo:

  • ▲TC (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (at 31 mo; univariate)

  • Sugar at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C (boys), graphic TC:HDL-C (girls) (at 31 mo; multivariate)

  • Starch, total carbohydrates intake at 18 mo:

  • < > Lipids (at 31 mo; multivariate)

—Low
DONALD study:
Buyken et al (2008)24———

  • Added sugars at 2 y:

  • < > %BF, BMIZ (at 2 y; 2-7 y change)

———Some
Herbst et al (2011)32———

  • Added sugars:

  • < > %BF at 7 y (higher intake at 1 y)

  • ▲BMIZ at 7 y (higher intake at 1 y)

  • graphic BMIZ at 7 y (higher intake between 1 and 2 y)

———
Garden et al (2011)31———

  • Carbohydrates intake at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Huus et al (2009)33———

  • Candy intake at 2.5 y:

  • < > Overweight/obesity at 5 y

———Some
Jardí et al (2019)34———

  • Free sugars at 12 mo:

  • ▲WHZ at 30 mo

  • < > WHZ at 12 mo

  • Natural sugars, starches at 12 mo:

  • < > WHZ at 12 mo

———Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Mono- and di- and polysaccharides at 14 mo:

  • +/– Presence of constipation at 24, 36, 48 mo

————Some
Nguyen et al (2020)41———

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > BMIZ at 10 y

  • < > FMIZ, FFMIZ at 10 y

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > Insulin at 10 y

  • Total carbohydrates at 12.9 mo:

  • ▲TG

  • < > TC, HDL-C, LDL-C at 10 y

  • Mono- and disaccharides at 12.9 mo:

  • ▲TG, HDL-C at 10 y

  • < > TC, LDL-C at 10 y

  • Polysaccharides at 12.9 mo:

  • < > TC, HDL-C, LDL-C, TG at 10 y

—Low
Scaglioni et al (2000)43———

  • Carbohydrates intake at 1 y:

  • < > Overweight at 5 y

———Some
Warner et al (2006)49———

  • Sweets consumption at 24 mo:

  • < > Obesity at 2 y

———Low
Williams and Strobino (2008)50———

  • Dietary sucrose at 3-4 y:

  • ▼BMI at 7-10 y

—

  • Dietary sucrose at 3-4 y:

  • < > TC, HDL-C, TG at 7-10 y

—Some
SSBs and fruit juice
Byrne et al (2018)25———

  • Mixed SSBs and fruit juice at 2, 3.7 y:

  • < > BMIZ at 2, 3.7 y

———Some
Cantoral et al (2016)26———

  • SSBs only at 1-5 y:

  • ▲Obesity at 8-14 y

  • ▲Abdominal obesity at 8-14 y

———Low
Dubois et al (2007)30———

  • SSBs at 2.5, 3.5, and 4.5 y:

  • ▲Obesity at 4.5 y

———Low
ECLS-B study:
DeBoer et al (2013)29———

  • SSBs at 2 y:

  • < > BMIZ at 2 y

  • < > Overweight at 2 y

  • < > Obesity at 2 y

———Low
Shefferly et al (2016)44

  • Fruit juice at 2 y:

  • ▲HAZ at 2-4 y

  • graphicWAZ at 2-4 y

——

  • Fruit juice at 2 y:

  • ▼BMIZ at 2 y, ▲ BMIZ at 2-4 y

  • < > Overweight at 2 y, ▲Overweight at 2-4 y

  • < > Obesity at 2 y, graphicObesity at 2-4 y

———Low
Garden et al (2011)31———

  • SSBs only and mixed SSBs and fruit juice at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Generation R Study:
Leermakers et al (2015a)37—————

  • Mixed SSBs and fruit juice at 13 mo:

  • graphicTG, HDL-C at 6 y

  • < > TC, LDL-C at 6 y

—Low
Leermakers et al (2015b)36

  • Mixed SSB and fruit juice at 13 mo:

