Substitution of sugar-sweetened beverages with other beverage alternatives: a review of long-term health outcomes

J Acad Nutr Diet. 2015 May;115(5):767-779. doi: 10.1016/j.jand.2015.01.006. Epub 2015 Mar 4.


Background: Excessive consumption of sugar-sweetened beverages (SSBs) has become an intractable public health concern worldwide, making investigation of healthy beverage alternatives for SSBs imperative.

Aim: To summarize the available evidence on the effects of replacing SSBs with beverage alternatives on long-term health outcomes.

Method: We systematically retrieved studies from six electronic databases from inception to November 2013. Prospective cohort studies and randomized controlled trials (RCTs) examining the effects of substituting beverage alternatives for SSBs on long-term health outcomes in both children and adults were included. The quality of included studies was assessed using the Scottish Intercollegiate Guidelines Network 50 methodology checklists.

Results: Six cohort studies and four RCTs were included in the systematic review with the quality rating ranging from acceptable to high. Evidence from both cohort studies and RCTs showed substitution of SSBs by various beverage alternatives was associated with long-term lower energy intake and lower weight gain. However, evidence was insufficient to draw conclusions regarding the effect of beverage substitution on other health outcomes, and which beverage alternative is the best choice.

Conclusions: Although studies on this topic are sparse, the available evidence suggests a potential beneficial effect on body weight outcomes when SSBs are replaced by water or low-calorie beverages. Further studies in this area are warranted to fully understand the long-term health implications of beverage substitutions.

Keywords: Health outcomes; Long term; Substitution; Sugar-sweetened beverages; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Beverages / adverse effects*
  • Cohort Studies
  • Diet, Carbohydrate-Restricted* / adverse effects
  • Diet, Reducing / adverse effects
  • Drinking
  • Energy Intake
  • Evidence-Based Medicine*
  • Humans
  • Nutrition Policy*
  • Nutritive Sweeteners / administration & dosage
  • Nutritive Sweeteners / adverse effects*
  • Overweight / etiology
  • Overweight / prevention & control*
  • Patient Compliance*
  • Prospective Studies
  • Randomized Controlled Trials as Topic


  • Nutritive Sweeteners