Unhealthy food and beverage consumption during childhood and risk of cardiometabolic disease: a systematic review of prospective cohort studies

Background: Global consumption of unhealthy foods, including ultra-processed foods (UPF) and sugar-sweetened beverages (SSB), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.

Objective: To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.

Methods: PubMed (Medline), EMBASE and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) compared to no or low consumption; studies assessing critical non-anthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).

Results: Of 30,021 identified citations, eleven articles from eight longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and four focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of pre-school age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation (GRADE): low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty).

Conclusions: No definitive conclusion can be made due to quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.