  • In boys at 6 y: ▼HAZ; < > WAZ

  • In girls at 6 y:

  • graphicHAZ; graphicWAZ

——

  • Mixed SSBs and fruit juice at 13 mo:

  • < > %BF at 6 y;

  • graphicHigher android and gynoid ratio at 6 y in girls only

  • ▲ BMIZ at 2, 3, 4, and 6 y in girls

  • < > BMIZ at 6 y in boys

———
Lim et al (2008)38———

  • SSBs at 3-4 y:

  • ▲ BMIZ at 3-4 y

  • ▲ Overweight or obesity after 2 y of follow up

———Low
Quah et al (2019)42———

  • SSB at 18 mo:

  • < > BMIZ, SSF at 6 y

  • ▲,graphicOverweight or obesity at 6 y

———Some
Viva Project study:
Sonneville et al (2015)45———

  • Fruit juice at 1 y:

  • < > WLZ at 1 y

  • ▲ BMIZ at 3.1 y; 7.7 y

———Low
Wu et al (2021)51———

  • Fruit juice at 1 y:

  • ▲ Abdominal adiposity at 8 y, 13 y

———Low
Warner et al (2006)49———

  • SSB at 2 y:

  • ▲ Obesity at 2 y

———Low
WIC study:
Chaidez et al (2014)27

  • SSB at 12-24 mo:

  • < > WAZ after 6 mo of follow-up

——

  • SSB at 12-24 mo:

  • ▲ WHZ after 6 mo of follow-up

  • ▲ BMIZ after 6 mo of follow-up

———Some
Newby et al (2004)40

  • Fruit juice; SSBs at 2-5 y:

  • < > Weight change after 6-12 mo

——

  • Fruit juice;

  • SSBs at 2-5 y:

  • < > BMI change after 6-12 mo

———Some
Nondigestible carbohydrates
Dietary fiber
ALSPAC study:
Cowin et al (2001)28

  • Fiber intake at 18 mo:

  • < > Height at 31 mo

——

  • Fiber intake at 18 mo:

  • < > BMI at 31 mo

—

  • Fiber intake at 18 mo:

  • < > TC, HDL-C, LDL-C, TC:HDL-C at 31 mo

—Low
Tappin et al (2020)46——

  • Fiber intake at 2 y:

  • ▼Stool frequency and consistency at 2.5 y

  • ▼ Presence of constipation at 4-10 y

————Low
Taylor et al (2016)47——

  • Fiber intake at 38 mo:

  • ▼Stool hardness (constipation) at 42 mo

————Some
Beyerlein et al (2015)23————

  • Fiber intake at 12 mo:

  • < >T1DM; islet autoimmunity up to 5 y

——Low
Buyken et al (2008) (DONALD)24———

  • Fiber intake at 2 y:

  • < > %BF, BMZ at 2 y; 2-7 y change

———Some
Jardí et al (2019)34

  • Fiber at 12 mo:

  • < > Excess weight at 12 mo

  • < > Excess weight at 30 mo

——————Some
Newby et al (2003)39 (WIC)

  • Fiber intake at 2.9 y:

  • < > Weight change after 6-12 mo

——————Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Fiber intake at 14 mo:

  • < > Presence of constipation at 24, 36, 48 mo

————Some
Van Gijssel et al (2016)48———

  • Fiber intake at 12.9 mo:

  • < > %BF z score at 6 y

  • Fiber intake at 12.9 mo:

  • < > Insulin z score at 6 y

  • Fiber intake at 12.9 mo:

  • ▼HDL-C, TG at 6 y

—Low
Williams and Strobino (2008)50———

  • Fiber intake at 3-4 y:

  • < > BMI at 7-10 y

—

  • Fiber intake at 3-4 y:

  • ▼ TC

  • < > TG, HDL-C at 7-10 y

—Some
Nakamura et al (2006)52 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 6 mo)< > Weight gain, height, arm circumference during 6 mo

  • graphic Number of diarrheal episodes during 6 m

  • ▼ Duration of diarrheal episodes during 6 m

  • ▼ Duration of diarrhea during 6 mo

  • < > Stool frequency during 6 mo

————Low
Waligora-Dupriet et al (2007)53 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 21 d)—

  • ▼Diarrheal episodes during 28d

  • ▼ Number of infectious diseases requiring antibiotic

  • Treatment during 28d

< > Stool frequency, consistency, and abdominal pain during 28 d———▼Bifidobacteria and Clostridia levels at 28 dSome
a

Effect direction—beneficial (positive) effect: ▼ (black arrow; statistical significance, P < .05); graphic (gray arrow; statistical nonsignificance, P ≥ .05); negative (not-beneficial) effect: ▲ (black arrow; statistical significance, P < .05); graphic (gray arrow; statistical insignificance, P ≥ .05); no association/no change: < >; +/– conflicting results.

b

Risk-of-bias assessment: based on the Mixed Methods Appraisal Tool (see Table S2A and S2B). “Low” risk of bias when ≤1 question was answered with “no” or “can’t tell”; overall risk of bias was considered as of “some concerns” when 2–3 questions were answered with “no” or “can’t tell”; overall risk of bias was considered “high” when 4–5 questions were answered with “no” or “can’t tell.”

Abbreviations: ALSPAC, Avon Longitudinal Study of Parents and Children; %BF, body fat percentage; BMI, body mass index; BMIZ, BMI z score; DONALD, Dortmund Nutritional and Anthropometric Longitudinally Designed Study; ECLS-B, Early Childhood Longitudinal Study, Birth Cohort; FFMIZ, fat-free mass index z score; FMIZ, fat mass index z score; HDL-C, high-density-lipoprotein cholesterol; LDL-C, low-density-lipoprotein cholesterol; RCT, randomized controlled trial; SSB, sugar-sweetened beverage; SSF, sum of skinfolds; T1DM, type 1 diabetes mellitus; TC, total cholesterol; TG, triglycerides; WAZ, weight-for-age z score; WC, waist circumference; WHZ, weight-for-height z score; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; WLZ, weight-for-length z score.

Table 3.
Open in new tab

Direction of Effects Assessed in the Included Studies

Exposure and study referenceOutcomes of interesta
Risk of biasb
GrowthInfectionBowel functionObesity, overweight, body compositionGlucose metabolism and homeostasisLipidsMicrobiota
Digestible carbohydrates
Glycemic carbohydrates
Chaidez et al (2014)27 (WIC)

  • Added sugars at 12-24 mo:

  • < > WAZ after 6 mo

——

  • Added sugars at 12-24 mo:

  • < > WHZ after 6 mo

  • < > BMZ after 6 mo

———Some
Cowin et al (2001)28 (ALSPAC)

  • Total carbohydrates at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Starch at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Sugars at 18 mo:

  • < > Height at 31 mo

——

  • Total carbohydrates, starch, sugars at 18 mo:

  • < > BMI at 31 mo

—

  • Total carbohydrates at 18 mo:

  • ▼TC (boys)

  • ▼TC:HDL-C (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (girls) at 31 mo

  • Starch at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C at 31 mo

  • Sugar at 18 mo:

  • ▲TC (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (at 31 mo; univariate)

  • Sugar at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C (boys), graphic TC:HDL-C (girls) (at 31 mo; multivariate)

  • Starch, total carbohydrates intake at 18 mo:

  • < > Lipids (at 31 mo; multivariate)

—Low
DONALD study:
Buyken et al (2008)24———

  • Added sugars at 2 y:

  • < > %BF, BMIZ (at 2 y; 2-7 y change)

———Some
Herbst et al (2011)32———

  • Added sugars:

  • < > %BF at 7 y (higher intake at 1 y)

  • ▲BMIZ at 7 y (higher intake at 1 y)

  • graphic BMIZ at 7 y (higher intake between 1 and 2 y)

———
Garden et al (2011)31———

  • Carbohydrates intake at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Huus et al (2009)33———

  • Candy intake at 2.5 y:

  • < > Overweight/obesity at 5 y

———Some
Jardí et al (2019)34———

  • Free sugars at 12 mo:

  • ▲WHZ at 30 mo

  • < > WHZ at 12 mo

  • Natural sugars, starches at 12 mo:

  • < > WHZ at 12 mo

———Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Mono- and di- and polysaccharides at 14 mo:

  • +/– Presence of constipation at 24, 36, 48 mo

————Some
Nguyen et al (2020)41———

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > BMIZ at 10 y

  • < > FMIZ, FFMIZ at 10 y

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > Insulin at 10 y

  • Total carbohydrates at 12.9 mo:

  • ▲TG

  • < > TC, HDL-C, LDL-C at 10 y

  • Mono- and disaccharides at 12.9 mo:

  • ▲TG, HDL-C at 10 y

  • < > TC, LDL-C at 10 y

  • Polysaccharides at 12.9 mo:

  • < > TC, HDL-C, LDL-C, TG at 10 y

—Low
Scaglioni et al (2000)43———

  • Carbohydrates intake at 1 y:

  • < > Overweight at 5 y

———Some
Warner et al (2006)49———

  • Sweets consumption at 24 mo:

  • < > Obesity at 2 y

———Low
Williams and Strobino (2008)50———

  • Dietary sucrose at 3-4 y:

  • ▼BMI at 7-10 y

—

  • Dietary sucrose at 3-4 y:

  • < > TC, HDL-C, TG at 7-10 y

—Some
SSBs and fruit juice
Byrne et al (2018)25———

  • Mixed SSBs and fruit juice at 2, 3.7 y:

  • < > BMIZ at 2, 3.7 y

———Some
Cantoral et al (2016)26———

  • SSBs only at 1-5 y:

  • ▲Obesity at 8-14 y

  • ▲Abdominal obesity at 8-14 y

———Low
Dubois et al (2007)30———

  • SSBs at 2.5, 3.5, and 4.5 y:

  • ▲Obesity at 4.5 y

———Low
ECLS-B study:
DeBoer et al (2013)29———

  • SSBs at 2 y:

  • < > BMIZ at 2 y

  • < > Overweight at 2 y

  • < > Obesity at 2 y

———Low
Shefferly et al (2016)44

  • Fruit juice at 2 y:

  • ▲HAZ at 2-4 y

  • graphicWAZ at 2-4 y

——

  • Fruit juice at 2 y:

  • ▼BMIZ at 2 y, ▲ BMIZ at 2-4 y

  • < > Overweight at 2 y, ▲Overweight at 2-4 y

  • < > Obesity at 2 y, graphicObesity at 2-4 y

———Low
Garden et al (2011)31———

  • SSBs only and mixed SSBs and fruit juice at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Generation R Study:
Leermakers et al (2015a)37—————

  • Mixed SSBs and fruit juice at 13 mo:

  • graphicTG, HDL-C at 6 y

  • < > TC, LDL-C at 6 y

—Low
Leermakers et al (2015b)36

  • Mixed SSB and fruit juice at 13 mo:

  • In boys at 6 y: ▼HAZ; < > WAZ

  • In girls at 6 y:

  • graphicHAZ; graphicWAZ

——

  • Mixed SSBs and fruit juice at 13 mo:

  • < > %BF at 6 y;

  • graphicHigher android and gynoid ratio at 6 y in girls only

  • ▲ BMIZ at 2, 3, 4, and 6 y in girls

  • < > BMIZ at 6 y in boys

———
Lim et al (2008)38———

  • SSBs at 3-4 y:

  • ▲ BMIZ at 3-4 y

  • ▲ Overweight or obesity after 2 y of follow up

———Low
Quah et al (2019)42———

  • SSB at 18 mo:

  • < > BMIZ, SSF at 6 y

  • ▲,graphicOverweight or obesity at 6 y

———Some
Viva Project study:
Sonneville et al (2015)45———

  • Fruit juice at 1 y:

  • < > WLZ at 1 y

  • ▲ BMIZ at 3.1 y; 7.7 y

———Low
Wu et al (2021)51———

  • Fruit juice at 1 y:

  • ▲ Abdominal adiposity at 8 y, 13 y

———Low
Warner et al (2006)49———

  • SSB at 2 y:

  • ▲ Obesity at 2 y

———Low
WIC study:
Chaidez et al (2014)27

  • SSB at 12-24 mo:

  • < > WAZ after 6 mo of follow-up

——

  • SSB at 12-24 mo:

  • ▲ WHZ after 6 mo of follow-up

  • ▲ BMIZ after 6 mo of follow-up

———Some
Newby et al (2004)40

  • Fruit juice; SSBs at 2-5 y:

  • < > Weight change after 6-12 mo

——

  • Fruit juice;

  • SSBs at 2-5 y:

  • < > BMI change after 6-12 mo

———Some
Nondigestible carbohydrates
Dietary fiber
ALSPAC study:
Cowin et al (2001)28

  • Fiber intake at 18 mo:

  • < > Height at 31 mo

——

  • Fiber intake at 18 mo:

  • < > BMI at 31 mo

—

  • Fiber intake at 18 mo:

  • < > TC, HDL-C, LDL-C, TC:HDL-C at 31 mo

—Low
Tappin et al (2020)46——

  • Fiber intake at 2 y:

  • ▼Stool frequency and consistency at 2.5 y

  • ▼ Presence of constipation at 4-10 y

————Low
Taylor et al (2016)47——

  • Fiber intake at 38 mo:

  • ▼Stool hardness (constipation) at 42 mo

————Some
Beyerlein et al (2015)23————

  • Fiber intake at 12 mo:

  • < >T1DM; islet autoimmunity up to 5 y

——Low
Buyken et al (2008) (DONALD)24———

  • Fiber intake at 2 y:

  • < > %BF, BMZ at 2 y; 2-7 y change

———Some
Jardí et al (2019)34

  • Fiber at 12 mo:

  • < > Excess weight at 12 mo

  • < > Excess weight at 30 mo

——————Some
Newby et al (2003)39 (WIC)

  • Fiber intake at 2.9 y:

  • < > Weight change after 6-12 mo

——————Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Fiber intake at 14 mo:

  • < > Presence of constipation at 24, 36, 48 mo

————Some
Van Gijssel et al (2016)48———

  • Fiber intake at 12.9 mo:

  • < > %BF z score at 6 y

  • Fiber intake at 12.9 mo:

  • < > Insulin z score at 6 y

  • Fiber intake at 12.9 mo:

  • ▼HDL-C, TG at 6 y

—Low
Williams and Strobino (2008)50———

  • Fiber intake at 3-4 y:

  • < > BMI at 7-10 y

—

  • Fiber intake at 3-4 y:

  • ▼ TC

  • < > TG, HDL-C at 7-10 y

—Some
Nakamura et al (2006)52 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 6 mo)< > Weight gain, height, arm circumference during 6 mo

  • graphic Number of diarrheal episodes during 6 m

  • ▼ Duration of diarrheal episodes during 6 m

  • ▼ Duration of diarrhea during 6 mo

  • < > Stool frequency during 6 mo

————Low
Waligora-Dupriet et al (2007)53 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 21 d)—

  • ▼Diarrheal episodes during 28d

  • ▼ Number of infectious diseases requiring antibiotic

  • Treatment during 28d

< > Stool frequency, consistency, and abdominal pain during 28 d———▼Bifidobacteria and Clostridia levels at 28 dSome
Exposure and study referenceOutcomes of interesta
Risk of biasb
GrowthInfectionBowel functionObesity, overweight, body compositionGlucose metabolism and homeostasisLipidsMicrobiota
Digestible carbohydrates
Glycemic carbohydrates
Chaidez et al (2014)27 (WIC)

  • Added sugars at 12-24 mo:

  • < > WAZ after 6 mo

——

  • Added sugars at 12-24 mo:

  • < > WHZ after 6 mo

  • < > BMZ after 6 mo

———Some
Cowin et al (2001)28 (ALSPAC)

  • Total carbohydrates at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Starch at 18 mo:

  • ▲Height (boys)

  • < > Height (girls) at 31 mo

  • Sugars at 18 mo:

  • < > Height at 31 mo

——

  • Total carbohydrates, starch, sugars at 18 mo:

  • < > BMI at 31 mo

—

  • Total carbohydrates at 18 mo:

  • ▼TC (boys)

  • ▼TC:HDL-C (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (girls) at 31 mo

  • Starch at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C at 31 mo

  • Sugar at 18 mo:

  • ▲TC (boys)

  • < > TC (girls), HDL-C, LDL-C, TC:HDL-C (at 31 mo; univariate)

  • Sugar at 18 mo:

  • < > TC, LDL-C, HDL-C, TC:HDL-C (boys), graphic TC:HDL-C (girls) (at 31 mo; multivariate)

  • Starch, total carbohydrates intake at 18 mo:

  • < > Lipids (at 31 mo; multivariate)

—Low
DONALD study:
Buyken et al (2008)24———

  • Added sugars at 2 y:

  • < > %BF, BMIZ (at 2 y; 2-7 y change)

———Some
Herbst et al (2011)32———

  • Added sugars:

  • < > %BF at 7 y (higher intake at 1 y)

  • ▲BMIZ at 7 y (higher intake at 1 y)

  • graphic BMIZ at 7 y (higher intake between 1 and 2 y)

———
Garden et al (2011)31———

  • Carbohydrates intake at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Huus et al (2009)33———

  • Candy intake at 2.5 y:

  • < > Overweight/obesity at 5 y

———Some
Jardí et al (2019)34———

  • Free sugars at 12 mo:

  • ▲WHZ at 30 mo

  • < > WHZ at 12 mo

  • Natural sugars, starches at 12 mo:

  • < > WHZ at 12 mo

———Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Mono- and di- and polysaccharides at 14 mo:

  • +/– Presence of constipation at 24, 36, 48 mo

————Some
Nguyen et al (2020)41———

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > BMIZ at 10 y

  • < > FMIZ, FFMIZ at 10 y

  • Total carbohydrates; mono- and di- and polysaccharides at 12.9 mo:

  • < > Insulin at 10 y

  • Total carbohydrates at 12.9 mo:

  • ▲TG

  • < > TC, HDL-C, LDL-C at 10 y

  • Mono- and disaccharides at 12.9 mo:

  • ▲TG, HDL-C at 10 y

  • < > TC, LDL-C at 10 y

  • Polysaccharides at 12.9 mo:

  • < > TC, HDL-C, LDL-C, TG at 10 y

—Low
Scaglioni et al (2000)43———

  • Carbohydrates intake at 1 y:

  • < > Overweight at 5 y

———Some
Warner et al (2006)49———

  • Sweets consumption at 24 mo:

  • < > Obesity at 2 y

———Low
Williams and Strobino (2008)50———

  • Dietary sucrose at 3-4 y:

  • ▼BMI at 7-10 y

—

  • Dietary sucrose at 3-4 y:

  • < > TC, HDL-C, TG at 7-10 y

—Some
SSBs and fruit juice
Byrne et al (2018)25———

  • Mixed SSBs and fruit juice at 2, 3.7 y:

  • < > BMIZ at 2, 3.7 y

———Some
Cantoral et al (2016)26———

  • SSBs only at 1-5 y:

  • ▲Obesity at 8-14 y

  • ▲Abdominal obesity at 8-14 y

———Low
Dubois et al (2007)30———

  • SSBs at 2.5, 3.5, and 4.5 y:

  • ▲Obesity at 4.5 y

———Low
ECLS-B study:
DeBoer et al (2013)29———

  • SSBs at 2 y:

  • < > BMIZ at 2 y

  • < > Overweight at 2 y

  • < > Obesity at 2 y

———Low
Shefferly et al (2016)44

  • Fruit juice at 2 y:

  • ▲HAZ at 2-4 y

  • graphicWAZ at 2-4 y

——

  • Fruit juice at 2 y:

  • ▼BMIZ at 2 y, ▲ BMIZ at 2-4 y

  • < > Overweight at 2 y, ▲Overweight at 2-4 y

  • < > Obesity at 2 y, graphicObesity at 2-4 y

———Low
Garden et al (2011)31———

  • SSBs only and mixed SSBs and fruit juice at 18 mo:

  • < > BMI at 8 y

  • < > WC at 8 y

———Low
Generation R Study:
Leermakers et al (2015a)37—————

  • Mixed SSBs and fruit juice at 13 mo:

  • graphicTG, HDL-C at 6 y

  • < > TC, LDL-C at 6 y

—Low
Leermakers et al (2015b)36

  • Mixed SSB and fruit juice at 13 mo:

  • In boys at 6 y: ▼HAZ; < > WAZ

  • In girls at 6 y:

  • graphicHAZ; graphicWAZ

——

  • Mixed SSBs and fruit juice at 13 mo:

  • < > %BF at 6 y;

  • graphicHigher android and gynoid ratio at 6 y in girls only

  • ▲ BMIZ at 2, 3, 4, and 6 y in girls

  • < > BMIZ at 6 y in boys

———
Lim et al (2008)38———

  • SSBs at 3-4 y:

  • ▲ BMIZ at 3-4 y

  • ▲ Overweight or obesity after 2 y of follow up

———Low
Quah et al (2019)42———

  • SSB at 18 mo:

  • < > BMIZ, SSF at 6 y

  • ▲,graphicOverweight or obesity at 6 y

———Some
Viva Project study:
Sonneville et al (2015)45———

  • Fruit juice at 1 y:

  • < > WLZ at 1 y

  • ▲ BMIZ at 3.1 y; 7.7 y

———Low
Wu et al (2021)51———

  • Fruit juice at 1 y:

  • ▲ Abdominal adiposity at 8 y, 13 y

———Low
Warner et al (2006)49———

  • SSB at 2 y:

  • ▲ Obesity at 2 y

———Low
WIC study:
Chaidez et al (2014)27

  • SSB at 12-24 mo:

  • < > WAZ after 6 mo of follow-up

——

  • SSB at 12-24 mo:

  • ▲ WHZ after 6 mo of follow-up

  • ▲ BMIZ after 6 mo of follow-up

———Some
Newby et al (2004)40

  • Fruit juice; SSBs at 2-5 y:

  • < > Weight change after 6-12 mo

——

  • Fruit juice;

  • SSBs at 2-5 y:

  • < > BMI change after 6-12 mo

———Some
Nondigestible carbohydrates
Dietary fiber
ALSPAC study:
Cowin et al (2001)28

  • Fiber intake at 18 mo:

  • < > Height at 31 mo

——

  • Fiber intake at 18 mo:

  • < > BMI at 31 mo

—

  • Fiber intake at 18 mo:

  • < > TC, HDL-C, LDL-C, TC:HDL-C at 31 mo

—Low
Tappin et al (2020)46——

  • Fiber intake at 2 y:

  • ▼Stool frequency and consistency at 2.5 y

  • ▼ Presence of constipation at 4-10 y

————Low
Taylor et al (2016)47——

  • Fiber intake at 38 mo:

  • ▼Stool hardness (constipation) at 42 mo

————Some
Beyerlein et al (2015)23————

  • Fiber intake at 12 mo:

  • < >T1DM; islet autoimmunity up to 5 y

——Low
Buyken et al (2008) (DONALD)24———

  • Fiber intake at 2 y:

  • < > %BF, BMZ at 2 y; 2-7 y change

———Some
Jardí et al (2019)34

  • Fiber at 12 mo:

  • < > Excess weight at 12 mo

  • < > Excess weight at 30 mo

——————Some
Newby et al (2003)39 (WIC)

  • Fiber intake at 2.9 y:

  • < > Weight change after 6-12 mo

——————Some
Generation R Study:
Kiefte de Jong et al (2013)35——

  • Fiber intake at 14 mo:

  • < > Presence of constipation at 24, 36, 48 mo

————Some
Van Gijssel et al (2016)48———

  • Fiber intake at 12.9 mo:

  • < > %BF z score at 6 y

  • Fiber intake at 12.9 mo:

  • < > Insulin z score at 6 y

  • Fiber intake at 12.9 mo:

  • ▼HDL-C, TG at 6 y

—Low
Williams and Strobino (2008)50———

  • Fiber intake at 3-4 y:

  • < > BMI at 7-10 y

—

  • Fiber intake at 3-4 y:

  • ▼ TC

  • < > TG, HDL-C at 7-10 y

—Some
Nakamura et al (2006)52 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 6 mo)< > Weight gain, height, arm circumference during 6 mo

  • graphic Number of diarrheal episodes during 6 m

  • ▼ Duration of diarrheal episodes during 6 m

  • ▼ Duration of diarrhea during 6 mo

  • < > Stool frequency during 6 mo

————Low
Waligora-Dupriet et al (2007)53 (RCT) (2 g/d of fructo-oligosaccharides supplementation or placebo for 21 d)—

  • ▼Diarrheal episodes during 28d

  • ▼ Number of infectious diseases requiring antibiotic

  • Treatment during 28d

< > Stool frequency, consistency, and abdominal pain during 28 d———▼Bifidobacteria and Clostridia levels at 28 dSome
a

Effect direction—beneficial (positive) effect: ▼ (black arrow; statistical significance, P < .05); graphic (gray arrow; statistical nonsignificance, P ≥ .05); negative (not-beneficial) effect: ▲ (black arrow; statistical significance, P < .05); graphic (gray arrow; statistical insignificance, P ≥ .05); no association/no change: < >; +/– conflicting results.

b

Risk-of-bias assessment: based on the Mixed Methods Appraisal Tool (see Table S2A and S2B). “Low” risk of bias when ≤1 question was answered with “no” or “can’t tell”; overall risk of bias was considered as of “some concerns” when 2–3 questions were answered with “no” or “can’t tell”; overall risk of bias was considered “high” when 4–5 questions were answered with “no” or “can’t tell.”

Abbreviations: ALSPAC, Avon Longitudinal Study of Parents and Children; %BF, body fat percentage; BMI, body mass index; BMIZ, BMI z score; DONALD, Dortmund Nutritional and Anthropometric Longitudinally Designed Study; ECLS-B, Early Childhood Longitudinal Study, Birth Cohort; FFMIZ, fat-free mass index z score; FMIZ, fat mass index z score; HDL-C, high-density-lipoprotein cholesterol; LDL-C, low-density-lipoprotein cholesterol; RCT, randomized controlled trial; SSB, sugar-sweetened beverage; SSF, sum of skinfolds; T1DM, type 1 diabetes mellitus; TC, total cholesterol; TG, triglycerides; WAZ, weight-for-age z score; WC, waist circumference; WHZ, weight-for-height z score; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; WLZ, weight-for-length z score.

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